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Full text of "Practical points in nursing for nurses in private practice, with an appendix containing rules for feeding the sick, recipes for invalid foods and beverages, weights and measures, dose list, and a full glossary of medical terms and nursing treatment"

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Boston Public Library 




PRACTICAL POINTS 

IN 

NURSING 

FOR NURSES IN PRIVATE PRACTICE 

WITH AN APPENDIX CONTAINING 

RULES FOR FEEDING THE SICK; RECIPES FOR 
INVALID FOODS AND BEVERAGES ; WEIGHTS AND 
MEASURES ; DOSE LIST ; AND A FULL GLOSSARY 
OF MEDICAL TERMS AND NURSING TREATMENT 



EMILY A. M. STONEY 

REVISED BY 

LUCY CORNELIA CATLIN, R. N. 

DIRECTOR OF SOCIAL SERVICE WORK AND EXECUTIVE DIRECTOR OF 
THE OUT-PATIENT DEPARTMENT, YOUNGSTOWN HOSPITAL, OHIO 






h'iFfH E^TTfON 



PHILADELPHIA AND LONDON 

W. B. SAUNDERS COMPANY 

1921 






JV76.^t 



Copyright, 1896, by W. B. Saunders. Revised, reprinted, and recopyrighted June, 
1897. Reprinted April, 1898; July, 1899; May, 1900; May, 1901; January, 1902; 
October, 1902. Revised, reprinted, and recopyrighted March, 1903. Re- 
printed November, 1903; August, 1904; April, 1905; November, 1905; 
May, 1906; January, 1907; September, 1907; January, 1908; Alay, 
1908; November, 1908; June, 1909; October, 1909; February, 
1910. Revised, repnnted, and recopyrighted May, 1910, 
Reprinted May, 1911 ; July, 1912; Apri4, 1913; 
January, 1914; and September, 19 14. Re- 
prmted January, 1915, and August, 
1915. Revised, reprinted and 
recopyrighted March, 1916 



Copyright 1916, by W. B. Saunders Company 



Reprinted September, 1917 



, ; j':R«'tri»fe:l/5Ci^y,j9i*9*«i?l JuJjjiOzp I '/ 
Reprinted Februa^^, 192 1 



PRINTED IN AMERICA 



PRESS OF 

W. B. SAUNDERS COMPANY 

PHILADELPHIA 



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PREFACE TO THE FIFTH EDITION 



The real practical value of this volume has been so 
well proven by its popularity that in undertaking the fifth 
revision the writer has endeavored to preserve the intent 
of the book to supply practical suggestions on nursing 
subjects. The entire text of the book has been carefully 
gone over and studied. Eliminations and additions have 
been made to bring the subject matter up to date, that 
the practical value of the book may still continue, both 
in the field of private nursing as a reference and in train- 
ing-schools as a foundation for instruction. A section 
has been added on the observation and classification of 
symptoms in nervous and mental diseases, with sug- 
gestions about nursing care. This addition has been 
made because the subject seemed quite important, and 
because nurses in training get so little experience in the 
care ot such cases. The young graduate may soon find 
herself in charge of a nervous or mental patient and be 
perfectly at sea about the management which constitutes 
the important part of the treatment. This new part is 
intended to help the nurse understand the patient, and 
to suggest the principles upon which the treatment is 
based. The Dose-list in the Appendix has been cor- 



lO PREFACE TO THE FIFTH EDITION. 

rected to conform to the National Standard Dispensatory 
of 1905, and many corrections were necessary because 
of radical changes that had been made in the 1905 Phar- 
macopeia. It is confidently hoped that this book will 
continue to hold its place as an authority upon Practical 

Points in Nursing. 

Lucy C. Catlin, R. N. 

YOUNGSTOWN, OhIOo 



PREFACE 



In preparing the subject-matter of this volume, whose 
title-page clearly indicates its design, the author has 
attempted to explain, in popular language and in the 
shortest possible form, the entire range of private nurs- 
ing as distinguished from hospital nursing, and to instruct 
the nurse how best to meet the various emergencies of 
medical and surgical cases when distant from medical or 
surgical aid, or when thrown on her own resources, stu- 
diously refraining, however, from advising the nurse to 
act upon her own responsibility or to assume personal 
treatment of the patient except under circumstances of 
great urgency. There is simply placed before the nurse 
what the different diseases are, their characters and chief 
points of distinction and the attention required, their 
possible complications, and the treatment likely to be 
adopted in a given case by the family physician, so that 
suitable preparations may be made by the nurse. 

An especially valuable feature of the work will be 
found m the directions, to the nurse how to improvise 
everything ordinarily needed in the illness of her patient 
In the sick-room the embarrassment of the nurse, through 
want of proper appliances due to unexpected condi*^''^*=^ 
or to her environments, is frequently extreme ; the diffi- 
culty may frequently be overcome by the simplest means 
when one possesses a knowledge of how to apply them. 

There has also been attempted a logical division of 
the text, which includes the following sections : 

11 



12 PREFACE. 

I. The Nurse; her responsibilities, quahfications, 
equipment, etc. 
11. The Sick-room ; its selection, preparation, and man- 
agement. 

III. The Patient ; duties of the nurse in medical, sur- 

gical, obstetric, and gynecologic cases. 

IV. Nursing in Accidents and Emergencies. 
V. Nursing in Special Medical Cases. 

VI. Nursing of the New-born and Sick Children. 
VII. Nursing Care of Nervous and Mental Patients. 
VIII. Physiology and Descriptive Anatomy. 

The latter section, while sketched briefly, will be ample 
for the purposes of the nurse. The Appendix contains 
much information in compact form that will be of value, 
and the full Index presents a ready medium for quickly 
consulting any desired topic. 

The numerous illustrations added will be serviceable 
aids in making clear the application of certain lines of 
treatment falling specifically to the work of the nurse. 

Finally, this discussion, being based on a series of 
lectures delivered before the Carney Training-school for 
Nurses, will serve as a text-book for student nurses and 
a useful teaching-book for those occupying positions as 
teachers in training-schools ; and it may prove interesting 
to the " home " nurse who wishes to comprehend some- 
thing of the purposes of the different methods adopted 
in nursing-treatment. 

''"he Author's sincere thanks are due to Dr. John R. 
Slattery for his technical revision of the work and for 
other kind assistance, and to all who have helped by 
friendly suggestions. 

ExMILY A. M. STONEY. 



CONTENTS 



I. THE NURSE 17 

Responsibilities of the Nurse, 17 — Qualifications of the Nurse, 
20 — Duties of the Nurse, 20 — Hospital Etiquette; the Nurse's 
Duties to her Superior, 23 — Etiquette when Nursing Pri- 
vately, 24 — Dress and Personal Habits of the Nurse, 25 — 
Some "Don'ts" to be Observed by Nurses, 25 — Equipment 
of the Nurse's Bag, 26 — Keeping the Records, 26. 

II. THE SICK-ROOM 30 

Selection and Preparation of the Sick-room, 30 — Preparation of 
the Bed, 30 — Changing the Bed-clothing, 32 — Bed-making for 
Different Cases, S2> — Appliances for the Relief of Bed-patients, 
35 — Care of the Sick-room, 37 — Hygiene of the Sick-room, 37. 

III. THE PATIENT 40 

I. Nursing in Medical Cases 40 

1. General Observations in Medical Cases: The Pulse, 40 — 
Body- temperature, 42 — Respiration, 47 — Observation of the 
Symptoms, 48. 

2. Bodily Care of the Patient : Changing the Clothing, 55 — 
Toilet of the Patient, 56— Baths, 58— Feeding of the Patient, 
59 — Moving of the Patient, 61. 

3. Relief of Functional Disturbances: Enemas, 63 — Rectal 
Feeding, 67 — Douches, 69 — Catheterization, 73 — ^Washing 
Out the Bladder, 75 — Washing Out the Stomach, 75 — 
Gavage, 77 — Nasal Feeding, 77 — Test-meaJs, 77. 

4. Administration of Medicines: Rapidity of Absorption of 
Medicines, 78 — Action of Medicines, 78 — Precautions to be 
Observed in Handhng and Administering Medicines, 80 — 
Medicines by the Mouth, 81 — Medicines Administered per 
Rectum, 83 — Hypodermatic Injection, 83 — Inunctions, 85 — 
Inhalations, 87. 

13 



14 CONTENTS. 

PAGE 

5. General and Local External Applications : Baths, 88 — Symp- 
toms of Inflammation, loi — ^Treatment of Inflanmiation, 102 
— Bleeding, 102 — Fomentations, 105 — Poultices, 107 — Dry- 
Heat, 112 — Application of Cold, 113 — Counter-irritants, 116 
— Blisters, 116 — ^Massage, 122 — Liniments, 123 — ^Lotions, 123 
— Gargles, Sprays, etc., 123 — Eye-drops, 125 — Syringing the 
Ear, 127. 

n. Nursing in Obstetric Cases 1 29 

Pregnancy, 1 29 — Signs and Symptoms, 1 29 — Duration of Preg- 
nancy, 130 — Conception and Date of Confinement, 130 — The 
Fetus, 132 — Fetal Movements, 132 — Disorders of Pregnancy, 
133 — ^Termination of Pregnancy, and Nurse's Preparations for 
the Confinement, 134 — Labor, 137 — Stages of Normal Labor, 
137 — Duration of Labor, 140 — Conduct of Normal Labor, 140 
— Management of the Puerperium, 144 — Pathology of the 
Puerperium, 148 — Extra-uterine Pregnancy, 152 — Cesarean 
Section, 152. 

in. Nursing in Gynecologic Cases 152 

Preparation for Gynecologic Examination, 152 — Positions for 
Examination, 153 — Preparation for Operation, 156 — After- 
care of Patient, 158. 

IV. Duties of the Nurse in General Surgical Cases 160 

Preparation of the Operating-room, 160 — Preparations for the 
Operation, 161 — Preparation of the Patient, 163 — Duties of 
the Nurse in Emergency Cases, 166 — Nurse's Duties in 
Operating-room, 171 — Arranging the Patient for Operation, 
173 — ^After-care of the Patient, 174 — Sequels of Operation, 
174 — After-treatment of Patient, 179 — Surgical Disinfection 
and Materials, 183 — Suturing, 187. 



IV. ACCIDENTS AND EMERGENCIES 188 

I. Surgical Accidents: Fractures, 188 — Dislocations, 192 — 
Sprains, 193 — Surgical Dressings, 193 — Bandages, 195 — 
Strapping, 205 — Splints, 207 — Extension, 208 — Wounds, 209 
— Suppuration, 210 — Erysipelas, 211 — Pyemia, 211 — ^Tet- 
anus, 211 — Gangrene, 212 — ^Abscess, 213 — Boil, 213 — Car- 
buncle, 213 — Ulcer, 214 — Fistula, 214 — Sinus, 214. 



CONTENTS. 15 



PAOK 



2. Common Emergencies: Hemorrhages, 214 — Bums and 
Scalds, 218 — Sunstroke, 221 — Heat-exhaustion, 222 — Light- 
ning-stroke, 222 — Fainting, 222 — Drowning, 223 — Accidents 
from Fire, 225 — Accidents from Electricity, 226 — Retention 
of Urine, 226 — Head-accidents, 226 — Cuts and Bruises, 227 — 
Foreign Bodies, 227 — Insect Bites and Stings, 228 — Dysmen- 
orrhea, 228 — Vomiting, 228 — Flatulence, 228 — Intoxication, 
229 — Toothache, 229 — Insomnia, 229 — Sunburn, 229 — Burns 
by Acids and Alkalies, 229 — Frost-bite, 230 — Chilblains, 230. 

3, Accidental Poisoning: Poison Defined, 231 — Classification 
and Action of Poisons, 231 — What to Do in Case of Poison- 
ing, 231 — Irritant Poisons, 232 — Narcotic Poisons, 234 — Bites 
of Rabid Animals, 235. 



V. NURSING IN SPECIAL MEDICAL CASES 236 

Infectious and Contagious Diseases, 236 — Typhoid Fever, 239 — 
Scarlet Fever, 246 — Typhus Fever, 250 — Small-pox, 251 — 
Chicken-pox, 253 — Measles, 253 — German Measles or 
Rubella, 254-^Malaria, 255 — Diphtheria, 255 — Gonorrhea, 
261 — SyphiHs, 262 — Fumigation of Sick-room after Conta- 
gious Diseases, 263 — Phthisis, 266 — Simple Croup, 268 — 
Membranous Croup, 268 — Whooping-cough, 269 — Influenza, 
271 — Tonsillitis, 272 — Croupous Pneimionia, 273 — Bronchitis, 
274 — Asthma, 276 — Pleurisy, 276 — Empyema, 276 — Heart 
Diseases, 277 — Gastritis, 279 — Peritonitis, 280 — Appendicitis, 
281 — Dysentery, 283 — Cholera Morbus, 284 — Acute Diar- 
rhea, 285 — Uremia, 285 — Cerebrospinal Meningitis, 286 — 
Cerebral Apoplexy, 286 — Paralysis, 289 — Epilepsy, 289 — 
Dropsy, 291 — Diabetes, 291 — Gout, 294 — Rheumatism, 295 
— Diseases of the Skin: Acne, 296 — Eczema, 296 — Scabies, 
297 — Ringworm, 297 — Herpes Zoster, 297 — Psoriasis, 297 — 
Erythema, 297 — Urticaria or Hives, 297 — Favus, 297 — 
Alopecia Areata, 297 — ^Lupus, 297 — Caring for the Dead, 298. 



VI. NURSING OF SICK CHILDREN 300 

Care of the Newborn, 300 — Care of Premature Infants, 308 — 
Diseases of Infancy, 309 — Diseases of Childhood, 316 — Sur- 
gical Diseases of Children, 319 — Nurse's Management of 
Children, 320. 



1 6 CONTENTS. 

PAGE 

VII. NURSING CARE OF NERVOUS AND MENTAL PA- 

TIENTS 323 

The Nurse's Qualifications, 323 — Physical Symptoms, 323 — 
Mental Symptoms and Characteristics, 325 — Suggestions for 
the Nursing Care, 330 — Feeding, 333 — The Care of Old 
People, 335 — Management of Adolescent Mental Cases, 336 — 
Neurasthenia and Hysteria, 338. 

VIII. PHYSIOLOGY AND DESCRIPTIVE ANATOMY 342 

1. Physiology: Blood-circulation, 342 — Respiration, 346 — Di- 
gestion, 347 — Secretions, 349 — Excretions, 349 — Urinary Or- 
gans, 350. 

2. Descriptive Anatomy: The Skin, 350 — The Bones of the 
Body, 350 — The Muscles of the Body, 353 — Heart, Blood- 
vessels, and Lymphatics, 354 — Brain, Cord, Nerves, and Or- 
gans of the Senses, 355 — Respiratory, Digestive, and Urinary 
Organs, 359 — Internal Female Organs of Generation, 362. 

APPENDED 365 

I. General Rules for Feeding the Sick ant) How to Make 

Certain Articles of Food 365 

1. Serving the Food 3^5 

Diet-kitchen Outfit, 369— Diet in Convalescence, 369. 

2. Recipes for Invalid Foods and Beverages 372 

Simple Farinaceous Foods, 372 — Beef-teas and Extracts, 
373— Broths, 376— Oysters, 377— Puddings, 378— Soups, 
379— Miscellaneous Dishes, 38c^Prepared Milk, 382— 
Toasts, 383— Desserts, 384— Beverages, 389— Mineral 
Waters, 394. 

n. Weights and Measures 397 

III. Table for Computing Date of Labor 399 

IV. Abbreviations 400 

V. Dose List 402 

VI. Glossary 421 

INDEX 481 



Practical Points in Nursing 

FOR NURSES IN 

PRIVATE PRACTICE. 



I. THE NURSE. 

Responsibilities of the Nurse. — In these pages the 
writer will endeavor to tell the nurse what she can do 
when nursing privately, especially in the homes of those 
in humble circumstances, who have not the proper 
things to do with ; what she can use in place of the 
things used in the hospital ; and what she can do in 
an emergency when at a distance from medical aid, 
and when she must use her own knowledge and judg- 
ment. It is because the nurse is sometimes called upon 
to trust to her own knowledge and judgment that the 
writer desires her fully to understand, and to have 
an intelligent idea about, the different cases which are 
most likely to come under her care. The following 
instructions are not intended for hospital use ; indeed, 
there would be no possible excuse for the nurse to act 
on her own responsibility 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 obsei-ye 
and to do in emergencies 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 

2 17 



1 8 PRACTICAL POINTS IN NURSING. 

which every woman embracing it must " walk worthy of 
the vocation wherewith she is called." Literally and 
figuratively, she must have "clean hands and a pure 
heart." " A nurse should have such tact, as well as skill, 
that she will do what is best for the patients, even against 
their will, knowing how to manage the weakest and most 
irritable, and doing all that is necessary for them without 
their knowing it." " She must be scrupulously clean and 
neat in her own person, especially with regard to the 
arrangement of her hair, which should be smooth and 
well kept. The office of nurse is too high and too holy 
for any woman called to it to wish to devote much time 
to the adornment of her person. This applies to her 
appearance whether on duty or off; extravagance in dress 
at any time is unbecoming a true nurse. Her one object, 
as regards herself, should be to be clean, simple, neat, 
modest, sweet-tempered, and to know how to mind her 
own business " — to keep her health unimpaired by secur- 
ing sufficient rest, sleep, food, and exercise, without which 
the best will break down and suffer in health. 

A nurse should improve her mind by reading the best 
books at her command, by going out and visiting friends, 
and by attending the theater twice a month : this will keep 
her in touch with outside affairs, and she will be able to 
converse inteUigently with her patients. Her manner 
toward her patients and toward all with whom she comes 
in contact should be kind, pleasant, courteous, and cheer- 
ful — repressing all attempts at famiharity. It should be 
remembered that while we cannot dictate the manner of 
other people toward us, yet we can to a certain extent 
have it what we would like it to be ; and we can always 
control our bearing toward them. By showing respect 
to others, we can command the same respect from them. 



THE NURSE. 1 9 

The nurse should cultivate a contented mind and a cheer- 
ful face, avoid affectation and all temptation to air her 
knowledge — a mistake that many nurses are prone to 
make — and learn to control her emotions. The patients 
should be made to feel that they are her first thought, 
and they will learn to have faith and trust in her. 

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

No nurse should take up the work unless she has 
the true spirit of service. 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 poor person should 
be as well and as tenderly nursed as if he were the 
highest in the land. The very essence of nursing in the 
homes of the poor is management, tact, and thinking for 
the patient. Applications of poultices are not the only 
duties of a nurse, although they are in themselves of 
vast importance. 

The writer wishes particularly to impress upon the 
nurse the responsibilities of night duty. It is in the 
night-time that a very large majority of patients require 
the most careful watching and nursing. It requires a 
very competent nurse to do night duty — one who is 
gentle, kind, charitable, and patient ; a large stock of 



20 PRACTICAL POINTS IN NURSING. 

patience is always necessary because of the large de- 
mands that are made upon it during the night. 

Qualifications of the Nurse. — The questions asked 
by physicians and surgeons before employing a nurse 
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 ? faithful 
to the physician's orders ? patient, and fitted for the cares 
of a severe and critical illness ? Has she tact and good 
sense? All these questions are asked, together with 
others, and it is a nurse possessing just these qualifica- 
tions 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 improvise 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 



THE NURSE. 21 

in the kitchen for some member of the family or the ser- 
vants to wash ; the nurse must do it herself, unless the 
critical condition of her patient demands her entire time. 

The patient should be closely observed, and all that 
can be done to make her comfortable should be antici- 
pated, not waiting to be asked for anything. The nurse 
should wear noiseless shoes, and move about the room 
quietly; she should look where she is going, and not 
knock against the bed or the furniture; and she should 
avoid everything that may annoy the patient. 

The nurse should begin early in the evening to pre- 
pare for the night — to get everything that may be needed, 
and when moving around in the night she should make 
no noise, so that the patient and the family shall not be 
disturbed. Sleep must be taken when it is most conve- 
nient 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 
thoroughly how everything is to be done. 

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

A nurse must 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 



22 PRACTICAL POINTS IN NURSING. 

they must not be talked of; it has a depressing effect 
on the patient. A nurse must be cheerful and talk of 
cheerful things. Nor must she tell of her experiences 
in other families : all that she hears or sees in the family 
for whom she is working must be kept secret; she has 
no right to speak of one patient to another in private or 
hospital practice, or to criticise or discuss her patient's 
peculiarities outside of her report to the physician. 

The directions of the doctor must faithfully be carried 
out, and in the absence of directions the nurse should 
think what he would like to have done. When she makes 
a mistake, it should be confessed at the first opportunity ; 
the physician will always be found very kind ; but if 
mistakes are left for him to find out, he will naturally 
lose confidence in his nurse. 

If any trouble should arise regarding meals, sleep, 
getting fresh air, or anything else, the nurse must not 
worry the patient about it ; she should speak to the phys- 
ician, who will always be found a warm friend. 

A nurse will often work for doctors who treat their 
patients differently from the way she has been used 
to seeing them treated. The doctor makes the diagno- 
sis and gives his orders as to the treatment of the case, 
and, no matter what the nurse may think, it must not 
interfere with her accurate and faithful execution of those 
orders. She should never be guilty of making sugges- 
tions to the doctor : she is there to carry out his orders, 
to observe every little thing about the patient, and to re- 
port to him in a clear, simple way; her judgment must 
never be allowed to prevent her from doing her duty to 
the physician in charge. 

Some families may question the nurse very closely 
about the attending physician. She must be very 



THE NURSE. 23 

careful how she speaks of him, and inspire all pos- 
sible confidence in him, whether she has or has noc 
worked for him before. The family may likewise ques- 
tion the doctor about the nurse ; the battle is half won when 
the family has confidence in both physician and nurse. 

Hospital Etiquette; the Nurse's Duties to her Su- 
periors. — The difference between hospital nursing and 
private nursing is very great. The regularity of hospital 
life and the strict discipline which prevails are of great 
benefit to a nurse in assisting her to become punctual, 
trustworthy, patient, obedient, and courteous. Every- 
thing needed in the care of the sick is at hand in the 
hospital, and a sister-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. She 
has also to meet anxious friends and relatives, 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 hospital officials 
standing, and remain standing Hke a sentinel on duty 
until they have left the ward or room. It is a courtesy 
due to the position which they hold. During the visit 
of a physician the nurses must be ready to accompany 
him, and answer any questions he may ask. If the 
head-nurse is in the ward, she will accompany the doc- 
tor on his rounds and answer all questions. A nurse 



24 PRACTICAL POINTS IN NURSING. 

must never answer a question or give the doctor any 
information about a patient or patients when the head- 
nurse is present, unless the question is put directly to 
her. The head-nurse is responsible for everything that 
occurs on the floor of which she has charge, and it is 
the duty of the nurses to keep her fully informed of 
everything relating to the patients. Perfect quiet must 
prevail while the doctor is examining his patient, partic- 
ularly while he is using the stethoscope. 

Etiquette -when Nursing" Privately. — Regarding the 
etiquette when nursing privately, there are no definite 
rules to be observed. It is a mark of respect for the 
nurse to rise when the physician enters the room, and 
to remain standing unless asked to be seated; she 
should hand him her report, answer all questions, then 
quietly leave the room. This is a good plan in both 
private practice and for hospital private patients, for in 
many cases the physician is the family friend, and there 
may be many things about which the patient would 
like to speak with the doctor, and not care to have the 
nurse hear. If the nurse observes this course from the 
beginning, it will save her the probable embarrassment 
of being asked to leave the room. Then, again, she 
will have an opportunity of speaking to the doctor of 
anything relating to the case of which the patient 
should not know. 

She should also leave the room when a visitor comes, 
so that patient and friend can enjoy their talk alone; if 
the visit is limited, the visitor should be told when the 
time has expired. 

A nurse should not whisper in the sick-room ; it 
makes the patient think she is being talked about. It 
should be remembered that the hearing of a patient who 



THE NURSE. 25 

is apparently insensible, unable to move or to speak, is 
often very acute, the lowest whisper being often quite 
audible. The nature of the illness therefore should not 
be discussed nor any but the kindest things said before 
a patient. 

Drees and Personal Habits. — The dress of a nurse 
should be of cotton goods. She should always wear her 
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, if on twenty-four-hour duty, she 
should wear a neat but not showy or expensive kimona 
and soft shoes, and look as neat as in the daytime. She 
should shun curl-papers ; under no consideration should 
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. 

The nurse should regard a daily bath as a necessity, 
not only for personal cleanliness, but in order to keep 
the skin healthy and active. A cold sponge, spray, or 
plunge is very desirable when well borne. If time for 
bathing in the morning is limited, the body may be washed 
with a wet towel, followed by a brisk rub with a coarse 
dry one. The care of the hands of the nurse is most 
important. With soiled hands she may easily become 
infected or carry infection to the patient. The nails es- 
pecially should be attended to. They should be trimmed 
rather short and kept smooth with the nail-file. Some 
good emollient lotion should be used to prevent chap- 
ping and irritation and keep the skin soft. 

Some '* Don'ts " to be Observed by Nurses. — Don't 
use perfumery of any kind when on duty. Don't taint 
your breath with onions or other obnoxious odors. 
Don't give an impression to your patient or her friends 



26 PRACTICAL POINTS IN NURSING. 

that your two hours off duty each day are of more im- 
portance to you than the other ten that you spend with 
her. On the other hand — don't be so devoted to your 
patient that you neglect yourself. Don't be familiar with 
your patient or any member of the family. Don't hold 
long conversations with the doctor after he has made his 
call upon the patient. Don't absent yourself from the 
sick room any great length of time, nor make long visits 
with the family. Don't question the physician too closely 
about his opinion of the condition of the patient, nor ask 
for his prognosis. Don't diagnose. Don't form the habit 
of speaking of your patients as " cases." Don't carry a 
whole wardrobe with you when called out on private 
duty. 

Equipment of the Nurse's Bag. — Some of the things 
which every nurse should carry in her bag are — a clin- 
ical thermometer ; a pair of surgical scissors and forceps ; 
a bottle of brandy ; a hypodermic syringe ; a fountain 
syringe ; two glass catheters ; a flexible catheter ; small 
bottles of corrosive sublimate tablets ; carbolic acid ; per- 
manganate-of-potash crystals ; oxalic-acid crystals and 
washing soda ; rubber tubing ; a razor ; large and small 
safety-pins ; needles and white thread ; one-ounce grad- 
uated minim-glass ; a medicine-dropper ; temperature and 
nourishment charts ; gauze sponges of various sizes ; a 
small ice-pick ; matches. 

A fountain syringe will be found very handy in pri- 
vate practice. It can be used for a number of things — to 
wash out the stomach and bladder, for douches, as an 
irrigator, and the rubber-tubing attachment can be de- 
tached and used as a tourniquet. 

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



THE NURSE, 2'J 

,,.„ ^ . r lO, 12 A. M. 

M.lk,6ounces, atj^'^^^^gp ^ 

Ordered medicine, i teaspoonful, at -j ' ' 

„„ . 1 , . r 8.30, 10.30 A. M. 

Whisky, 4 ounce, at ■{ ,;^' ^ ::^ , ^^ „ „ 
■"2 » ^ 12.30, 2.30, 4.30 p. M. 

Flaxseed poultices to chest, atj ^' " J^*p^' 

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, lo, II, 12 A, m; I, 2, 3, 4, 5, 6, 7 P. M. Total, 

24 ounces. 
Whi.sky, 2 drams, S^, g^, lo^o, ii30, i230 a. m. ; i^, 2^^, f^, 4'o, 530, 
530^ 730 p. M. Total, 3 ounces. 

Strychnin, gr. J^j subcutaneously, 9, ii A. m.; i, 3, 5, 7 P. M. Total, 

Milk, 4 ounces, 1 u ^ ^ -r. , . 1 

,,,, . ' , > by rectum, 10 A. m. ; 2, 6 p. m. Retamed. 

Whisky, ^ ounce, J 

Effervescent citrate of magnesiurri, bottle i. Given in divided doses 

during the day. 
Low enema of — 

Turpentine, ^ ounce, 

Epsom salts, 3 ounces. 

Glycerin, 4 ounces, 

Warm water, 12 ounces. 

High enema of — 

Turpentine, i ounce, 

Magnesium sulfate, 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. Re- " 
turned as soon as injected. 



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



28 PRACTICAL POINTS IN NURSING. 



n 



Urinated at lo A. m., 3 ounces, 

" " 3 p. M., 6 ounces, \ Total, 13 ounces. 

" " 6 P. M., 4 ounces. 
Bowels did not move. 
Though patient did not sleep, yet she had a comfortable day. i 

If 
Night Report. 

Mrs. . J 



Magnesium sulfate, l dram, )^ 8 p m 
Hot coffee, i dram. / 



Hot coffee, i dram, 

Strychnin, gr. ^^3^, subcutaneously, 9, 11 p. m. ; i, 3, 5, 7 a. m. Total, 

^ths. 

Whisky, \ ounce, 10, 12 p. m.; 4, 6 a. m. Total, i\ ounces. 

Oxalate of cerium, grs. 5, at 9, 10. Total, 10 grains. 

Nourishment — S 

Milk, 10 ounces, > Total, 15 ounces through the night. 

Beef-tea, 5 ounces, ) 

Temperature and pulse taken every two hours and recorded on chart. 

Urinated at 9 p. m., 2 ounces, "j 

" "II p. M,, 3 ounces, > Total, 7 ounces. 

" " 2 A. M., 5 ounces, ) 

■k Very good movements, character 

Bowels moved at o, ii."?© p. m. I , ^^1.1. 

^' -^ L loose ; movements, though 

" " 2 A. M. [ „ A 

) small, were very good. 

After bowels moved at 9 o'clock distention gradually disappeared; very 
little distention this morning. Passed considerable gas. 
Slept continuously i^ hours, \ 

" " li " L Total, 5 hours. 

" at intervals 2 " j 

Had a comfortable night. 

Another favorite way is to rule a sheet of paper, leav- 
ing spaces for the hour, temperature, pulse, respiration, 
nourishment, stimulants, medicine, sleep, and remarks. 
For instance : 



THE NURSE, 



29 



Date.. 



Hour. 


i 




1 


C 

6 

1 


id 

1 

3 

s 


c 



1^ 


i 


1 




Remarks. 


7 A. M. 

8 " 

9 " 

10 " 

11 " 

12 " 

1 p. M. 

2 " 

3 " 

4 " 

5 " 

6 " 

7 " 

8 " 

9 " 

10 " 

11 " 

12 midnight. 

1 A. M. 

2 " 

3 " 

4 " 

5 " 

6 " 

7 " 




















Total. 























These twenty-four-hour charts, or records, are very 
useful for operative cases in which the treatment is con- 
tinually changing. The report should be rriade out and 
ready for the physician, and everything that has happened 
since his last visit should be written clearly and defi- 
nitely ; also what the nurse has done. This detailed re- 
port will save questioning in the presence of the patient. 



30 PRACTICAL POINTS IN NURSING. 



II. THE SICK-ROOM. 

Selection and Preparation of the Sick-room. — The 

sick-room should be on the sunny side of the house 
and capable of thorough ventilation. If there is a sta- 
tionary 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 accessible to 
the bath-room, in a quiet part of the house, and in the 
case of a contagious disease, on an upper floor, that the 
germs may not be carried upward by the heat and circu- 
lation of the air in the house. In the case of an old 
person, a cripple, or a chronic invalid, the selection of a 
room on the first floor is desirable, that members of the 
family may go in frequently, and access to the dining- 
room may be had, if advisable. If the light is too bright, 
the bed should be so made that the patient will lie with 
the back to the window, or a screen may be put before 
the window. If the case is disease of the brain or the eye, 
the room must be darkened ; the curtains so arranged 
that there will be no flapping when the window is open, 
nor flashes of light. Eliminate all superfluous furniture, 
retaining only that which is needed for the care and com- 
fort of the patient. The room will be much more easily 
taken care of, as there will be fewer places for dust and 
germs to accumulate. 

Preparation of the Bed. — Probably the first thing 
that will need the attention of the nurse will be the bed. 
If possible, eliminate the feather bed. In very few fami- 
lies will she find the mattress protected, which should be 



THE SICK-ROOM. 3 1 

done both for cleanliness and to lessen expense. Many 
persons 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 
they can possibly be avoided, as it is impossible to know 
where they have been or how dirty they are ; they may 
be filled with germs. One can always procure news- 
papers, which will absorb the discharges, and which can 
be burned when removed. They are to be placed be- 
tween the under sheet and the draw-sheet, which, if put 
on here, will keep the under sheet clean much longer. 
Where there is paralysis or mental derangement with 
great restlessness, or when the patient is an aged person, 
when involuntary evacuations may occur for a long time, 
the mattress may be more fully protected by making a 
cover of rubber sheeting and muslin to slip over the mat- 
tress like a pillow-case is put on a pillow. The rubber 
for the top should be a little wider than the mattress, so 
as to cover the edges, and full length, and it should be 
made to fit tightly to prevent wrinkles. Three draw- 
sheets may be used on this bed, in place of the full- 
length under sheet, then the middle part that is most 
often soiled can be easily removed and there is much 
saving of linen. 

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 



32 PRACTICAL POINTS IN NURSING. 

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-clothmg. — Before beginning to 
change the bed-linen or the 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 upper clothing is then spread out, and the patient 
moved back to the clean side, after which the soiled sheets 
can be removed, and the clean sheets be well stretched 
and tucked in at the top and sides. To change the 
upper sheet, the spread and one blanket are removed ; 
over the soiled sheet put the clean sheet and blanket ; 
then, with one hand holding the clean sheet and blanket, 
the soiled sheet and blanket are drawn down toward the 
foot of the bed and removed with the other hand. In 
changing the bed in this way we guard against exposing 
and chilling the patient. 



THE SICK-ROOM. 33 

When the patient cannot turn on the side, the bed- 
linen should be changed from the top, the soiled sheet 
being first loosened at the top and sides and pushed well 
down under the pillow. Another person must assist at 
the other side of the bed in working down the two 
sheets ; the shoulders, back, and upper part of the thighs 
of the patient must be raised with one hand, while the 
sheets are worked down with the other hand. In case 
of a fractured limb, one person must support the limb 
above and below the fracture, taking care to raise the 
limb very gently. 

When arranging the pillows, the head of the patient 
should be lifted and supported by the nurse's arm, her 
hand supporting the back ; with the other hand the pil- 
low is turned, the lower pillow being brought under the 
shoulders to support the back, the upper one to support 
the head without bringing it too far forward or too far 
backward. The patient must be permitted to suit herself 
in arranging her pillows, as every patient has a favorite 
way. A pillow should never be shaken up on the bed ; 
the upper pillow should be removed and shaken away 
from the bed, then the second pillow taken out and re- 
placed with the fresh one, so that the patient will always 
have one pillow. 

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

Medical and Surgical Beds. — A medical and a surgical 

3 



34 PRACTICAL POINTS IN NURSING, 

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 delivery, is easily re- 
moved, and the patient lies on a clean bed ; both beds 
during labor must be pinned securely to the mattress 
at each corner, the protectors also being pinned at their 
four corners. If the bed is a large double bed, then one 
side of it should be prepared, or the lower part of one 
side. After delivery the patient is lifted to the other 
side, or to the upper part of the bed, whichever has been 
prepared. Here the writer again warns the nurse not 
to use old comforters or blankets, unless positively sure 
that they are clean ; if there is any doubt about it, then 
give way to the doubt by not using them. 

Cross-bed. — A cross-bed is very often used for gyne- 
cologic examinations and minor operations : the pillows 
are arranged across the bed in the middle, which arrange- 
ment brings the hips of the patient to the edge of the 
bed; across the mattress under the sheet is slipped a 
table-leaf or board, which will, to a certain extent, take 
the place of the examining table ; the patient lies upon a 
hard surface, thus preventing the body sinking into the 
bed. A sheet and a blanket are the upper coverings. 

Water-bed and Air-bed. — Water-beds and air-beds are 
used in cases of long illness, in cases in which bed-sores 
are present or in which there is a tendency to their for- 



THE SICK-ROOM. 



35 



mation, and in cases in which there is much moisture. 
The water-bed is placed on the bed-springs, which should 
be covered with rubber sheeting, a comforter, or paper, 
to prevent rusting, and the bed filled with water (at a 
temperature of about ioo° F.) by means of a funnel and 
pitcher. To empty a water-bed, it is laid in a slanting 
position until all the water has run out ; it is then rolled 
up and laid away. India rubber, if unused for any length 
of time, becomes hard and is apt to break ; for this reason 
the bed should be filled every six weeks or oftener and 
the water allowed to remain in it three or four hours. 
The air-bed is filled with air by means of a pair of bel- 
lows or an air-pump ; after filling, it is made up in the 
usual way. Care must be taken that these beds are not 
pricked with pins, or they will collapse. 

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

The cradle (Fig. 2) can be improvised by taking one or 
two chairs, placing them 
backs uppermost, and 
securing them by tying 
their two lower legs to 
the sides of the bed ; 
to be sure, they look 
clumsy, but a chair is 
always to be had in the 
absence of anything else. 
Half barrel-hoops, with 

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




Fig. «.— Cradle for protecting patient from pres- 
sure of bed-clothes. 



36 



PRACTICAL POINTS IN NURSING. 



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

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

Pads and rings are used to relieve pressure. When an 
air-cushion or water-pillow cannot be obtained, such pads 
and rings (Fig. 3) may be made of cotton-batting, blanket, 

compress, oakum, horse-hair, 
straw, or even of a sheet, formed 
into a circular pad (having a 
hole in the centre), covered 
with a compress, and wound 
around with a bandage to keep 
it in place. 




Fig. 3. — Heel-pad or ring : a, 
end of bandage. 



Fig. 



-Bed-cushion. 



A cushion (Fig. 4) for the foot of the bed to prevent 
the patient slipping down, or to be placed under the 
knees to relax the abdominal muscles, may be impro- 



THE SICK-ROOM. 37 

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

Care of the Sick-room. — It should be remembered 
that the sick-room is the home of the patient during the 
time she is in it; hence great pains should be taken by the 
nurse to keep the room clean, the air pure and fresh, and 
herself bright, cheerful, quiet, and gentle, so that when the 
illness of the patient is a thing of the past, she will look 
back to the pleasant room, the systematic way in which 
everything was done, the kindness of the physician and 
nurse. Sweeping, if done at all, must be done slowly, 
the broom being kept near the floor, lest the dust be 
thrown around and back ; the sweepings must be gath- 
ered up and burned. Moistened bits of paper may be 
used to scatter over the floor, and as they are swept 
about they will gather the dust, and prevent its rising 
in the room. Instead of sweeping, it is better practice 
to wipe up the floor (or the carpet, if there be one) with 
a damp cloth. A damp cloth should be used to dust 
with ; if a feather-duster or a dry cloth be used, the dust 
is thrown around the room and settles again. If there 
is a fire in the room, the coal should be wrapped in 
paper or placed in paper bags before carrying it to 
the room ; it can then be dropped on the fire without 
noise. 

Hygiene of the Sick-room. — Temperature. — The 
temperature of the room must be kept as even as pos- 
sible — from 65° to 70° F. A point to be remembered 
is that the temperature decreases at night, and that be- 
tween the hours of 12 and 4 a. m. the vital powers are 
at their lowest ebb ; the sick patient must be care- 
fully watched, and hot drinks be given and extra 
blankets and heaters applied if necessary. The tern- 



38 PRACTICAL POINTS IN NURSING. 

perature must be regulated by opening or closing the 
registers, and applying extra clothing, not by closing 
the windows, thus shutting off the fresh air. Dry air, 
which is irritating, can be made moist by keeping a kettle 
of boiling water in the room, or by dropping very hot 
bricks into a pail of water, or, if there is a fire or register 
in the room, blankets or sheets wrung out of water may 
be hung up to dry. 

Air. — The air of the room must be kept pure, whole- 
some, and cool. To keep a room cool in hot weather is 
not always an easy matter, but good results have been 
obtained by keeping the windows and blinds closed dur- 
ing the day, thus shutting out the hot air and sun, and 
opening them in the evening when the air has become 
cooler. If the hot air be let into the room during the 
day, it remains, and the room is hot for the patient at 
night; whereas, if the windows and blinds be kept 
closed during the day and opened in the evening, when 
the air is cooler, the patient may be able to sleep. An- 
other way, and one which also gives to the room a very 
cool appearance, is to place near the window the branch 
of a tree in a tub containing large pieces of ice. 

Ventilation. — Ventilation is the process whereby im- 
pure air, in a confined space, such as a room, is replaced 
with pure air. One of the duties of the nurse is to see 
that the patient is kept supplied with fresh air. In al- 
most every case the window can be kept open \\ 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- 
ney ; a lighted lamp or candle will also direct an upward 
current. A board from 4 to 6 inches wide may be placed 



THE SICK-ROOM. 



39 



under the lower window-sash, and the fresh air will enter 
between the sashes (Fig. 5), 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 ever>' morn- 
ing and evening. iMany 
patients will object to the 
window being of>en at 
night, but the night air 
is purer than that of the 
i}:: I: 5 fiid that the 
:-:.: : M..: :hester, that 
^.c.^: :...^:-U Picturing dis- 
trict — ^**the workshop of 
England," as it is called — 
is purest after 10 p. M., as 
then there is no smoke 
from the immense factory' chimneys, and orir: 
which tend to make the air impure are lacl%.i: 




Fig 



jinons 
Bowel 

movements, urine, vomited matter, soiled linen, and dress- 
ings, inasmuch as they make the air impure, should 
always be removed immediately from the room. The 
patient should have all the sun possible. It must be 
remembered that all fires in a room, and burning candles, 
lamps or gas jets, take the ox\-gen from the air ; conse- 
quently, more fresh air must be admitted from outside to 
supply enough ox}'gen for the occupants of the room. 



40 PRACTICAL POINTS IN NURSING, 

III. THE PATIENT. 

I. NURSING IN MEDICAL CASES. 

In reporting to the doctor the nurse must remember 
two things — namely, that he wants facts, not opinions, 
and that he is dependent upon her for a faithful and ac- 
curate account of the patient's condition since his last 
visit; he must be told things just as they are, nothing 
added to or taken from the facts. Many things which 
the nurse may think too simple to report may be very 
important to the doctor, and may help him considerably 
in making his diagnosis. The temperature, pulse, and 
respiration must be taken and be recorded on the chart. 

I. General Observations in Medical Cases. 

The Pulse. — The pulse, temperature, and respiration, 
which are called the " three vital signs," are so closely 
connected that whatever affects one generally affects the 
others. Every time the heart contracts blood is thrown 
into the arteries (see p. 344), which are distended on re- 
ceiving the blood ; it is this distention, this rising up of 
the wall of the artery at regular intervals, corresponding 
with the beatings of the heart, that is called " the pulse." 

In feeling the pulse we should determine its frequency 
(which tells us the number of times per minute the heart 
beats), its force, its fulness, and its regularity. Posi- 
tion and action alter the pulse-rate ; for instance, it is 
generally faster when standing than when sitting, and 
faster when sitting than when lying ; it is slower in sleep 
and faster when dying ; it is slower in old age than in 
middle life, slower in men than in women, faster in 



THE PATIENT. 4 1 

children than in adults, faster, again, during excitement 
or exercise. 

Frequency and Varieties of Pulse. — We notice the fre- 
quency of the pulse — that is, how fast or how slow it is ; 
when we say a pulse is frequent, we mean that it beats 
about 105 to 1 10 times per minute; a r^/^^ pulse is from 
120 to 140; and a running pulse is above 140, and is also 
weak. 

A pulse is said to be regular when the beats occur at 
regular intervals and are of equal strength. A pulse is 
full when the artery is distended by a large volume of 
blood. In an irregular pulse the intervals between the 
beats are unequal, or some of the beats are feebler than 
others. A pulse is intermittent when a beat is dropped 
every few beats, the pulse being generally otherwise 
regular; this pulse may occur in health, or it may be 
due to some heart disorder, or to neurotic conditions, or 
to the immoderate use of tea, coffee, tobacco, etc. A 
pulse is compressible when it is soft and easily obliterated 
by pressure with the finger ; it is incompressible when it 
is hard and not easily obliterated by pressure with the 
finger. It is of high tension when the artery remains 
persistently full between beats and is resisting to the 
finger ; it is oi low tension when it is soft and easily com- 
pressed — non-resistant to the finger. The pulse is said 
to be dicrotic when there seems to be two beats to each 
beat of the heart, the second beat being smaller than the 
first. In reality there, is but a single beat, the larger 
one, which must be counted ; the second and smaller 
beat, which must not be counted, is an exaggerated 
" dicrotic wave " or recoil wave, a secondary wave in the 
blood-current corresponding to the closure of the aortic 
valves, and not due to a second beat of the heart. This 



42 PRACTICAL POINTS IN NURSING. 

fact is very important for the nurse to remember : the 
large beat is to be counted, and not the smaller wave 
which comes immediately after it. If there be any diffi- 
culty in making the distinction, the nurse should place 
one hand over the heart and with the other she should 
feel the pulsations in the artery at the wrist or the tem- 
ple, whereupon she will notice that a single heart-beat 
occurs to what seems to be two beats in the arteries. 

Taking the Pulse. — The way to take the pulse is to 
place two or three fingers on the radial artery at the 
wrist or on the temporal artery just in front of the ear, 
and to count the pulsations preferably for a full minute, 
or for at least a half minute and then multiply the result 
by two. The thumb should not be placed on the artery, 
because this method of taking the pulse is awkward, and 
because the pulsations of the artery in the thumb are 
frequently so readily perceptible as unconsciously to 
lead the nurse to determine her own pulse-rate rather 
than the patient's. 

The pulse in the fetus is from 130 to 160 per minute. 

In the infant at birth 

At I year 

At 2 years , 

At 3 " 

At 7 *' 

At 12 " 

At puberty the pulse may be from 80 to 85 per min- 
ute, because at this time the nervous system is more or 
less excitable ; in the prime of life it is from 70 to 75 ; in 
old age, from 65 to 70. In very old age it may rise 
slightly. 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 



" 130 to 


150 ' 


" no to 


130 ' 


" 90 to 


115 ' 


" 80 to 


no * 


" 72 to 


90 ' 


" 70 to 


76 ' 



THE PATIENT. 43 

body in adults is 98.6° F. ; but, like the pulse-rate, it 
may be slightly higher or slightly lower than the aver- 
age, and still be normal for the individual. The body- 
temperature is subject to diurnal fluctuations of a fraction 
of a degree, which are physiologic. Thus, it gradually 
rises from about 7 or 8 o'clock in the morning until about 
7 or 8 o'clock in the evening, whereupon it gradually falls. 
It reaches its maximum between 5 and 8 p.m., and its min- 
imum between 12 and 4 a. m. In infants and in children 
below the age of puberty the temperature is often slightly 
higher than in adults, and it is much less stable, being 
readily disturbed by slight causes. In advanced life the 
temperature is frequently persistently subnormal. In addi- 
tion, the body-temperature is commonly slightly elevated 
after a full meal on account of the activity of digestion, 
and it maybe increased by exercise or by emotion, espe- 
cially in children and in certain susceptible, particularly 
hysterical, patients. Profuse perspiration and immod- 
erate indulgence in alcoholic beverages tend temporarily 
to lower the body-temperature. 

The following terms have been applied to different 
degrees of body-temperature : 

Algid collapse, below 95° F. 
Collapse, from 95° to 97° F. 

Subnormal, '' 97° to 98° F. 

Normal, " 98.4° to 98.6° F. 

Subfebrile, " 99.5° to 101° F. 

Moderate fever, " 101° to 103° F. 
High fever, *' 103° to 105 °F. 

Hyperpyrexia, " 106° F. and above. 

A body-temperature below 95° F. or above 108° F., 
if it persists for any length of time, is likely to be fol- 



44 PRACTICAL POINTS IN NURSING, 

lowed by death. In some cases, as death approaches, 
hyperpyrexia gradually increases and may become ex- 
treme, the temperature reaching i io° F. and more. In 
a case of tetanus recently seen the thermometer just 
before death registered a temperature of 109° F., one 
hour after death 111° F., and two hours after death 
II2°F. In sunstroke the temperature maybe II2°F. 
or above. Hysterical patients have been known to put the 
bulb of the thermometer in a cup of hot milk or tea, or in a 
hot-water bag, and to shake the mercury up, when the at- 
tention of the nurse has been called to other things, thus 
producing apparently an alarmingly high temperature. 

More or less persistent subnormal temperature may be 
observed during convalescence from some of the pro- 
tracted fevers, such as typhoid fever, pneumonia, etc. ; in 
certain wasting diseases, such as starvation, cancer, etc. 
A sudden fall of the temperature to below the normal may 
result from hemorrhage from the lung, stomach, bowel, 
etc., or from perforation of the bowel, as in typhoid fever, 
or from shock from any cause, and it sometimes occurs 
in the crises in acute diseases, such as pneumonia. 

Generally there is a definite relation between the pulse- 
rate and the temperature, the pulse, as a rule, increasing 
from eight to ten beats with each additional degree of 
temperature. Thus — 



A temperature 


of 98° F. 


generally corresponds with a pulse-rate 


of 60. 




99° 




( <( « 


70. 




100° 




a ii (( 


80. 




101° 




I « tt 


90. 




102° 




( tt (t 


100. 




103° 




< « (( 


1 10. 




104° 




' « . « 


120. 




105° 




< tt u 


130. 




106° 




< tt tt 


140. 



THE PATIENT. 45 

Taking the Body-temperattire . — The temperature of the 
body is taken with a cHnical thermometer (Fig. 6) in the 
mouth, the axilla, the groin, the vagina, or the rectum. 
The temperature of the axilla is about half a degree lower 
than that of the mouth. The temperature of the rectum 
and of the vagina is about half a degree higher than that 
of the mouth, because these cavities are constantly closed. 

For convenience the temperature is generally taken in 



Fig. 6. — Clinical thermometer. 

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

The temperature of very weak patients unable to keep 
the mouth closed, of unconscious and delirious patients, 
and of children, should be taken in the axilla or the rectum. 
The clothing is removed from under the arm, the arm- 
pit is dried from perspiration, the bulb of the thermome- 
ter is placed between the folds of the skin of the armpit, 
the elbow is bent, and the arm is held close to the side, 
the hand touching the opposite shoulder. The ther- 
mometer should remain in the axilla from seven to ten 
minutes. Before taking the temperature in the rectum 
the latter must be emptied if full, or the thermometer 



46 PRACTICAL POINTS IN NURSING. 

may become imbedded in the fecal matter and not come 
in contact with the mucous membrane. The thermom- 
eter is oiled and inserted for about ij inches, and is al- 
lowed to remain five minutes. The same length of time 
is allowed for taking the temperature in the vagina. A 
thermometer that is used in the rectum or the vagina 
should be marked by means of a piece of adhesive 
wrapped around the end opposite the bulb, so that it 
will not be used in the mouth by mistake. 

Should the same thermometer be used for several per- 
sons care must be exercised to insure that it does not 
carry disease germs from one to the other. In case of 
contagious disease it is well to have a separate thermom- 
eter for each patient. If this be impossible, and at all 
events at the termination of the disease, the thermometer 
must be sterilized by careful washing with soap and 
water, alcohol, and carbolic acid solution (i : 20). The 
carbolic acid should be washed off with clean water 
before inserting the thermometer in the patient's mouth. 

Fevers are said to end by ct'isis or by lysis. By crisis 
is understood a sudden fall of the temperature to or 
below the normal — which is usually accompanied by 
profuse perspiration, an increased flow of urine, and 
lessening of the pulse-rate and respiration-rate ; by lysis, 
a gradual decline of the temperature, accompanied by a 
gradual fall of the pulse-rate and respiration-rate — occu- 
pying usually several days. Diseases of sudden onset 
usually terminate by crisis, such as pneumonia ; diseases 
of slow onset usually terminate by lysis, such as typhoid 
fever. A sudden rise or fall must always be reported 
promptly, as some complication has probably set in, 
though with hysterical patients the temperature may rise 
to 103° F. or above, and fall without indicating anything 



THE PATIENT. 4/ 

serious. The same is also true of children. Very little 
things will often cause in a child a rise of temperature, 
which falls in a short time, so that a high temperature in 
a child is not so serious as in an adult. 

Respiration. — The normal number of respirations iiv 
an adult is i6 to 18 per minute ; we breathe once to four 
beats of the heart. In children of both sexes and in 
man the breathing is chiefly abdominal^ and in women 
it is chiefly thoracic. When taking the respirations one 
should notice if they are regular or irregular, frequent, 
quiet, deep, shallow, thoracic, or abdominal. The respi- 
rations can be counted by watching the rise and fall of 
the chest after having taken the 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's breathing slower or faster when he knows the 
respirations are being counted. It is always best to 
count the respirations when the patient is asleep, as they 
are then slower, but natural; excitement and exertion 
increase them. The respirations in 

Infants are from 30 to 35. 

At the fifth year " 20 to 25. 

" " eighth year . . . the same as those of an adult. 

Cheyne-Stokes breathing is a peculiar form of rhythmic 
irregularity of the breathing. After a period of apnea m 
which the patient ceases to breathe, there occur slow, 
shallow respirations followed by others that progressively 
increase in depth and quickness until the acme is reached, 
after which the order of the respirations is reversed until 
the patient again ceases to breathe. The time that 
elapses between the cessations of breathing varies in 
most cases between thirty seconds and two minutes. 
Cheyne-Stokes breathing is encountered in certain dis- 



48 PRACTICAL POINTS IN NURSING. 

eases of the brain, such as apoplexy, tumor, tuberculous 
meningitis, in uremia, and in certain acute fevers. It is 
always a serious symptom, and is frequently followed by 
death of the patient. 

The pulse, temperature, and respirations must be ac- 
curately recorded on paper or on a chart ; when there 
is any doubt as to their correctness, a question-mark 
should be made, so that the attention of the attending 
physician w^ill 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 may become depressed. If unusual 
symptoms have developed, it is a good plan to leave a 
note downstairs for the doctor informing him. 

Observation of Symptoms. — The accurate observa- 
tion of symptoms in the cases which a nurse has 
under her care is of the utmost importance, so that she 
may know how to give the doctor a faithful and accurate 
account of everything that has happened since his last 
visit. 

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 hes on the back with the knees 
drawn up, to relax the muscles of the abdomen ; one ill 
with pleurisy or asthma will breathe much easier when 
propped up. If one lung is affected, the patient will 
generally be found lying on the affected side, so that the 
sound lung can work better. Again, when a patient has 
been very ill, and has been lying on the back continually, 
it is a good sign when he turns ov^er on the side. 

Nausea and Vomiting. — Under all circumstances nau- 
sea and vomiting must be reported, and the following 



THE PATIENT. 49 

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, 
or particles Hke coffee-grounds, as in hemorrhage from 
the stomach ? is it fecal in character, such as we get in 
intestinal obstruction ? or are the contents of the stomach 
rejected without any distress or nausea ? 

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

The Mouth. — The state of the mouth should be ob- 
served : Is there any pain ? is the mouth hot ? are the 
teeth decayed or unclean ? does sordes collect on the 
teeth ? The condition of the gums should also be ex- 
amined : are they a normal red or very pale, swollen, 
bleeding, or rather blue ? 

The Tongue. — The condition of the tongue should be 
noted :. Is it coated ? if so, is the color light, the coat gra}^ 
dry, and brown, as seen in typhoid fever, or is the tongue 
red like beef, or of the so-called " strawberry tongue " 
or " raspberry tongue " — the uniformly red tongue with 
projecting papillae, seen especially in scarlet fever after 
the coating has come off Another condition of the 
tongue to be noticed is the trembhng 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. 



50 PRACTICAL POINTS IN NURSING. 

Facial Expressio7i. — The expression of the face must 
carefully be watched : Is it anxious and pinched ? does 
the patient seem to take an interest in what is going on ? 
or is he dull and listless ? Are there hot flushes of the 
face, paleness, blueness (commonly called " cyanosis," 
which is caused by insufificient oxygen in the blood)? 
or does the color come more in one cheek than in the 
other ? 

Cough and Expectoration. — The nature of the cough 
and expectoration must be determined : Is the cough 
hard and dry, without expectoration, or moist, loose, 
or hacking ? does it tire the patient to cough ? and does 
he cough more when lying upon his back than upon his 
side ? and upon which side ? or does the attack come on 
in paroxysms or fits of coughing? The expectoration 
may be frothy and watery, rusty, and adhere to the vessel ; 
it may be the color of prune-juice, as is seen in gangrene 
of the lung, and have an offensive odor ; it may also re- 
semble pus ; it may be streaked with blood, or be thick 
and yellow. The expectoration should always be saved 
for the doctor's inspection and its character and quantity 
noted. Line a sputum-cup (Fig. 90) with paper, which 
can be taken out and burned and the cup boiled. This 
should be done at least three times a day, especially in 
infectious diseases, such as pneumonia and consumption, 
in which the germs leave the body through the expec- 
toration. 

The Breath. — The character of the breath should be 
observed : Is its odor sweetish like chloroform ? or has 
it a fetid odor caused by decayed teeth, dyspepsia, con- 
stipation, fetid bronchitis, gangrene of the lung, etc. ? 
^ Sleep must be noted : Is it quiet and restful ? or does 
the patient sleep all night and awake very tired, entirely 



THE PATIENT. 5 I 

unrefreshed ? at what time did she fall asleep, and how 
long did she sleep ? was it in the first or the latter part of 
the night ? or would she fall asleep and awake at intervals, 
and remain awake for a few minutes, an hour, or a few 
hours, then drop off to sleep again ? was she restless 
when asleep? Notice whether the patient is hard to 
waken ; is there twitching of the muscles during sleep, 
muttering, or any sign of delirium ? 

The character of the breathing-. Was it quiet, deep, 
shallow, rapid, regular, irregular, or snoring (stertorous), 
with flapping out of both cheeks, or of one cheek more 
than the other ? This condition must always be reported 
promptly, as it generally denotes serious disease of the 
brain. 

Delirium. — Note the kind of dehrium : is it quiet or 
busy; muttering; picking at the bed-clothes or at 
imaginary objects ; or violent ; if so, when is it most 
violent? Patients are very often quiet during the physi- 
cian's visit ; indeed, they seem to know the instant he 
enters the house. They are, as a rule, very cunning, 
and must not be left alone for a single moment, no mat- 
ter how mild the delirium, as they may get out of bed 
and harm themselves, or may even jump out of the win- 
dow. Terrible accidents and death have happened through 
delirious patients being left alone ; hence the nurse should 
always remain near a delirious patient, no matter how 
slight and apparently insignificant the delirium, until 
some one can relieve her. 

Chills.^^ln reporting a chill there should be given the 
time it occurred, how long it lasted, and the temperature, 
pulse, and respiration. As very many diseases and 
complications begin with a chill, it is necessary that a 
chill be reported at once. It may vary from a mere 



52 PRACTICAL POINTS IN NURSING. 

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 bed-linen and body-linen may be 
changed, but the nurse must be sure that the fresh linen 
is thoroughly aired and warmed before changing, thus 
guarding against another chill. 

The Skm, etc. — The color of the skin must be noted, 
its pallor, blueness, or yellowness ; any discoloration, 
hardness, or edema, which is a watery swelling caused 
by a collection of serum in the cellular tissue, and which 
pits on pressure. Note if the skin is hot and dry, or 
if there are hot flushes of the head and face, succeeded 
by creeping chills down the spine alone or over the 
whole body; also, the condition of the nails: are they 
discolored, blue, dry or brittle ? Is there any discharge 
from the nose, the ears, or the eyes ? 

The Bowels. — The condition of the bowels must care- 
fully be watched, noting if there is constipation or diar- 
rhea ; also the color of the movements. Black move- 
ments follow the use of certain medicines, such as bis- 
muth, iron, charcoal, and tannin. When hemorrhage 
has taken place and the blood has been retained in the 



THE PATIENT. 53 

bowels, as sometimes occurs in typhoid fever, the move- 
ments are of a black or tarry color, but when the blood 
passes from the bowels immediately after the hemorrhage 
has occurred, the blood being very little if at all changed, 
the movements are of a red color. One should notice if 
the feces contain mucus or pus, undigested food, or even 
pills which may pass through the bowels without being 
dissolved. The patient may have diarrhea accompanied 
by the so-called " packed " feces — that is, the bowels are 
packed with small, round, hard lumps like marbles ; the 
movements are then frequent and watery or contain these 
small lumps, and still the bowels may not be emptied. 
This condition must" be reported, as well as whether the 
movements are attended with pain. Pain, tenderness, 
distention of the abdomen, and flatulence, also must be 
reported. The passage of gas by the rectum after an 
abdominal operation is a very good sign. 

The Bladder : Urine. — The condition of the bladder 
must be recorded : is the normal amount of urine passed, 
or is the amount decreased or increased ? is there reten- 
tion, suppression, or a constant dribbling of urine (incon- 
tinence) ? is there a constant desire to urinate, and is the 
urine passed with difficulty or pain ? Anything abnor- 
mal in the color, odor, etc. of the contents of either 
bowels or bladder must always lead the nurse to save a 
specimen for inspection. 

Unless otherwise ordered, a specimen of the morning 
urine should always be saved for examination, because 
the secretion has not generally been influenced by food 
or medicine. In many cases, however, the physician 
will desire a specimen of both the morning and the even- 
ing urine, or a specimen of the mixed twenty-four-hour 
urine. To obtain a twenty-four-hour specimen, the urine 



54 PRACTICAL POINTS IN NURSING. 

that is passed in twenty-four hours must be saved in one 
vessel, and a portion of this taken for examination. A 
complete urinalysis can only be made with such a speci- 
men. If necessary, the urine should be drawn with a 
glass catheter into a clean bottle or a tumbler, and be 
labelled with the name, date, quantity, and hour that it 
was drawn. The bottle must be covered tightly and 
placed in a cool place to avoid the changes caused by 
undue warmth. 

The general points to be noted about the urine are the 
amount passed during the twenty-four hours ; its odor, 
color, and appearance ; whether perfectly clear or cloudy ; 
the time the urine was passed, its reaction, and specific 
gravity. It must be noticed whether there is retention 
or suppression of urine ; is the urine passed with pain or 
in very small quantities ? does it contain blood or pus ? 
To record the twenty-four-hours' amount, the excretion 
should be taken from 6 a. m. to 6 p. m. and from 6 p. m. 
to 6 A. M., and both amounts added together. When 
the bladder is very full it should be emptied slowly. In 
some cases it maybe advisable to draw off only a portion 
of the urine at first, and the remainder later on. 

Hiccough and the periods of its occurrence must be 
reported. It is a spasmodic contraction or movement 
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 reheve 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 



THE PATIENT. 55 

locality and character of the pain ; the character of the 
flow, whether it is of a normal color and odor, or scanty, 
dark, or pale, and, if clots come away with it, their number 
and size. If there is any leucorrhea, the character and 
quantity should be noted : is it profuse, thick, and stringy, 
or does it resemble the white of an ^g^ ? Leucorrhea is 
not a disease of itself, but is a symptom of many inflam- 
matory and other diseases of the vagina and the lining 
membrane of the uterus. 

2. Bodily Care of the Patient. 

Changing- the Clothing. — To change the nightdress 
and undershirt, they are loosened at the neck and wrists, 
and brought well up under the shoulders on one side of 
the patient ; the arm is taken out of the soiled garments, 
and the corresponding clean sleeves are put on, and both 
sets of garments slipped over the head ; this slips the 
soiled shirts off and the clean shirts on. The nurse 
now goes to the other side of the bed, removes the 
soiled clothing, and puts on the sleeves of the clean 
clothing, raising the patient sHghtly 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. When one 
side of the body is injured or paralyzed, the clothes should 
be 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 the wrist to the 
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. 



56 PRACTICAL POINTS IN NURSING. 

Toilet of the Patient. — The Hair. — The hair must be 
combed every day, and be braided in two braids ; if it is 
done up in a tight knot at the back of the head the patient 
will have 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 140), or kerosene 
oil should be rubbed into the hair, and the head be 
wrapped in a towel or cloth for two or three days. 
When the hair is dry, the nits can be destroyed by very 
thoroughly rubbing it with alcohol 

Washing the Hair. — For washing the hair of a bed- 
patient, the patient is brought to the edge of the bed ; 
one end of a rubber sheet is pinned round his neck, and 
the rest of the rubber sheet is arranged Hke a trough, so 
as to carry the water into a drainage-pan on the floor. 
The head is covered with a thick lather of soap solution 
and every part of the scalp well rubbed. The soap is 
then carefully rinsed out and dried with a towel, followed 
by fanning. 

The Mouth. — The patient's mouth should be attended 
to each day punctually. The mouth, to be kept perfectly 
clean, should be washed at least three times a day, and 
the teeth carefully brushed. Nothing is more refreshing 
in illness than a clean mouth and well-brushed teeth. If 
the patient has no tooth-brush, a piece of cotton wrapped 
around the end of a toothpick or a matchstick will serve 
to clean the teeth. A satisfactory mouth-wash may be 
made by placing 6 or 8 drops of pure alcohol in half 



THE PATIENT. 5/ 

a glass of water. Lime-water containing a few drops of 
rose-water is also efficient. A very agreeable wash con- 
sists of equal parts of tincture of orris, rose-water, and 
alcohol, flavored with a drop of oil of bitter almond. If 
the patient wears artificial teeth, they should be removed 
and cleansed two or three times a day. 

The nails must be cleaned and trimmed if necessary. 
The hands and face should be bathed and the teeth 
brushed just before settling down for the night. 

The Body. — The nurse should be careful to keep the 
bed-linen and body-Hnen perfectly dry and free from 
wrinkles, and the bed free from crumbs. She should 
guard against bed-sores, which are generally the result of 
careless nursing in allowing continued pressure upon the 
prominent parts of the body, except in cases such as 
those of fractured spine resulting in paralysis, in which 
the nerve-supply is injured, and in which bed-sores may 
form under the best of care. It must not be forgotten 
that a bed-sore is a disgrace to a nurse, except, of course, 
in these exceptional cases, and every good nurse will do 
all in her power to prevent it. She must not wait for 
redness to appear before beginning to bathe the back. 
Alcohol in any form, cologne, vinegar, or lemon-juice, 
may be used to harden the skin ; and oxid of zinc, pow- 
dered laundr}^ starch, corn-starch, baby-powder, bismuth, 
or borax may be used to powder the back. In the ab- 
sence 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^ 



58 PRACTICAL POINTS IN NURSING. 

sweet oil, mutton-tallow, lard, or even melted candle. 
There are some patients so very thin and emaciated that 
bed-sores form notwithstanding all the care that can be 
taken. Should one form, the pressure must be removed 
with a ring, the part painted with the white of an ^g^, 
which is the next best apphcation to collodion and will 
exclude the air, or it should be dressed with oxid-of-zinc 
ointment. If the nurse is at a distance from an apothe- 
cary store, and has oxid-of-zinc powder and pure lard, 
four parts of the lard should be mixed with one part of 
powder ; the regular ointment is prepared with benzoated 
lard, but the nurse may use common lard in an emergency. 

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

Sponge-bath. — To give a sponge-bath to a patient in 
bed, the nurse first gets everything ready, and sees that 
the fresh clothing is thoroughly aired ; the patient is then 
wrapped in a blanket, the clothing removed, and one 
part bathed at a time. She begins with the patient's 
face and neck, then the chest, abdomen, and arms, then 
the back, bathing the lower extremities last of all. The 
water should be changed at least three times, and the 
patient have the full benefit of the water as far as possi- 
ble ; the arms, the legs, and the feet placed in the basin 



THE PATIENT. 59 

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 
no bath-tub, a wash-tub will answer, the patient being 
seated in it and pailsful of water poured over the body. 

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

Feeding- of the Patient. — Serving the Meal. — At 
meal-times the nurse should have the napkin and tray- 
cloth spotless, and the china, glassware, and silver of 
the best that the house affords ; hot food should be 
served hot, not lukewarm, and cold food and cold drinks 
cold. It is better to serve too little than too much, and 
there should be a variety. Plenty of time should be 
allowed for the meal ; the patient must not be hurried, 
so that the food can be thoroughly masticated and mixed 
with the digestive juices. The liquid must not be spilled, 
nor must a tumbler or cup be held at the rim where 



6o PRACTICAL POINTS IN NURSING. 

the patient is going to drink, but it should be held at the 
bottom. The tray must be removed when the meal is 
over, and if the patient has left anything to eat later, 
it should be put away, and on no account be left in the 
room. It is perhaps needless to add that the nurse's 
hands must be washed before preparing the food, also 
the hands of the patient before each meal. 

Feeding Feeble Patients. — The principal thing to ob- 
serve in feeding a feeble patient is to feed often and a 
little at a time. One will be astonished at the end of the 
day to find how much nourishment a patient has taken 
by giving it in small quantities 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 
an Qgg)f gruel, beef-tea, oyster-broth, raw oysters (which 
are very nourishing and easily digested), and eggnog, may 
all be given (see Dietary, p. 369) ; as the patient gains 
strength the food may be gradually changed to soft solids. 
When feeding an unconscious patient the nurse should 
pass the spoon containing the food far back into the 
mouth, empty it slowly, and then close the lips and nos- 
trils ; the patient will involuntarily swallow. Milk and 
brandy dropped on the tongue will be absorbed. When 
feeding an unconscious patient by the rectum (see p. 67) 
the enema should be given as high up into the intestine 
as possible, so that the fluid will be injected into the 
colon rather than into the rectum, because, according to 
some authorities, absorption goes on very slowly from 
the rectum, but very rapidly from the colon. Both the 
colon and the rectum must be free from feces before the 
enema is injected. 

When supplying a patient with ice to suck, a piece of 



THE PATIENT. 6 1 

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. 

Gavage and nasal feeding are described on p. 77. 

Moving" of the Patient. — The nurse should never at- 
tempt to lift a helpless patient alone : she should ask 
some one to help, nurse and assistant standing at the 
same side of the bed. The nurse places one arm under the 
neck of the patient ; this brings the head resting on her 
arm, her hand being passed under the arm on the other 
side ; the other hand and arm are passed under the 
middle of the back. The assistant passes one arm under 
the lower part of the back and the other under the knees, 
and both lift the patient toward the head of the bed. If 
a limb is injured, a second assistant will be needed to 
support the limb above and below the seat of injury. 

A patient can be moved from one side of the bed to 
the other by the nurse placing one hand and arm down 
the patient's back, thus supporting the head and shoul- 
ders, and by passing her other hand over and slipping it 
under the upper part of the back ; the upper part of the 
body can then be moved to the fresh side of the bed. 
The nurse's hands are then placed, one under the lower 
part of the back and the other under the knees, and the 
lower part of the body is lifted over. Or the under sheet 
can be secured to the mattress with safety-pins, the draw- 
sheet loosened, and the patient on the draw-sheet be 
drawn to the fresh side of the bed ; the draw-sheet being 
then replaced. The best way is to have two beds of equal 
height, one for day and one for night, each having its own 
set of bedding ; when changing the patient the beds are 



62 PRACTICAL POINTS IN NURSING. 

placed side by side, the nurse taking the sheet at the 
head, an assistant at the foot ; the patient in this way is 
lifted to the fresh bed without jarring. If the patient is 
very heavy, an assistant will be needed at each corner, or 
if there are broken limbs, other assistants will be needed 
to support the limbs. If alone, the nurse should loosen the 
under sheet, gather in her hands the side nearest to her 
top and bottom, and draw the patient to the fresh bed. 
When two beds cannot be obtained, a sofa or a lounge 
may be used for the daytime. If the patient is in a large 
double bed, one half of it should be kept for the day, the 
other half for the night. 

It needs two persons to carry a patient, and this is 
done by each grasping the forearms of her companion 
at the patient's back and under the knees, thus forming a 
chair, the patient resting an arm on the shoulder of 
each; but a much better way is to improvise a 
stretcher by rolHng two long broom-handles or poles 
tightly in each side of the under sheet ; in this way, with 
an assistant at the head and foot, the patient may be car- 
ried steadily to any part of the room or the house. The 
nurse must first make sure that the under sheet is good 
and stout, or she may have an accident by the sheet 
tearing and the patient falling. 

To carry a baby, one arm is passed downward under 
the shoulders, with the head resting on the upper 
part of the arm; the other arm is passed under the 
knees, the lower part of the back resting on the hand. 
A child should never be carried with one arm around 
the neck, the other under the knees, thus allowing the 
body to sink between the arms and the head to hang 
down over the arm. The head must always be sup- 
ported. 



THE PATIENT. 63 

3. Relief of Functional Disturbances. 

Enemas. — An enema is a liquid preparation for injec- 
tion into the rectum, and is given to relieve constipation 
or to check diarrhea; to give nourishment, stimulants, 
or medicines when they cannot be retained by the stom- 
ach;, to relieve the bowels of flatulence; and for other 
purposes. For all large enemas a Davidson or a 
fountain syringe should be used, and a hard-rubber 
syringe for small enemas. After being used the syringe 
must be cleansed by running hot soapsuds, and after- 
ward hot water, through it, the outside wiped dry, and 
the instrument hung up to drain. If a hard-rubber 
syringe leaks and is not tight enough, filling it with 
water and leaving it full will cause the washer to swell 
and fit tightly ; it always shrinks when not in use, and 
for this reason it is always well to soak rubber syringes 
every other day or so, that they may always be ready 
for use. In place of the hard-rubber syringe for a small 
enema, a funnel may be attached to a rectal tube, and the 
liquid preparation poured from a pitcher. This manner 
of giving is especially good for oil or nutritive enemata, 
as the apparatus is simple and more easily cleansed. 

Evacuant Enema. — A simple enema, to relieve the bow- 
els, consists of soapsuds, made with castile or brown soap ; 
the amount of warm water varies from one to three 
pints. A sheet or rubber sheet should be placed under 
the patient, who should lie upon the left side with the 
knees drawn up, or upon the back. Both ends of the 
syringe should be put in the water, and the air expelled ; 
the tube is oiled, and also the first finger of the nurse's 
left hand, which is passed under the clothes to the rec- 
tum, the finger acting as a guide. With the right hand 



64 PRACTICAL POINTS IN NURSING. 

the tube is inserted, as gently as possible, upward and 
slightly backward, following the natural curve of the 
rectum; the tube is held in place with the left hand 
and the injection slowly made with the right. If there 
is any difficulty in inserting the tube, it should be re- 
moved. No force is to be used ; the resistance may be 
caused by the rectum being packed with fecal matter 
(which can be removed with the fingers), or obstructed 
by hemorrhoids (piles) or other obstacles. 

Should the enema give pain to the patient, the nurse 
should rest a few moments until the pain has passed 
away; then the injection can generally be continued 
until all the fluid has been given. The tube is gently 
removed, and to the anus is placed a folded towel, 
which will apply pressure and help the patient to retain 
the enema a few minutes. The result must always be 
accurately reported. If there is no result from one 
enema, it is safe to repeat it in half an hour. 

High Enema. — A high enema is an injection of fluid 
high up into the bowel, given generally in cases of obsti- 
nate constipation. There are needed a rectal tube and a 
soft-rubber catheter, or a piece of rubber tubing which 
is connected with the tube of the syringe and inserted 
up the rectum about 8 inches. If there is no rectal tube 
or rubber tubing, and the nurse has a fountain syringe, 
the hard-rubber or metal tip can be taken off, and the 
soft tubing will answer. If the syringe is a Davidson, 
the patient's head is lowered, the hips raised by placing 
a pillow under them, and the foot of the bed is also 
raised as high as possible on chairs. This position of 
the patient will send the flow higher up into the bowel, as 
will also the knee-chest position (Fig. 44; see p. 156). 
When the tubing is used there is always the possibility 



THE PATIENT. 65 

of its coiling up inside the rectum. Should the nurse 
suspect this, she should insert a finger, and if a coil is 
found, the tubing should be drawn out a little, then in- 
serted again. 

Colon Flnshmg; Abdominal FhisJiing. — Colon flushing 
is sometimes ordered for obstinate constipation in order 
to wash out the colon more thoroughly than is possible 
with the patient in the ordinary position for an enema. 
The patient is placed in the knee-chest position (see p. 

155). 

Conti7uious enteroclysis for shock and severe hemor- 
rhage is described on p. 178. 

Purgative Enemas. — An enema of olive oil or castor oil 
is to soften the feces. Six ounces of oil are warmed 
and injected as high as possible, this injection being 
followed in half an hour with an enema of i quart of 
soapsuds. 

For a glycerin enema from \ an ounce to 2 ounces of 
glycerin are mixed with the same amount of warm soap- 
suds. In many poor families the nurse may not find 
olive oil, castor oil, or glycerin, in which case either 
vasehn, butter, or lard melted and strained before inject- 
ing may be used. 

If a turpenti7ie enema is ordered, i ounce of turpen- 
tine added to 3 ounces of warm water, is given first, 
followed with an enema of I pint of soapsuds. 

Rochelle salt and Epsom i"^// (sulfate of magnesium) are 
each given as a purgative enema, i ounce of the salt and 
I ounce of turpentine being mixed with i pint of warm 
soapsuds. 

Molasses is an excellent purgative : from 2 to 10 
ounces are mixed with i pint of soapsuds, or the mo- 
lasses heafed will readily pass through the syringe, the 

5 



66 PRACTICAL POINTS IN NURSING. 

molasses enema being followed in half an hour with a 
soapsuds enema. 

Enemata that have been used with success are — 

1. Glycerin, 4 ounces, 
Turpentine, i ounce, 
Warm soapsuds, 8 ounces. 

2. Molasses, 2 ounces, 
Glycerin, 4 ounces. 
Magnesium sulfate, i ounce, 
Turpentine, I ounce, 
Warm soapsuds, 8 ounces. 

3. Rochelle salt, 2 ounces, 
Turpentine, i ounce. 
Warm soapsuds, i pint. 

4. Magnesium sulphate, i ounce. 
Glycerin, 2 ounces, 

Warm soapsuds, 3 ounces. 

Number 4 is called the i, 2, 3 enema. It is effective, 
and the proportions are easily remembered. 

Astrmgent Enema. — A starch-and-laiidannin enema is 
to check diarrhea. The starch is prepared as for laundry 
use, except that it should be thin enough to pass through 
the syringe ; then the quantity to be used, usually 2 J 
or 3 ounces, is measured, and to it are added 30 
drops of laudanum, this being the usual quantity or- 
dered. The enema is to stand until lukewarm before 
being injected. 

Bland Ejtemas. — Barley^ flaxseed ^ oatmeal ^dind Indian- 
meal enemas 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 Ejiemas. — A salt enema is given for a 



THE PATIENT. 67 

stimulating effect: ij teaspoonfuls of common salt are 
dissolved in i quart of hot water. Other stimulating 
enemas are black coffee, half a pint (to be strained be- 
fore injected) ; plain hot water ; or whisky or brandy, i 
ounce added to 2 ounces of hot water. If there is no 
brandy or whisky at hand, but there is pure alcohol, 
on-ly one-half this amount should be given, because the 
brandy and whisky are only half as strong as pure alco- 
hol, but of about the same strength as the ordinary 
diluted alcohol, the wines, port and sherry, being still 
weaker. When, therefore, the nurse is directed to give 4 
teaspoonfuls (half an ounce) of brandy or whisky, she 
may, in the absence of brandy and whisky, gwe. the same 
amount of diluted alcohol, or 2 teaspoonfuls of pure 
alcohol, or i ounce of the wines. 

If the pulse becomes less frequent, the temperature 
lower, the patient quieter, and an improvement in the 
general condition takes place, the nurse will know that 
the stimulants are doing good ; but if the face becomes 
flushed, the restlessness increased, and the general con- 
dition does not improve, she will know that they are not 
doing good, and she should report their effect to the 
physician. 

A stimulating nutritive enema may consist of — 

Peptonized milk, 4 ounces. 

Whisky, \ ounce. 

Tincture of digitalis, 10 or 15 minims, 

the enema being injected high up into the bowel. 

Rectal Feeding". — Nutritive enemas must be injected 
as high up into the intestine as possible, because the colon 
absorbs more quickly than the rectum, and if the enema 
is not given high it is very apt to remain in the lower 



6S PRACTICAL POINTS IN NURSING. 

bowel, and to be incompletely absorbed when the second 
one is given; as a result the second and part of the first 
enema may be rejected. 

A nutritive enema consists of — 

Peptonized milk, 4 ounces, 
Whisky, \ ounce, 
White of one egg. 

Or, Peptonized milk, 4 ounces, 

and one ^%%. 

Beef-tea, beef-juice, liquid foods, extracts of beef, 
cream, and oyster-broth may be given per rectum. 
Starch-water, pancreatic extract, sodium bicarbonate, 
and common salt (which hastens absorption) are often 
added to nutritive enemas. Stimulants are very irrita- 
ting to the mucous membrane, and for this reason they 
should not be put into every enema, but only into every 
other one. The nurse should report whether the enema 
is or is not retained, also as to the presence of food in 
the movements. 

A nutritive enema must not be given oftener than once 
in every three or four hours, and must not exceed from 
4 to 6 ounces each time, unless differently ordered by the 
physician. A cleansing enema of warm water must be 
given first, to clean the bowel and to prevent irritation 
of the mucous membrane. 

If the patient is very weak and does not retain the 
enema very well, it is a good plan to plug the bowel 
with soft linen or gauze, the end inserted having first 
been oiled. This measure will prevent the enema from 
being returned. The same result is sometimes attained 
by adding 10 drops of deodorized tincture of opium to 



THE PATIENT. 69 

each enema, and by making each enema small (less than 
4 ounces) until the rectum becomes tolerant. 

Douches. — A douche is a stream of water directed 
against a part or used to flush a cavity for purposes of 
cleanliness, stimulation, or to relieve inflammation or 
hemorrhage. Three of the commonest douches are the 
aural, the vaginal, and the rectal. 

Vaginal Douche. — The vaginal douche is generally for 
cleansing purposes and to reheve inflammation. The 
surgical antiseptic douche is for cleansing purposes, 
from I to 3 quarts of warm water being used. The 
gynecologic hot douche is to relieve inflammation. The 
amount of water used is from 5 to 6 quarts, beginning 
with a temperature of 110° F., and gradually increasing 
it each day until it reaches 1 19° F. The temperature 
must always be tested with a bath-thermometer, if avail- 
able ; if not, the water must be allowed to run from the 
can on the back of the nurse's hand, and if it burns, it 
is too hot to be used as a douche. Too great care in 
giving douches cannot be used to guard against burning 
with heat, or with too strong an antiseptic solution. The 
mucous membrane which lines the genital tract is very 
delicate and sensitive, and, therefore, is easily injured. In 
the case of vaginitis in a child, douches are prescribed to 
relieve inflammation and to stop the progress of the dis- 
ease ; even greater care must be used by the nurse in 
giving such treatments, as the child is less sensitive, and 
injury may result before she complains. 

The apparatus shown in Fig. 7 is best adapted to the 
giving of vaginal douches. The flow may be regulated 
by raising or lowering the can and by partly closing the 
clamp on the tube. The doctor's directions must be fol- 
lowed as to quantity, flow, kind of solution to be used, 



70 PRACTICAL POINTS IN NURSING. 

and frequency, and the treatment must not be given 
unless he prescribes it. 

When taking a douche the patient should lie on her 
back, with the hips raised by means of a pillow and the 



Fig. 7. — Apparatus for vaginal douche. 



knees drawn up. In this position the water comes in 
contact with the whole vagina, and reaches high enough 
to influence the womb and ovaries, for the benefit of 
which it is usually given. If taken sitting over a vessel 



THE PATIENT. 7 1 

the water, reaching only as high as the nozzle, runs down 
by the side of the tube as fast as it runs in. 

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

The vagina being a cur\-ed and not a straight canal, 
the tube must be inserted slightly downward, then up- 
ward. Again, the injection does not flow into the womb, 
as many think : if one will stud\^ a \'aginal 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, a severe attack of uterine 
colic might result. A hard-rubber tube is generally to 
be preferred, though one may use a glass nozzle, which 
can be rendered aseptic more thoroughly than one of 
any other material. 

All persons have noticed how red and swollen the 
hands become on putting them into hot water, caused by 
the blood-vessels dilating and bringing more blood to the 
parts ; then after a while the vessels contract and the 
blood is driven away, and the hands have a wrinkled 
appearance, commonly called "washerwoman's hands." 
A vaginal douche given to relieve inflammation has ex- 
actly the same effect. The hot water dilates the blood- 
vessels and brings more blood to the parts ; then, on 
continuing the use of the hot water, the vessels contract, 
the blood is driven away from the parts, and the inflam- 
mation is subdued. The nurse will therefore see why 
she must be faithful in keeping up the douches as ordered, 
giving them at the proper time and temperature and 
length of time. A patient should he quietly for half an 



72 PRACTICAL POINTS IN NURSING. 

hour after taking a douche ; if she is taking only one a 
day, it may be best to give it at night, because the tem- 
porary weak feeling which sometimes follows a douche 
will be gone before morning. However, the nurse 
should go according to the orders given by the physician. 

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

Antiseptic Douches. — Corrosive sublimate, carbolic acid, 
creolin, lysol, and boric acid are used for antiseptic 
douches. Corrosive sublimate and carbolic acid are 
very poisonous. Creolin is irritating, and to prevent 
absorption and irritation a plain water douche is often 
ordered to follow any of these antiseptics when a strong 
solution has been used. 

Rectal Douche. — Rectal douches are for cleanliness 
and to relieve inflammation. Hot rectal injections to 
relieve inflammation are given with a fountain syringe 
and a rectal tube. The patient lies on her back with the 
knees drawn up, and a small pillow is placed under the 
hips to direct the flow upward. The physician will give 
directions as to the amount of water to be used, its tem- 
perature, etc. 

Douches to the external genitals, to the perineum, or 
to the anus for the relief of inflammation or hemorrhoids 
may be given with the patient in the sitting position and 
with an ordinary rectal tube. The force of the stream 
and the temperature of the water are decided by the 
physician. 



THE PATIENT. 



73 



Catheterization. — Before catheterizing a patient great 
care must be taken in cleansing the hands, the catheter, 
and the parts, as there is danger of infecting the bladder, 
and causing septic poisoning by passing a dirty catheter 
or in neglecting to wash the hands and parts. If the 
catheter be of glass or of silver, it should be boiled five 
minutes, and put in a solution of carbolic acid (i : 2o). 
Before being used the catheter should be placed in a 
basin of sterile water or boric-acid solution. 




Fig. 8. — Catheters: i, Glass; 2, silver; 3, soft rubber ; 4, elastic (Macfarlane). 

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 into very hot water until needed. 
For women glass catheters are the best ; they are easily 
rendered aseptic, and show whether they are or are not 
perfectly clean. Besides the catheter, which is taken to" 
the bedside in a basin of very hot water, there are needed 
a basin of corrosive sublimate solution (i : lOOo), steril- 
ized gauze or cotton, a vessel to receive the urine, and a 
lubricant of sterilized oil to render the entrance of the 
catheter as easy as possible. Gynecologists prefer that 
no lubricant should be used, and when one is necessary 
it should be a mixture of carbolic acid solution (i 140) 
and glycerin. 



74 PRACTICAL POINTS IN NURSING. 

TJic Operation. — The patient lies on her back with the 
knees drawn up and separated, the upper clothing being 
divided over each knee to guard against unnecessary 
exposure. A douche-pan or bed-pan is placed on the 
bed close to the perineum. The labia are separated with 
the thumb and forefinger of one hand, and the parts 
washed with the corrosive solution, followed by sterile 
water or normal salt solution. The catheter is inserted 




Fig. 9.— Catheterization of the bladder: a, Shows the catheter being introduced; 
h, the urine being retained in the catheter by placing the tip of the finger over the 
opening at the proximal end ; c, shows the urine escaping from the catheter (Ashton). 

into the urethra, the opening just above the vagina (Fig. 
9). If there is any difficulty, the catheter should be 
withdrawn a little, and gently pointed a little downward 
or upward, to the right or to the left. If the flow should 
cease before enough urine has been drawn, the catheter is 
withdrawn a little or is inserted a little farther than be- 
fore. Before removing the catheter a finger should be 
placed over its end to prevent any drops of urine wetting 
the bed. After the operation the parts are again washed. 



THE PATIENT. 75 

and the catheter boiled and placed in a bottle containing 
a solution of carbolic acid (i : 20), unless the catheter is 
of rubber; carbolic acid ruins rubber. 

A bladder very full of urine must be emptied grad- 
ually. Cystitis is due to many causes, one being the 
introduction of germs into the bladder by means of a 
dirty catheter, and the nurse who passes the catheter is 
always blamed. 

Washing- out the Bladder. — To wash out the blad- 
der there are needed a fountain syringe, which must 
have boiling water and a disinfectant run through to 
cleanse it, and a glass catheter, which is cleansed in the 
same way as for catheterizing ; the parts are also bathed. 
The patient is first catheterized; the catheter is then 
rinsed with boiling water and attached to the rubber 
tubing of the syringe which contains the ordered solu- 
tion, its temperature being about 100° F. The solution 
must run warm before the catheter is inserted, and care 
must be exercised that no air gains access to the bladder. 
A pint of the solution is allowed to run gently into the 
bladder, the reservoir of the syringe being held just high 
enough (a foot or less) to cause the fluid to flow ; then 
the tubing is disconnected from the catheter and the fluid 
is drawn off. If a double catheter is used, the tubing is 
not removed. This operation is repeated until the fluid- 
returns clear. 

Washing- Out the Stomach (Lavage). — The stomach 
may be best washed out by means of a soft-rubber stom- 
ach-tube, to which a glass funnel may be attached, or one 
may use a special tube provided with a rubber funnel. In 
the absence of a stomach-tube, a fountain syringe may be 
utilized, the hard-rubber nozzle having been removed. 
The tube having been cleansed, the patient should be 
seated or raised up in bed and the tube passed far back 



76 



PRACTICAL POINTS IN NURSING. 



into the throat, whereupon the patient is told to swallow. 
The tube is immediately grasped by the lower pharynx 
and the esophagus and carried downward, the nurse at 
the same time making gentle pressure downward. It is 
not necessary to oil the tube, the patient's saliva furnish- 
ing sufficient lubricant ; the patient's head should not be 




Fig. io. — Position of the patient for in- 
troduction of stomach-tube ; also method 



Fig. II. — Method of inducing expul- 
sion of gastric contents by siphonage 



of passing tube into the mouth (Boston). (Boston). 

directed backward, but rather forward ; and the patient 
should be reassured while the tube is being passed, being 
asked to take a long breath, or to say " a," etc. The 
tube having reached the stomach, a pint or more of luke- 
warm water may be poured into the funnel, whereupon, 
if the funnel (while it still contains some water) is de- 
pressed below the level of the stomach, the water in the 
stomach will run out by siphonage (Fig. ii). The proc- 
ess should be repeated until the water returns clear. 
When the washing has been completed the tube should 
be removed quickly. 



THE PATIENT. yj 

Gavage is feeding by means of the stomach-tube, the 
food being in liquid form, such as milk, beef extracts, 
eggs, etc. The tube is introduced as in stomach wash- 
ing ; a few minutes are allowed to elapse, and then the 
food is slowly poured in. When the feeding is finished 
the tube is quickly but gently withdrawn. 

Nasal feeding* is sometimes needed after operations in 
the mouth or throat, or for insane or unconscious pa- 
tients. It is performed by a funnel and tubing attached 
to a small soft-rubber catheter. The patient is in a sit- 
ting posture, with the head held level. The tube is intro- 
duced through the nostril, passed backward, and steadily 
pushed forward. Care must be taken not to get the tube 
into the trachea. To insure this the outer end of the tube is 
put into a glass of water, and if any air-bubbles appear, the 
tube should be removed at once, for it is in the trachea. 
After the tube is properly introduced and the patient is 
breathing comfortably, the food is introduced very slowly. 

Test-meals are given in various digestive diseases to 
ascertain the condition of the gastric juice and stomach- 
contents. After a certain time has passed the stomach- 
contents are withdrawn by siphonage. The test-meal is 
usually preceded by washing out of the stomach. Ewald's 
test-breakfast consists of one or two rolls and eight ounces 
of water or weak tea without sugar or milk. Boas' test- 
breakfast consists of six ounces of strained oatmeal gruel. 
Riegcl and Leube's test-dinner consists of specified quan- 
tities of beef soup, beef-steak, white bread, and water. 

4. Administration of Medicines. 
The five ways of introducing medicine into the system 
are by the stomach, the rectum, the cellular tissue (sub- 
cutaneously), the skin (inunction), and the lungs (inhala- 
tions). 



78 PRACTICAL POINTS IN NURSING. 

Rapidity of Absorption of Medicines. — The rapidity of 
absorption depends upon the parts to which the medicine 
is applied, the state of the circulation, the solubility of the 
medicine, and the power it has of passing rapidly through 
a living membrane. Absorption takes place more rapidly 
when the medicine is given subcutaneously, it taking only 
about five minutes for the drug to act, because it enters di- 
rectly into the circulation ; it is more slowly absorbed by 
the vessels of the mucous membrane of the stomach, and 
slower still by the intestines. Absorption through the 
lungs is rapid on account of their large blood-supply. 

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

Action of Medicines. — Sometimes a drug produces 
symptoms or affects the patient in a way entirely differ- 
ent from the ordinary : this is called an " idiosyncrasy," 
which means an individual peculiarity in regard to the 
action of certain drugs. Some drugs have what is called 
a " cumulative " action ; that is, the excretion of the drug 
is so very slow that one dose is not entirely excreted 
from the body when the next one is given ; the drug 
thus accumulates in the body, and after a while symp- 
toms of poisoning may develop through cumulative 
action. 



THE PATIENT. jg 

When patients have been taking a drug for some time 
the system becomes accustomed to it, so that after a 
while it takes a larger quantity to produce the desired 
result. This may continue until the habit of taking the 
drug is formed, when the patient not only craves it but 
thinks he cannot do without it. 

Some medicines act as tonics, some as stimulants, and 
some as 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. 
Thfere are many kinds of tonics, all of which act upon 
and improve the tone of the organs upon which they 
have a special effect. 

Stimulants are to prevent or counteract some depressing 
effect, as in shock, collapse, in typhoid and other fevers, 
w^hen the heart's action is depressed, and in debilitated 
conditions due to any cause. To do good in fever condi- 
tions they should strengthen and slow the pulse and respi- 
rations, lower the temperature, moisten the tongue, cool the 
skin, lessen delirium, and induce sleep. An opposite effect 
would show that the stimulants are doing harm instead of 
good, or at least that they are not producing the desired 
effect. This should be reported to the physician. 

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

Cerebral stimulants are drugs that increase the activity 
of the brain. They are also called exhilarants. Cerebral 
sedatives lower the activity of the brain. Vascular stimu- 
lants are substances that excite the action of the heart 
and cause dilatation of the peripheral vessels, and thus 



8o 



PRACTICAL POINTS IN NURSING. 



render the flow of blood through them more rapid. 
Vascular sedatives quiet the action of the heart and some- 
times contract the vessels, lessening the flow of blood 
through them. 

Narcotics are drugs that produce sleep. Some of them 
are at first excitants. 

Precautions to be Observed in Handling and Ad- 
ministering" Medicines. — Medicines must be kept out 




Fig. 12. — Medicine-glass and minim-glass. 

of the reach of patients, especially children and delirious 
patients ; what is left of the medicine when it is discon- 
tinued must always be disposed of The nurse should 
look at the label three times before giving the medicine — 
before measuring it, afterward, and when putting the 
bottle on its shelf; this rule must not be departed from, 



THE PATIENT. 61 

in view of the many sad mistakes that have been made. 
She should also be sure that the one who is to have 
charge of her patient while she is absent fully under- 
stands how to give the medicine. 

Medicine-glasses (Fig. 12) and medicine-spoons (Fig. 
14) must be thoroughly washed after being used, the 
nurse having separate ones for strong-smelling medicines 



Fig. 13. — Medicine-dropper. 



and for oils. When ordered before meals, medicines 
should be given half an hour before^ and those to be 
given after meals should be given about half an hour 
after, unless otherwise ordered. An unconscious patient 
must have the medicine dropped far back on the 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 this condition they may cause suffocation. 




Fig. 14. — Medicine-spoons. 

1. Medicines by the Mouth. — The nurse should 
always give minim doses when viiniins are ordered, and 
dreps if drops are ordered, because of the marked differ- 
ence between minims and drops — in some cases they 
are equal, in other cases two drops equal one minim, etc. 

Drops may be given upon a piece of lump sugar or in 

a little water. 

6 • 



82 



PRACTICAL POINTS IN NURSING. 



Powders may be given dry upon the tongue and be 
swallowed by drinking water, or they may be dissolved in 
water or hot milk. Powders that are unpleasant to take, 
such as quinine, may be enclosed in gelatin capsules (Fig. 
15), which are placed on the tongue and swallowed with 
water. 





Fig. 15. — Empty hard capsules. 

Pills should be placed at the back of the tongue and 
be swallowed with water. For children, who find it 
very hard to swallow a pill, the pill may be finely 
crushed and given with a Httle preserve, molasses, 
honey, or sugar. Powders may also be administered in 
this form. 

Acids ^^N\i\Q\\ injure the teeth, should be taken through 
a glass tube and the mouth thoroughly rinsed afterward. 

Oils may be taken in coffee, hot beef-tea, milk, ale, or 
brandy, or in lemon-juice or orange-juice. Oily medi- 
cines are sometimes given in gelatin capsules. 

Purgatives must be given early in the day, so that the 
patient will not be disturbed at night, but laxatives should 
be given late in the evening; a result is then had the 
next morning. 

Many medicines of unpleasant flavor are given in 
wafers and capsules. 

Should a patient vomit directly after, or in five or ten 
minutes after, taking a medicine by the viouth, or if the 
medicine is returned when given by recti^::i^ it is safe to 
repeat the dose in from, fifteen to twenty minutes. 



THE PATIENT. 



83 



2. Medicines Administered per Rectum. — Medi- 
cines given by the rectum are in the form of suppose 
tories or of enemas, which latter should be given high 
up in the bowel (see p. 63). 

Suppositories. — Suppositories are drugs incorporated 




Fig. 16.— DifTerent forms- of suppositories : «, vaginal suppository; h-e rectal sup- 
positories ; /, uretiiral suppository (Thornton). 

with cacao-butter and then made up into conical shapes 
(Fig. 16) for their convenient introduction into the rec- 
tum, the vagina, or the urethra. The finger is first oiled ; 
then the suppository is inserted, and pushed well up in 
the rectum until it cannot be felt by the finger, a cloth 
being applied and pressed against the part. The patient 
is in the same position as that for giving an enema. 

3. Hypodermatic Injection. — A hypodermatic or 
subcutaneous injection means the injecting of a medicine 
under the skin for a more rapid and certain effect than 
we would get if given by stomach or the rectum. The 
most convenient places for the injection are the outside 



84 



PRACTICAL POINTS IN NURSING. 



of the arms, the forearms, the thighs, the chest, and the 
abdomen, the injection being made into the fleshy part, 
avoiding the large blood-vessels, nerves, and bone. The 
syringe (Fig. 17) is cleansed by drawing through it sev- 
eral times a I : 20 solution of carbolic acid, followed by 
very hot water. The needle is boiled in a large spoonful 




Fig. 17. — Hypodermic syringe. 



of water over a gas-flame. The preferable syringe is one 
that can be entirely sterilized. The syringe is loaded 
with the ordered solution, the needle is screwed on 
tightly, making sure that it does not leak at the junction, 
and the air is expelled. 

After cleansing the part a fold of skin is pinched up 
between the thumb and finger (Fig. 18), the needle 
quickly and slantingly inserted, then withdrawn slightly, 
and the fluid is slowly injected. A gentle friction over the 




Fig. 18. — Method of giving a hypodermatic injection. 

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



THE PATIENT. 85 

1 
The syringe must afterward be thoroughly washed, by 

drawing through it the carbolic-acid solution and hot 
water, and the thin wire kept constantly in the needle to 
keep it clear. If not often used, the syringe should be 
soaked every few days in hot water to prevent the pack- 
ing from shrinking. Abscesses following hypodermatic 
injections are generally caused by the syringe and needle 
not being thoroughly clean and the solution not fresh or 
pure. A glass syringe is the best to use, for it can be 
boiled without injury, it is simple in construction, so not 
easily put out of order, and all parts can be thoroughly 
inspected. A metal syringe should be taken apart often 
and the parts that screw together well cleansed, as infec- 
tion may come from this source. Rubber or leather por- 
tions should be watched to see that solutions or drugs 
do not act upon them to harden or disintegrate, and so 
interfere with the action of the syringe, or cause particles 
that are likely to infect. 

Intrave7ious injection, which is the injection of solutions 
into a vein, is only practised in cases of emergency, as, 
for instance, the injection of blood or of salt-solution 
when there has been an excessive hemorrhage. 

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

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



86 PRACTICAL POINTS IN NURSING. 

thigh is taken, then on successive evenings the left arm- 
pit and the right are taken. In this way one part is taken 
each evening, and irritation on account of excessive fric- 
tion on the same part is avoided. The rubbing should 
take about fifteen minutes, the ointment being thor- 
oughly rubbed in. The application is to be omitted on 
the sixth evening, and on the seventh the patient takes 
a warm bath, changes the underclothing, and resumes 
treatment. Dr. W. H. Devine in his lectures on medi- 
cines gives the following order: 

First evening, the buttocks ; 

Second " the thighs ; 

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

Fourth " the internal surface of the arms and 

forearms ; 

Fifth " the back and abdomen ; 

Sixth " omit treatment ; 

Seventh" bathe, change underclothing, and re- 

sume treatment. 

This method of applying mercury to the skin is 
resorted to when the stomach will not bear any mer- 
curial, and also to obtain the general action of mercury. 
The mercury passes through the skin without producing 
any irritation, and is absorbed into the general circula- 
tion, where the general effects of the drug are produced. 

The symptoms of mercurial poisoning are an increased 
amount of saliva, a fetid breath, swollen and spongy 
gums, with a bluish line along their margins, and a 
metallic taste in the mouth ; any one of these symptoms 
must promptly be reported. 

Children are not easily salivated, but when the breath 
becomes fetid the mercury must be stopped at once. 
When applied to children, it is a good plan to put the 



THE PATIENT. 8/ 

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

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

Moist Inhalation. — In the absence of a steam-inhaler 
the vaporized substances may be inhaled from a tea-pot 
or a coffee-pot standing over an oil or a spirit lamp by the 
bedside, the spout being directed toward the patient ; or 
the solution may be put into a pitcher or a tin pan, cov- 
ered with paper, which is perforated, and through which 
the patient can inhale the vapor. The patient must breathe 
quite naturally, taking in the vapor through the mouth, 
then closing the mouth, and letting it escape through the 
nose, breathing five or six times in succession before 
withdrawing the face for a few moments ; then the pa- 
tient begins again, and continues in the same wav 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. 
Inhalations may also be given in a croup-tent (see p. 269). 

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. 



PRACTICAL POINTS IN NURSING. 



io° F. 

98° " 
85° " 



5. General and Local External Applications. 

Baths. — Temperature. — The temperature of baths 
varies, and the water must be tested with a bath-ther- 
mometer (Fig. 19). 

A hot bath varies from 98° to 
A warm " " 85° to 

A tepid " " 70° to 

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

Action of Baths. — A hot bath stimulates 
the nervous system through its action on 
the cutaneous nerves, which are connected, 
in a manner too varied and difficult for us to 
trace out, with the main nerves of the heart 
and with the respiratory and digestive sys- 
tems. The nei"ves 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 
19. -Bath- j^ j^gg consciousness, slip under the water, 

rmometer. •' ' jr ' 

and be drowned. 
Vapor-baths also act as stimulants to the nervous sys- 
tem and induce perspiration. A warm bath acts as a seda- 




FlG. 

thermometer. 



THE PATIENT, 89 

tive; it relieves inflammation, stupor, and delirium. The 
vessels of the surface of the body are dilated, but not so 
much as by the hot and vapor-baths ; the blood is drawn 
from the brain, the activity of which is lessened, and the 
patient falls asleep. The warm and the hot sitz-bath^ also 
the hot foot-bath, increase the circulation in the pelvic 
organs. They relieve retarded menstruation by dilating 
the arteries, so that the supply of blood is increased in 
the pelvic organs. Mustard, being a powerful stimulant, 
increases the effect of the hot bath. The amount used 
is i^ teaspoonsful to i gallon of water. 

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

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



go PRACTICAL POINTS IN NURSING. 

skin will absorb the water, and the system will get 
enough water to satisfy its demands. Water when in- 
jected will also relieve thirst. After an abdominal ope- 
ration, when nothing is given by the mouth for several 
hours, the bathing of the hands and face greatly relieves 
the extreme thirst. Hunger, which is felt in the stomach, 
may also be relieved otherwise than by the mouth. If 
nourishment be given by rectum, it will be absorbed by 
the intestines, and the hunger be alleviated to the same 
extent as though nourishment had been taken by mouth. 

Cold tub-baths are much used in the treatment of fevers 
(Brand bath) . The tub is half-filled with water at a tem- 
perature of 68° F. The patient, wrapped in a sheet, is 
gently lifted and gradually lowered into the water. While 
in the bath friction is applied to the limbs and the body, 
but not over the abdomen. Cold is applied to the head, 
which is kept raised. After the bath the patient is lifted 
out, laid in a bed on a large rubber sheet covered with 
a dry sheet, and mopped dry. Should the patient com- 
plain of persistent coldness, heat may be applied. The 
pulse and temperature must be taken before and after the 
bath. The duration of the bath is from ten to twenty 
minutes. In private houses, in the absence of an ordinary 
bath-tub, one of the several forms of portable bath-tubs 
now made will be found convenient and serviceable. 

Cold sponge-batJis are also employed for reducing the 
temperature in feven The bed is protected by a rubber 
sheet, a bath blanket, or two bath towels tucked under 
the patient. The water should be brought to the bed- 
side in a large pan or foot-tub, and should have a tem- 
perature of 65° F., which should be maintained by either 
renewing the water or adding ice. The sponging may 
be done with an old soft towel. Remove the bed covers 



THE PATIENT. 



91 



and nightgown and place a towel across the loins, leav- 
ing the rest of the patient exposed. Place an ice-cap or 
a cold compress upon the head and a hot-water bag at 
the feet. The sponge should be wet, but not dripping, 
and the sponging done with long downward sweeping 
strokes. The patient is turned on his side in order to 
permit sponging of the back. He is then rolled in a dry 
sheet and dried with light friction. 

Hot Baths. — Hot baths arid vapor-baths are given to 
produce perspiration. When the kidneys are not work- 
ing properly and the waste material is not carried away 
from the body, hot baths and vapor-baths dilate the super- 
ficial blood-vessels (those near the surface of the body), 
causing the patient to perspire profusely and a large 
amount of the waste material to be thus thrown off. If 
a tub-bath is ordered, the tub may partly be filled with 
warm water, the patient be lifted in, and then the tem- 
perature gradually increased by adding very hot water. 
At the end of fifteen minutes the patient is taken out, 
put to bed, and wrapped in blankets, which are tucked 
in very securely about the neck and body so that no air 
can enter. Cold cloths are applied to the head, and 
water is given to drink, because when there is a large 
quantity of water in the body the perspiration becomes 
much more profuse, and consequently the impurities 
thrown off are larger in amount. After the bath is com- 
pleted the blankets are removed and the patient is 
sponged with warm water or with alcohol and water. 

The Bed Bath. — When a bath is given in bed, the room 
should be sufficiently warm and all draughts must be 
avoided. Bring to the bedside two bath blankets, two 
towels, wash cloths, soap and other necessary toilet 
articles, a foot bath-tub half-filled with water at 1 10° F.. 



92 PRACTICAL POINTS IN NURSING. 

and a pitcher of hot water for use in keeping the bath up 
to the necessary temperature. The patient is drawn to 
the side of the bed. As the bedclothes are turned 
down, one of the bath blankets is unfolded so as to cover 
the patient ; the second blanket is then slipped under the 
patient, and the nightgown removed. The patient is 
then washed under the blanket, beginning with the face, 
ears, neck, and proceeding with the chest, arms, back, 
abdomen, legs, etc., each part being washed and dried 
before proceeding to the next. No part of the patient 
need be exposed. 

Hot Foot-baths. — When giving hot foot-baths the nurse 
must remember to keep the temperature of the water 
even by adding hot water. The bedclothes at the foot 
of the bed are loosened, newspapers or a rubber cloth 
is spread across to prevent the bed from getting wet, the 
patient's knees are drawn up, the feet are placed in the 
tub, and the clothing is drawn around the limbs to pre- 
vent chilling. When taken out the feet are to be wiped 
dry, and care taken that they are made comfortably warm 
either by wrapping in a blanket or applying heaters. 

Sitz-bath. — In the sitz-bath the water should be about 
110° F. It can best be given in a tub specially designed 
for the purpose, the patient sitting in the tub so that only 
the thighs and hips to the waist-line are immersed. The 
patient and tub should be surrounded by a large blanket, 
and another blanket should be wrapped around the pa- 
tient's legs and feet (Fig. 20). 

Tepid or Neutral Bath. — The tepid bath is sometimes 
ordered in cases of nervous irritability. The w^ater should 
be maintained at a temperature of 92° F. and the patient 
is kept immersed for from thirty minutes to three or four 
hours. A pillow covered with rubber is suspended at the 



THE PATIENT. 93 

head of the tub in order that the patient may be com- 
fortable. The tub is covered with a bath blanket. 

Contimcoiis Bath. — The continuous bath is one in which 
the patient is kept immersed for from several hours to 
several days. It is employed in cases of severe burns or 
foul-smelling wounds. The stationary tub in the bath- 
room must be used, a mattress, pad, or folded blanket 
being put into the bottom of the tub. A rubber-covered 




Fig. 20.— Sitz-bath (Bandler). 

pillow is adjusted at the head of the tub, and a rubber 
ring provided for the hips and also for the shoulders. 
The tub is covered with a rubber sheet, rubber side down. 
The water should come up to the neck and the required tem- 
perature should be maintained. Twice during the twenty- 
four hours the water should be drained off, the patient 
taken out to use the bed-pan, have dressing changed, etc. 
The tub should be thoroughly cleaned before refilling. 



94 PRACTICAL POINTS IN NURSING. 

Hot-vapor Bath. — To give a hot-vapor bath, a rubber 
cloth or an oilcloth and blanket are put on the bed (the 
patient 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 
table, the whole being covered with a blanket to direct 
the steam under the blankets (Fig. 21). If the bed has 




— Simple arrangement for giving a hot-vapor bath. 



a high footboard, the steam can be directed from one 
side of the foot of the bed. The nurse should guard 
against fire. The doctor will give orders as to the 
length of time the patient is to remain in the bath. He 
may order a thermometer to be placed in the bed, and 



THE PATIENT. 



95 



the steam continued until the thermometer registers 120° 
F. or above, when the steam is stopped and the patient is 
treated as after the hot bath. As the water in the kettle 
boils down it must be replaced with boiling water, not 
with hot or cold water, or the steam will stop until the 
water boils again. Careful watch must be kept over the 
patient's pulse, which can be taken at the temples. 

In the absence of an oil-stove or a spirit-lamp, very- 
hot bricks, smoothing-irons, or plates may be wrapped 
in wet flannel or cloths ; the hot bricks in contact with 
the wet cloths will make steam. The cloths must be 
placed about the patient on plates or in dishes to prevent 
wetting the bed, and care be taken not to burn the patient. 
If able to sit up, the patient can be seated on a cane-bottom 
chair, the clothing being removed, and surrounded with 
blankets or comfortables, which must be fastened from the 
neck down (Fig, 22). A kettle 
of boiling water over a spirit- 
lamp or an oil-stove, or a pan 
or pail of boiling water, is 
placed under the chair. The 
feet may be put into a pail of 
hot water to increase the effect, 
because the blood-vessels of 
the surface of the body are 
dilated, and remain so while the 
heat or vapor is continued ; in 
this way the activity of the skin 
is increased, the pores of the skin ^^^^ZZZ^^^^^^^Z^^^r^v^xs, 
are opened, and perspiration is >" giving a hot-air bath to patient in 

1111 sitting position. (Thornton). 

produced. The nurse should be 

sure that the blankets or coverings are fastened closely 

around the patient's neck and about the chair to prevent 




96 PRACTICAL POINTS IN NURSING, 

the steam escaping. Cold is applied to the head, and 
water is given to drink, for the same reason as that given 
in describing the hot baths, and the after-treatment is the 
same. 

Hot-air Bath. — The general details of giving a hot-air 
bath are the same as those for giving a hot-vapor bath, 
with the exception of the use of water to generate 
steam. The hot air is generated by means of an alcohol 
lamp or an oil lamp, and it is conveyed to the bed and 
beneath the clothes by means of an elbow of stove-pipe. 

Acid Steam-bath. — An acid steam-bath, which is a 
valuable application in rheumatism, is given by prepar- 
ing the patient in the usual manner, and placing around 
her very hot bricks wrapped in flannel which has been 
steeped in vinegar. The bath is continued for fifteen 
minutes, after which the body is wiped over with a towel 
wrung out of cold water, then thoroughly dried. 

Shower-bath. — A shower-bath is given by directing 
the water from an ordinary watering-can, a pitcher, or a 
pail elevated a few feet above the patient. To douche the 
head the patient generally lies upon her stomach, her 
head hanging over the side of the bed, or the bath may 
be given her lying in bed. The patient lies on her side 
or back ; the pillows are removed, the clothing loosened 
and pushed well down under the shoulders to prevent 
wetting; a pad is made with rubber cloth, oilcloth, 
or newspapers, by rolling the cloth at each side and 
at one end ; the pad is put under the shoulders of the 
patient, her head resting on it, and the unrolled end 
hangs in a pail. The pad will prevent the water from 
running down the patient's back and the sides of the 
pad, and will also keep the bed dry. The water is poured 
upon the patient's head from a pitcher elevated a little 



THE PATIENT. 



97 



distance above. After the douche the patient's head and 
shoulders are raised and wiped, the pad is slipped down 
into the pail, and the clothing and pillows are replaced. 

Medicated Baths. — Baths containing bran, starch, sul- 
phur, or bicarbonate of soda are used in certain skin dis- 
eases. In giving the bran bath, put a quart of bran into 
a bag and allow it to stay in the bath water for half an 
hour before the bath is given. For the starch bath dis- 
solve half a pound of starch in cold water, add two quarts 
of hot water, and pour the mixture into the bath. For the 
soda bath dissolve bicarbonate of soda in the bath in the 
proportion of eight ounces of soda for each gallon of 
water. The sidphur bath is prepared by placing four 
ounces of potassium sulphid in a porcelain tub containing 
thirty gallons of water. It is ordered for scabies and other 
skin diseases. 

Salt-water baths are given as tonics. Two or three 
pounds of sea-salt are dissolved in a tub half-full of 
water, the water being hot for the purpose of dissolving 
the salt. The patient is rubbed briskly while in the tub 
and dried by friction with towels. 

Effervescent Baths. — The Schott bath or Nauheim bath 
and the Carlsbad bath may be made from the artificially 
prepared salts obtainable in this country. These salts are 
dissolved in bath water at about 70° F. These baths are , 
given in cardiac disease and in nervous and rheumatic 
conditions. They are to be employed according to the 
physician's orders. 

Sheet-bath {Drip-sheet or Wet-sheet Rub). — The sheet- 
bath, or drip-sheet, which is frequently applied in 
nervous diseases, is generally given in the follow- 
ing way : The patient, with clothing removed, stands 
in a tub which contains enough warm water to 



98 



PRACTICAL POINTS IN NURSING. 



cover the feet to the ankles to prevent chilling 
(Fig. 23). A sheet wrung out of tepid water is 
thrown over the patient from behind, and covers the 

head and entire body. The 
patient is then gently rubbed 
(over the sheet) with both 
hands to produce friction and 
bring the blood to the sur- 
face. 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 pa- 
tient should be in the sheet. 
After being dried some physi- 
cians like the patient to be put 
to bed for a certain length of 
time, while others will leave 
orders for the patient to dress 
and go out for a short walk 
or to sit by an open window. 

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




Fig. 23. — Application of the sheet- 
bath (drip-sheet). 



THE PATIENT. . 99 

chiefly for its influence on the nervous system. In giv- 
ing it a sheet should be wrapped over the patient's chest 
and around his legs, leaving the back exposed. 

Scotch Douche. — The Scotch douche consists in the 
alternate application of hot and cold water. The hot 
application lasts from one to four minutes, and the cold 
from five to thirty seconds. The temperature of the hot 
application should begin at about 100° F. and gradually 
increased to from 110° to 120° F. 

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 cold water and wrung 
out is placed on the blankets. The patient is laid upon 
the sheet (the patient's clothing having first been re- 
moved), and every surface of the body is covered by 
pressing the folds of the sheet down between the arms, 
body, and lower extremities. The sheet is tucked well 
in at the neck and feet ; the blankets are then folded over 
and tucked evenly under the patient on both sides. The 
feet are lifted up and the corner ends of the sheets and 
blankets are tucked under them (Figs. 24 and 25). A 
wet towel or compress is applied to the head. The 
patient should be kept in the pack ten or fifteen min- 
utes. It will be found that, besides lowering the tem- 
perature, the cold pack will relieve nervousness and 
induce sound sleep. 

The shoiver-pack is given like the cold pack, except 
that when the sheet becomes warm from contact with the 
body, it is rewet by pouring on water from a sprinkler. 

Hot Pack. — The hot pack is given in the same way as 
the cold pack, with the exception that the blanket, the 



[OO 



PRACTICAL FOIXTS AV NURSING. 



sheets, or tablecloth is wrung out of boiling water by 
placing the blanket in a sheet, and pouring the boiling 




Fig. 24. — ^Applicauon of the cold pack (pressing the sneet between the patient's arm 
and body). 

water over them ; two persons, each taking an end of the 
sheet, wring in opposite directions. More coverings are 




Fig 25. — Application of the cold pack (patient completely covered, with wet towel 
the head). 



placed over the patients than in the cold pack. Should 
the nurse not have an}*thing with which to prevent the 



THE PATIENT. lOI 

mattress from getting wet, a table may be arranged \*-ith 
blanket and sheets ; in the absence of a table the floor 
near the bed may be prepared Towels, tablecloths, 
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 dr)- with soft towels, the 
clothing is put on, heat is applied if necessary, and the 
pulse and temperature are taken. Partial packs are 
compresses applied to different parts of the body, and 
covered \s-ith a flannel or a cotton bandage to prevent 
the patient's clothing becoming damp. 

Inflammation. — Blood is made up of three parts : a 
watery, almost colorless fluid, called "plasma," and 
red and white corpuscles, which give to the blood its 
rich red color ; there are more red corpuscles in the 
blood than white. The plasma contains a substance 
called " fibrin,'' which is an albuminoid, and which is the 
nourishing part of the blood. Blood in its normal con- 
dition is perfectly fluid, but when drawn from the body 
into a basin the fibrin causes the blood to coagulate or 
clot ; the corpuscles, which are hea\-ier than the plasma, 
sink to the bottom of the basin and are bound together 
by the fibrin, the whole forming a red semi-solid mass, 
covered with a clear yellowish liquid called "serum." 
The clot is the corpuscles, together \\-ith the fibrin, which 
has now left the plasma, and the serum is the plasma 
without the fibrin. It is thus seen that when the blood 
is fluid there are two parts — the plasma and corpuscles ; 
when it is clotted or coagulated there are t\vo parts — 
the serum and clot, the clot being made up of the cor- 
puscles and fibrin, the serum consisting of the plasma 
without the fibrin. 

Symptoms of Inflammation. — The four cardinal 



102 PRACTICAL POINTS IN NURSING. 

symptoms of inflammation are heat, redness, swelling, 
and pain : heat, due to abnormal tissue changes and 
probably increased heat production at the seat of the 
inflammation ; redness, to the congestion and overfiUing 
of the blood-vessels of the part; swelling, to the in- 
creased amount of blood in the part and the inflam- 
mator>' exudate ; and pain, to pressure on the end-organs 
of the sensory nerves exerted by the inflammatory 
exudate, as well as probably by the irritating proper- 
ties of the products of the inflammation. Associated 
with the local increase of temperature at the site of 
the inflamm.ation which, if superficial, we may per- 
ceive with the hand, there is an increase of the 
general body-temperature appreciable with the clinica4 
thermometer. 

Treatment of Inflammation. — If heat or cold is 
applied at the beginning of inflammation, the latter may 
subside; but should it continue, it may terminate in 
an abscess. The poultice or fomentation which is gen- 
erally ordered softens and relaxes the skin and tissues, 
dilates the blood-vessels, quickens the circulation in the 
part, so that the fresh, pure blood can pass through, and 
the tight, painful feeling caused by the blood-pressure to 
the part is relieved. Ice contracts the capillaries, and 
thus lessens the amount of blood flowing to the part, and 
pus-formation may be prevented. When pus has formed 
poultices are again ordered to bring it up to the surface, 
bringing it to a heady as it is termed. 

Bleeding. — Leeching. — Leeches are used in inflamma- 
tion when it is necessary to remove a small quantity of 
blood. The part must be washed very clean, shaved H 
necessary, and be wiped dry; the leech is taken be- 
tween the folds of a towel and appHed. If it does not 



THE PA TIE XT. IO3 

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 \^ry unpleasant sensation to 
the patient, and tend to make some patients ner\'0U3, A 
leech generally holds from i to 2 teaspoonfuls of blood, 
and when full it will drop off. If necessar}' to remove 
leeches after beino- on a certain lencrth of time, a little 
salt sprinkled on their heads 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 best — a pad of graduated compress-cloth ; or 
cold may be used — a small lump of ice. The patient must 
not be left for the night until the bleeding has stopped. 

Leeches should not be applied over an arter}', a vein, 
nor over loose cellular tissue where pressure cannot be 
applied, but, if possible, over a bony surface. It should 
also be known that the odor of tobacco, vinegar, or dis- 
infectants in the room will often prevent a leech from 



I04 PRACTICAL POINTS IN NURSING. 

biting. All cavities must be filled with cotton if leeches 
are to be applied near ; should a leech get into one, it 
can be removed with an injection of salt and water. 
Leeches must always be disposed of after being used by 
putting them into a very strong solution of salt and water 
or into dry salt, and covering the vessel tightly. The 
nurse must be sure they are dead before throwing them 
away. The American leeches are best for children ; they 
draw less blood. In case the patient is a child, the leech 
should be well covered, so that the child will not be 
frightened. 

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

For dry cupping there will be needed two or three 
tumblers, or wine-glasses, or medicine-glasses ; alcohol ; 
a candle, a lamp, or a spirit-lamp ; matches ; towels. 
The part is washed with warm water, the glasses rinsed 
with hot water, and thoroughly dried. A few drops of 
alcohol are poured into a glass and shaken around ; the 
edge of the glass is wet with the finger or is oiled, which 
prevents the fire reaching the patient's skin ; the alcohol 
is then lighted with a match, and the glass turned over 
on the part, which must be an even surface. All this is 
done very quickly. The skin is seen to rise almost im- 
mediately in the interior of the glass, and the blood is 
drawn toward the surface. To remove the glass the 
skin is pressed down with the thumb or finger. The 
air will then enter the glass, which can be taken off. 
Care must be taken to avoid getting too much alco- 
hol in the glass or getting the edges of the glass too 
hot. Further, the nurse must not forget that she is using 
fire and an inflammable drug very close to her patient, 



THE PA TIE XT. I05 

and take even* precaution to prevent the unfortunate ex- 
perience of having the bed-clothing catch fire. 

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

Fomentations. — Moist heat is applied to the bod)- in 
the form of warm or hot baths, poultices, and fomenta- 
tions (stupes). For a hot-n'att?' fomentation coarse flan- 
nel or two or three thicknesses of old blanket is the best. 
White flannel is preferable, as the d}-es o( colored flan- 
nels are apt to be poisonous. The flannel is placed in 
the middle of a towel, and both dipped in a basin of 
boiling water for a few moments, the ends of the towel 
being twisted in opposite directions until all the water is 
wrung out (Fig. 26) ; the fomentation is then carried to 
the bedside, the towel untwisted, and the flannel shaken 
out before applying, to let in the air ; it will then retain 
the heat much longer. The fomentation is covered with 
dr}- flannel or towels and a piece o^ rubber cloth (both 
flannel and rubber being larger than the fomentation), 
and a bandage is applied to keep it in position. This 
procedure will retain the heat of the fomentation longer 
and also keep the patient dry. When renewing the fo- 
mentation the fresh stupe must always be ready before 
the cool one is removed. 



io6 



PRACTICAL POINTS IN NURSING. 



Laudamini 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. 




Fig. 26. — Method of wringing out a hot fomentation (Ashton). 

Mustard foincntatioii consists of flannel wrung out 
of very hot (not boiling) water, about i pint, to which 
has been added i tablespoonful of mustard. It is pref- 
erable to make a paste of the mustard before adding it 
to the hot water ; there will thus be less danger of it 
forming lumps. Mustard must not be added to boiling 
water, or the action of the volatile oil which the mus- 



THE PATIENT. lO/ 

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 boil- 
ing water and be pressed out with a lemon-squeezer, 
which is ver}' handy for these small stupes. 

When fomentations are applied to the breast, a hole 
should be cut in the flannel for the nipple. 

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

Poultices. — A flaxseed-meal poultice is made by rap- 
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 
Xsy turn in of about i-^ inches all around the poultice. 
Another layer of muslin is put over the face of the poul- 
tice; the edges are turned well under to prevent the flax- 
seed escaping. The poultice should be rolled in a towel 
and carried on a plate to the patient. When applying 
the poultice the nurse places her hand under it, the back 
of her hand resting on the part to which the poultice is 
to be applied, and slowly removes her hand ; this will 
get the patient used to the heat, and is far better than 
suddenly putting a hot poultice on an already tender 
and sensitive skin, as repeated applications make the 
part ver)^ tender. This fact applies also to children : 
if once a child is frightened by too hot a poultice, the 



I08 PRACTICAL POIXTS IX NURSING. 

nurse will probably never be able to put on another. The 
poultice should be covered with flannel and rubber cloth 
or with newspapers, and be fastened with a bandage ; the 
heat will thus be retained and the patient kept dr>'. 

Large poultices should be changed every four hours, 
or if well covered they will last five or six hours ; the 
smaller ones must be changed every- one or two hours. 
A poultice must never be removed until a fresh one is 
made and ready to be applied ; then the old poultice is 
removed and the part wiped dry with a piece of soft cot- 
ton, for the reason that the air acts as an irritant to a 
moist surface and causes an itching sensation. A poul- 
tice once used must never be reheated : it is valueless : 
hence poultices must be freshly made each time they 
are needed. If, for some reason, the nurse has to wait 
before applying a poultice, it can be kept hot by placing 
it between two plates over a pan of boiling water ; if it 
is put in an oven, it will bake. 

When applied for the removal of a slough, the poul- 
tices must be discontinued as soon as the slough is re- 
moved, as further poulticing will prevent the healing of 
the part by making the skin too moist and flabby. 

Jacket-potiltices. — A jacket-poultice, which is a poultice 
to encircle the whole chest, is readily made by taking 
four large pieces of muslin, old linen, etc., that will reach 
from the neck to the w^aist-line, and sloped out to fit 
under the arms ; the poultice is then made in the usual 
way, one poultice being appHed 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 renew^ed until the fresh 
poultice is ready to be applied ; then the bandage is 
unpinned, the patient turned on his side, the cold 



THE PATIENT. lOQ 

poultice removed, the back wiped dn% 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 safet}'-pins. It is an expert act 
to remove a poultice or a fomentation without awaken- 
ing a sleeping patient : it can be done on almost any 
part of the body excepting the back, and even here it 
may be accomplished if the nurse has the confidence of 
her patient, who will wake up just enough to turn over 
and have the poultice renewed, and then drop off to 
sleep again. 

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

Bread Poultice. — Bread poultices are applied to very 

tender parts, and are milder than flaxseed, but they do 

not retain the heat as long. The poultice is made by 

stirring- stale bread-crumbs into boiling- water, and beat- 
fc> & ' 

ing the mixture well to remove the lumps ; then the 

water is drained off and fresh boiling water is added. 

which will remove the alum found in some bread ; the 

second water is drained off, the poultice being then 

spread and applied. 

Mustard Poultice. — A mustard poultice is made by 

adding to ver}' hot water two parts of mustard (all 

the lumps being thoroughly dissolved) to four parts 



no PRACTICAL POINTS IN NURSING. 

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, 
mixed and made in the usual way, a little additional 
charcoal being sprinkled over the surface of the poul- 
tice before applying. This poultice, which is ordered 
for wounds which have an offensive discharge, acts as 
a deodorant by absorbing the odor and promoting a 
healthy condition. Another method of making this 
poultice is to add \ an ounce of charcoal to 4 ounces 
of flaxseed meal and bread-crumbs, mixing all together 
and making the application in the ordinary way. 

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

Spice Poultice. — A spice poultice is made by placing 
in a bag equal parts of cloves, cayenne pepper, ginger, 
and cinnamon. The bag is sewed up and submerged in 
hot alcohol or in vinegar for a few moments, when it is 
wrung out and applied. Another way is to mix the 
spices with about i ounce of flour and enough hot alco- 
hol to make a paste, and to spread this between two 
layers of muslin or linen. If the skin is tender, the 



THE PATIENT. Ill 

proportions of cloves and pepper should be decreased. 
In the absence of the spices flannel may be wrung out 
of hot whisky or pure alcohol and applied to the part. 
The action of a spice poultice is that of a mild counter- 
irritant. 

Yeast Poultice. — To make a yeast poultice, which is 
used as a stimulant to slow-healing wounds, take 3 
ounces of fluid yeast and hot water, and stir in a quarter 
of a pound of either flour, oatmeal, flaxseed, or Indian 
meal. This mixture is heated, stirring it all the time 
until it is hot ; or it is set by the fire until it rises ; 
it is then spread on muslin the same as a flaxseed- 
meal poultice is prepared, and is applied while fer- 
menting. 

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

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

Digitalis Poultice. — A digitalis poultice is made by 
soaking digitalis leaves in warm water (two ounces of 
leaves to a pint of water). When the leaves are soft, the 
water is drained off and the leaves boiled. These are 
then spread as in an ordinary poultice. Digitalis poul- 
tices are applied to the loins for stimulating the action of 
the kidneys in nephritis. 

Antiseptic Poultices. — Corrosive sublimate is used for 
antiseptic poultices, the strength varying from i : 5000 to 
I : 10,000. A towel, absorbent cotton, or gauze is wrung 
out of a hot solution, applied to the part, and covered 
with a dry towel, oil-silk, or paper, and a bandage. Car- 



112 PRACTICAL POINTS IN NURSING. 

bolic acid is used for poultices in strengths varying from 
I : 60 to I : lOO. Both carbolic acid and corrosive sub- 
limate are very easily absorbed, and the general effects 
of the drugs must be watched for. Creolin, which is 
not so poisonous as the preceding, is used in strengths 
of from 2 to 5 per cent. For boric-acid poultices a 4 
per cent, solution is generally used. 

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

Ice Poultice. — An ice poultice is to relieve hemor- 
rhage, or pain due to neuralgia or inflammation, and 
is made of crushed ice, mixed with salt and sawdust, 
flaxseed, bran, or oatmeal, and sewed up tightly in 
rubber cloth, a coarse towel, or in paper, so as not 
to wet the patient and the bed. 

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

Dry Heat. — Dry heat is applied with hot bottles, 
bricks, plates, or smoothing-irons, well covered to pre- 
vent burning the patient. Hot flannel and bags filled 
with salt or bran or sand are used in aural surgery to 
relieve pain in the ear : the bags are made of old mus- 
lin or gauze, cut half-moon shape, and applied around 
the ear, never over it, as there would be danger of the 
heat causing the walls of the aural canal to swell ; this 
would bring the walls together, and if the Eustachian 



THE PATIENT. 



113 



tube were closed and there was an abscess in the mid- 
dle ear, the nurse would have a sad state of affairs. 
Two bags will be needed — one being in the oven or 
in a farina-boiler heating, the other being on the pa- 
tient. When using a hot-water bag the contained air 
must be expelled before putting in the stopper; the 
bag will then lie flat. 

Application of Cold. — Leiter Coil. — Cold is applied 
to a part to relieve pain, to relieve inflammation, to ar- 
rest hemorrhage, and as a local anesthetic to freeze 
the tissues and allow slight operations to be performed 
painlessly; also as a stimulant, as when cold water is 
dashed on the face of a fainting person. It relieves 
pain by reducing the feeling of sensation, acting as an 
anesthetic ; it relieves inflammation by contracting the 
blood-vessels, so that the amount of blood flowing to 
the inflamed part is considerably lessened and pus- 
formation is prevented. 

The Leiter coil (Figs. 27, 28), which is used to apply 
continued cold to a part, is made 
of coils of pliable metal through 
which ice-water runs continually. 
Coils are made to fit the head, 
the ear, the abdomen, and differ- 
ent parts of the body. Two long 
pieces of rubber tubing are at- 
tached to the coil; the end of 
one tube being put in a vessel 
containing ice-water ; the water 
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. 28). The ice-water pail, which should 




Fig. 27. — Leiter coil applied to 
the ear. 



114 



PRACTICAL POINTS IN NURSING. 



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 




Fig. 28. — Leiter coil applied to the head. 

in getting 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 part. Should the patient complain of the intense 



THE PATIENT. II5 

cold, a piece of compress first put between the part and 
the coil will make it more bearable ; this applies also to 
ice-bags. 

Ice-bags. — Ice-bags must carefully be watched : if the 
nurse has only one ice-bag, ice-cold compresses must be 
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 much harm. 
When applying an ice-bag to the back or to any part 




Fig. 29. — Incorrect {a) and correct method (/') of applying an ice-bag- (Ashton). 
Note that in illustration a the bag is distended with air and does not adjust itself to the 
surface of the body. In illustration b the air has been expelled before screwing on the 
cap and the bag hugs the parts closely. 

of the body upon which the bag will lie, two things 
must be remembered : first, that there is air in the bag, 
and second, that the heat of the part to which it is ap- 
plied very rapidly melts the ice in the upper portion of 
the bag, the water becomes warm, and the ice lying at 
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. 



Il6 PRACTICAL POINTS IN NURSING, 

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

An ice-cap is a double rubber cap into which crushed 
ice is placed through an aperture at the top. It is pro- 
vided with strings for fastening it under the chin. 

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

Counter-irritation. — Counter-irritants are substances 
used to influence reflexly a part more or less removed 
from the point of application of the counter-irritant. 
They act probably by exciting the sensory nerve-end- 
ings in the skin, whence, through reflex action, vascular, 
nutritional, and secretory changes are effected in adjoin- 
ing and subjacent parts of the body. For instance, a 
deep-seated inflammation may be relieved by the dilata- 
tion of the superficial blood-vessels and the flow of blood 
to the site of the counter-irritation, with a consequent 
lessening of the congestion, pain, and swelling of the 
inflamed area. There are three classes of counter-irri- 
tants : Those of the first class are known as rubefacieJits 
— substances that produce temporary redness and con- 
gestion of the skin by distending the small superficial 
blood-vessels. Mustard poultices, mustard fomentations, 
mustard plasters, turpentine stupes, hot water, friction, 
and the like, are examples of counter-irritants of this 
class. Counter-irritants of the second class are known 
as vesicants or blisters. They cause marked inflamma- 
tion of the skin with the exudation of serum from the 



THE PATIENT. II7 

blood-vessels between the epidermis and the true skin. 
lodin and cantharides (Spanish-fly blister) are examples 
of this class of counter-irritants. In many respects no 
sharp dividing line can be drawn between counter-irri- 
tants of the first and of the second class — prolonged 
action of those of the first class may be followed by 
vesication or blistering, whereas a mild application of 
cantharides, but especially of iodin, may be followed by 
only a more or less temporary congestion of the skin. 
Counter-irritants of the third class are known as pustu- 
lants — substances that affect certain isolated parts of the 
skin, such as the orifices of the sweat glands, and give 
rise to the formation of pustules. Croton oil is a well- 
known example of a counter-irritant of this class. 

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

The reader may have had an inflamed finger, and have 
noticed that when the hand was hanging down by the 
side the throbbing and pain were increased ; this was due 
to the blood rushing down to the hand, thus putting 



Il8 PRACTICAL POINTS IN NURSING. 

more pressure upon the finger ; but on raising the hand 
the pain .was relieved, because the pressure of blood 
became less. It is for this reason that rest is ordered 
for inflammation. The part is kept quiet and elevated ; 
the arterial blood is thus prevented from rushing to the 
part, and the venous blood can better return to the 
heart. 

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

Tincture of lodin. — 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 



THE PATIENT. 



I I( 



be put into the bottle after being used on the patient. 
There should be a separate brush for each patient. 

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

Cantharis Blistering. — A blister is raised with either 
cantharidal plaster (Spanish-fly), cantharidal cerate (blis- 
tering cerate), or cantharidal collodion. The part must 
be washed, and shaved if necessary, and be wiped per- 
fectly dry ; the plaster is cut the desired size and shape 




Fig. 30.— Shapes of plasters: a, for left ear; b, for right ear; c, for chest; d, 
for shoulder; e, for back; f, for side; g, pattern for breast-plate; h, plaster for 
breast. 



(Fig. 30) and applied. If the cerate is used, it should be 
spread on a piece .of cotton and be kept in place with a 
bandage. If adhesive plaster is used to keep either of 
these plasters in place, there will be no room for the 
blister to rise, and it will cause a dragging pain. Before 
applying the cantharidal collodion the parts to be blis- 



120 PRACTICAL POINTS IN NURSING. 

tered must be outlined with vaselin or with oil, which will 
prevent spreading of the blistering solution. The collo- 
dion, which is painted on with a swab or a brush, causes 
an itching sensation when first applied ; patients must be 
told of this to guard against scratching. 

The action of the cantharis must be watched. It is 
a powerful irritant and affects the kidneys, and some- 
times causes painful urination or suppression of urine. 
For children and very weak persons the plaster should 
be kept on just long enough to start the blister, then a 
poultice be applied to make the blister rise, otherwise a 
slough may be formed. It generally takes from four to 
eight hours for a blister to rise (collodion acts more 
Quickly). If at the end of that time the blister has not 
risen, the application of a flaxseed poultice will hasten 
this result. 

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

Chloroform Blistering, — A ready way to produce a 



THE PATIENT. 



121 



blister is to pour a few drops of chloroform or of strong 
ammonia into a watch-crystal, which is then placed over 
the part ; the blister will rapidly rise. 

A blister must not be produced over a bony part, be- 
cause here the circulation is less active, and a slough 
may be the result. 

Guaiacol. — A mixture of guaiacol and glycerin is ap- 
plied very thin by means of a camel's-hair brush. The 
part should then be covered with absorbent cotton or 
gauze and a bandage applied. 




Fig. 31. — Paquelin's cauterj-. Note that the benzene is contained in the handle of the 
apparatus (W. E. Ashton). 

Ca2iterizatio7i. — Cauterization is the scarring of the 
skin by heated metal. It is usually performed by the 
Paquelin cautery, an instrument shown in Fig. 31. The 
instrument is used by the doctor, never by the nurse. 
The nurse, however, prepares the site for the application 
by scrubbing the skin with soapy water, rinsing with 
clean water, and applying carbolic acid or boracic acid 
solution. 

Ironi?ig. — Counter-irritation for relief of pain in lum- 
bago, etc., is done by a heated flat-iron, a thick paper 



122 PRACTICAL POINTS IN NURSING. 

being placed over the part and the iron passed lightly 
over this until the skin becomes reddened. 

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

Repose of touch should be cultivated, and work be 
done from the wrists, or the movements will be jerky 
instead of being even. Tender parts should be gone 



THE PATIENT. 1 23 

lightly over at first : later on more force may be used. 
It will be found, if done skilfully (and skill can only 
be acquired by constant practice), that massage is a 
nerve sedative, relieves neuralgia and also some chronic 
affections. In order that the student may have a perfect 
knowledge of massage and its application, it is absolutely 
necessary that she should first take a complete course in 
anatomy, and familiarize herself with the bones, muscles, 
and organs of the body, their form and location. 

Liniments. — A liniment is a thin, liquid ointment, con- 
sisting of a solution of a medicinal substance in an oily 
excipient. It is intended for external use, to relieve pain, 
or to produce local stimulation. It must be applied to 
the skin with friction until the part is entirely dry. A 
cloth must not be used, or the effect will not be so 
good. 

Lotions. — A lotion is a medicinal solution intended 
for external use. It may be evaporating or non-evap- 
orating ; it is used externally for cooling purposes and 
for the relief of pain. Where evaporating lotions, such 
as alcohol, vinegar, or camphor, are used, one single 
thickness of cotton, saturated with the selected lotion, is 
applied, and left uncovered. Lotions must be changed 
often, and not be allowed to become warm or dry. Non- 
evaporating lotions are applied with two or three thick- 
nesses of compress wrung out of the ordered solution 
and covered with rubber tissue or cloth, and a bandage 
to keep it in position. 

Gargles, Sprays, etc. — To gargle the throat the solu- 
tion is taken into the mouth, the head being thrown back 
and moved from side to side. The fluid in this way is 
brought in contact with the back part and sides of the 



124 PRACTICAL POINTS IN NURSING. 

throat, and is more beneficial than by causing the fluid to 
bubble up in the throat. If the gargle is an acid, the 
mouth must afterward be rinsed with water, so that the 
teeth will not be injured. Sprays are much better than 
gargles when the throat is ulcerated ; a patient can seldom 
gargle thoroughly. A spray will reach all the parts. 
When spraying or painting the throat the nurse should 
stand a little to one side, so that the patient will not 
cough in her face. When painting, the rule is to paint 
from down up, because the patient will always gag ; by 
beginning to paint at the bottom of the throat one can 
paint upward, bringing with one sweep the brush or 
cotton-stick out of the mouth. A roll of paper answers 
nicely for blowing powder into the throat ; the paper roll 
is placed back in the throat with the powder inside, and 
is blown in by the nurse or is inspired by the patient 
For esthetic and other reasons, however, a powder-blowei! 
is much to be preferred. 

All instruments used in the throat must be very clean 
and warm, also be free from odor, so as not to nauseate 
the patient. The back part of the throat is connected 
with the Eustachian tube, which is about i^ inches long, 
and passes from the ear to the back of the throat, and 
which in order to hear perfectly should be kept open ; 
but when one has a cold in the throat the mucous mem- 
brane which lines the back of the throat and this little 
tube is swollen, and a temporary deafness results. 
Gargling the throat with very hot water is very bene- 
ficial when the soreness is first felt, and will very often 
prevent its extension. The 7tose also calls for special 
attention; its passages must be kept open and clean. 
We breathe through the nose, and by so doing the cold 
air becomes warmed in passing through the nasal cavities 



THE PATIENT. I 25 

to the lungs, and dry air is moistened ; but if we breathe 
through the mouth, as when the nostrils are inflamed, 
the cold air goes directly to the lungs, the mouth and 
throat become dry, and the throat becomes sore. Certain 
diseases of the nose call for special treatment and special 
directions. When spraying the nose it should be sprayed 
down on a level with the roof of the mouth, and not up 
to the roof of the nose; this mistake is often made. 
The patient must be instructed to close the mouth and 
draw the fluid into the throat, then to cough it out ; if 
this is not done, the fluid will run out the nose as the 
spray is applied. 

Bye-drops. — To put a drop in the eye the patient 
should look up, the lower lid be drawn down, and the 
drop be put in with a dropper or a quill on the center of 
the lower lid ; it will then flow over the surface of the 
eye to the duct near the nose. A mistake often made is 
that of putting drops in the eye in the inner corner, near 
the nose. 

The interior of the eyelids and the front of the eyeball 
are covered with a mucous membrane called the " con- 
junctiva," and in the orbit on the outer side of the eye- 
ball is a gland called the " lachrymal gland," which 
secretes the tears and keeps the eye moist. The tears 
pass over the surface of the eyeball, and those not used 
are carried off into the nose by a small canal called the 
" lachrymal duct," which passes down from the orbit into 
the nose. This secretion of tears is going on day and night, 
but we do not notice it until either the conjunctiva is irri- 
tated by a foreign body in the eye or by strong vapors, or 
when we are affected by strong emotional feelings of sor- 
row or of happiness, when the secretion of tears by the 
lachrymal gland exceeds the drainage-power of the duct 



126 PRACTICAL POINTS IN NURSING. 

and they overflow on the face. When we try not to cry 
the tears pass down through the duct to the nose, and 
pass out through the nose ; then we get the " blowing of 
the nose," commonly thus called when people try not to 
cry. So we see that the gland which secretes the tears 
is at the outer part of the eye, and the duct which re 
moves them from the eye is in the inner corner. It 
must now be clear why a drop should be put in the cen- 
tre of the lower lid, so that the solution will pass over 
the surface of the eye to the duct next the nose. 




Fig. 32.— Method of syringing the eye (after McCombs). 

Ointment should also be applied in the center of the 
lower lid, either with a small spatula used for the pur- 
pose, with the handle of a small teaspoon, or with any- 
thing that has a smooth, flat, narrow surface. 

A medicine-dropper, or soft-rubber ear-syringe, may 
be used to syiinge the eye, which must be done from the 
inner to the outer corner (Fig. 32). 



THE PATIENT. 



27 



Syringing the ear must not be done with too much 
force or the drum-membrane may be ruptured. A foun- 
tain syringe (Fig. 33) is the 
best to use, as with it we get 
a continuous flow, and injec- 
tion of air into the ear is 
prevented ; still, an ordinary 
Davidson syringe will answer 
if the nurse has not a fountain 
or a hard-rubber syringe. 

The necessary things for syringing the ear are a foun- 
tain or a hard- rubber syringe, a bowl for the water to be 
used (unless the nurse uses a fountain syringe), a bowl for 




Fig. 33. — Fountain syringe. 




Fig. 34. — Method of syringing ear with fountain syringe. The lower end of bag should 
be above the level of the auditory canal (after McCombs). 

the return flow, a towel for the patient's shoulders, and 
one for the assistant. The syringe is filled, the air ex- 
pelled, and the tip of the ear is pulled backward and 



128 PRACTICAL POINTS IN NURSING. 

upward to straighten the canal, which is then syringed 
gently. The patient may hold the small bowl beneath 
the ear, but if not able an assistant will be necessary. 
Warm water is used for ordinary syringing. 

For an ear-douche to relieve inflammation the tempera- 
ture of the water is about ioo° F. The douche is continued 
for fifteen or twenty minutes, unless the patient should 
complain of dizziness, which is often due to the water 
being directed to one spot or to too much force being 
used. When syringing for the removal of discharge, the 
nozzle of the syringe should be moved around, directing 
the stream against the sides of the auditory canal and 
not in the central axis. This procedure is also necessary 
when syringing to remove a hard collection of wax. By 
syringing thus the water will pass between the sides of 
the canal and the plug of wax, and, reaching the space 
behind, will bring out the wax with the return current. 

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

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



THE PATIENT. 1 29 

No liquids should be dropped into the ear without 
direct orders from a specialist. Laudanum, oil, glycerin, 
lard, and other applications that we hear of as ear-drops 
are all injurious, though they may alleviate the pain for 
the instant. Pain should be relieved by heat until an 
aural specialist can be consulted. The nurse is justified 
in putting oil into the ear only when it is invaded by an 
insect ; then the oil must be warmed and poured in, and 
the insect will float to the top and fall out. li no oil is 
at hand, warm water will do — the insect will thus be 
drowned. Beans and other things likely to swell with 
water must not be interfered with, but a surgeon should 
at once be consulted. The ears must not be picked with 
pins; the drum-membrane is often perforated through 
this habit. Before washing the patient's head it is always 
well to put cotton in the ears, the ends of the pledgets 
having first been dipped in oil or in vaselin. If cotton 
alone is used, the water will soak through ; but as water 
and oil do not mix, the water cannot get beyond the oil 
into the ears. 

II. NURSING IN OBSTETRIC CASES. 

Pregnancy: Signs and Symptoms. — The probable 
signs of pregnancy are — stoppage of menstruation, morn- 
ing sickness (though with some women this is entirely 
absent or may come on regularly every evening), en- 
largement of the abdomen at the end of the third month, 
a sense of weight and fulness in the breasts, and darken- 
ing of the skin around the nipples. Still, these symp- 
toms are uncertain. Nurses having experience in gyne- 
cologic wards know that the abdomen may be en- 
larged by a tumor, and that the blue color of the vagina, 
due to dilatation of the veins from congestion of the cir- 



130 PRACTICAL POINTS IM NURSING. 

culation, may be caused also by the presence of a tumor. 
Menstruation may cease from cold and from anemia ; or 
a change of climate and of living will many times stop 
the menstrual flow for a few months, as will also an 
attack of any of the acute fevers, until the nervous sys- 
tem .regains its normal condition. In some womb dis- 
eases the breasts have increased in size and contained 
milk, and the nausea and vomiting may be caused by 
some disease of the stomach. None of these symptoms, 
taken singly, is a positive sign of pregnancy. 

The positive signs of pregnancy are the fetal pulse, 
which can be heard about the sixth month, and the fetal 
movements, which are felt between the fourth and fifth 
months. There are other signs, but they belong to the 
obstetrician. 

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

Conception and Date of Confinement. — Conception 
may take place just before or very soon after a menstru- 
ation. We begin to count the probable date of confine- 
ment from the last menstruation. The way to date is to 
find out on what day the last menstruation began, count 
forward nine months or three months backward, and add 
seven days, which is the probable duration of the men- 
struation ; when the date of the last menstruation is 
uncertain, add four and a half months to the date of 
quickening, which will give the probable date of confine- 
ment. There is always a possibility of a mistake, because 
conception may take place just before or soon after a men- 
strual period ; that is, if conception did not occur soon 
after a menstruation, it probably took place just before 
the date of the next occurring period. 



THE PATIENT. 



131 



As pregnancy advances the abdomen becomes larger 
(Fig. 35). About the fourth month the abdomen begins 
to enlarge, and the top of the womb can be felt above the 
brim of the pelvis ; at the fifth month it is halfway to the 




Fig. 35. — Abdominal enlargement of pregnancy, showing varying heights of the 
fundus marked in weeks (Schaefer). 



navel ; at the sixth month it is on a level with the 
navel ; at the seventh month it is between the navel and 
the point of the breast-bone ; at the eighth month it 
reaches the sternum ; and at the ninth month it gradually 



132 PRACTICAL POINTS IN NURSING, 

sinks into the abdomen, the pressure upon the organs 
within the chest is removed, and the woman breathes 
easier, though pressure at the same time is now put 
upon 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 Fetus. — The fetus receives its nourishment from 
the mother through the blood-vessels of the placenta, 
which, when fully formed, consists of two portions, a 
fetal and maternal. These two portions are connected 
so closely that waste material from the child is carried 
to the mother, and nourishment from the mother is car- 
ried to the child very easily without there being any 
direct blood-communication between the mother and 
fetus ; the blood is carried from the placenta to the fetus 
by the umbilical vein, and the two umbilical arteries carry 
the waste substance from the fetus to the mother. The 
umbilical cord is connected with the navel of the fetus 
and the placenta. When fully developed the cord is 
about 20 inches long, and is covered with a gelatinous 
substance called " Wharton's jelly," which acts as a pro- 
tective. The cord contains two arteries and one vein. 
The arteries twist around the vein, which carries the 
blood from the placenta to the fetus, and it is returned 
by the arteries. After a while the fetus is enclosed in a 
membrane which gradually fills with what is called the 
"amniotic fluid," which is water containing albumin and 
certain salts. In this bag of waters the child floats, it 
being thus preserved from all injury. The bag of waters 
at the beginning of labor acts also as a wedge to dilate 
the mouth of the womb, and usually w^hen it is fully 
dilated the membranes give way and the waters escape. 

Fetal Movements. — The movements of the fetus are 



THE PATIENT. I 33 

felt between the fourth and the fifth month, and they gen- 
erally occur two weeks later in a woman who has been 
pregnant before. The supposition that the child — or 
" fetus," as it is called while in the womb — has no life 
until between the fourth and the fifth month, when its 
movements are felt by the mother, is entirely wrong. 
The child is living from the moment of conception, but 
its movements are not felt because, up to the first four 
and a half months, the womb, which is not sensitive, is 
not large enough to come in contact with the inner sur- 
face of the abdominal wall, which is fully endowed with 
sensibility. 

Disorders of Pregnancy. — Some of the disorders 
which may arise during pregnancy are — nausea, vomit- 
ing, constipation, diarrhea, leucorrhea, retention or in- 
continence of urine, salivation, swelling of the veins of 
the legs and thighs, swelling of the external parts, heart- 
burn, neuralgia, etc. The constipation is due to the 
pressure of the enlarged uterus on the intestines. The di- 
arrhea may be caused by the constipation, as there is then 
the packed feces. Pressure on the bladder is the cause 
of the constant desire to urinate, as the pressure inter- 
feres with the distention of the bladder and there is little 
room for the urine to accumulate. The pressure of the 
enlarged womb on the nerves of the pelvis is said by 
some to be the cause of the nausea and v^omiting. This 
disorder disappears about the fourth month, when the 
womb rises out of the pelvis into the abdomen, but may 
appear again during the last month, and then is probably 
due to renal inadequacy. The swelling of the Hmbs and 
external parts is due to the amount of pressure put upon 
some of the blood-vessels, thus causing distention of 
other blood-vessels. 



134 PRACTICAL POINTS IN NURSING. 

Convulsions during pregnancy may be hysteric or epi- 
leptic, though they are generally uremic, caused by a 
disease of the kidneys, in consequence of which the 
waste material of the body, ordinarily disposed of by them, 
is 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 premonitory symptoms which announce the convul- 
sions in the majority of cases are — edema of the face^ 
feet, and ankles, dull headache, dimness of vision, bright 
flashes before the eyes, ringing in the ears, a confused 
condition of the mind, and the presence of albumin in 
the urine. The convulsions of pregnancy are treated in 
the same manner as uremic convulsions. 

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

Termination of Pregnancy and Nurse's Preparations 
for the Confinement. — We will now suppose that a nurse 
has been called to a confinement case. What is the first 
thing to be done ? She should find out if the patient is 
really in labor — if the pains are true pains or false pains. 
\i false, the pains will be irregular and short; if true, 
they will be regular, first felt in the lower part of the 
back, and gradually increase to a certain intensity, then 
gradually subside. If the pains are the true labor-pains, 
the nurse should ask the patient at what time they 
began. The physician in charge of the' case should then 
be notified, as well as subsequently, as he may direct. 



THE PATIENT. 135 

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

A full bath is to be given if possible ; if there is not 
time for the bath, the external parts should be washed 
thoroughly. The hair of the patient should be 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 the Bed. — The nurse should prepare the 
bed as follows : A large rubber sheet should be tightly 
pinned over the mattress, and covered with a sheet and 
a draw-sheet tightly tucked under the mattress ; over 
these should be placed another rubber sheet and a draw- 
sheet, which must be tightly pinned at the four corners, 
so as not to be pulled out of place. If rubber sheets are 
not at hand, one may use newspapers, which can be 
burned afterward. The patient's napkins should be 
soaked in a solution (i : looo) of corrosive sublimate, 
and when dry folded in a towel and so kept until needed. 

Accessory Preparation. — Antiseptic pads can be made 
with cheese-cloth and common cotton-wool. The 
cheese-cloth is to be washed with soap and water, 
boiled, dried, and then cut it into as many pieces as the 
required number of pads (the number should be about 
thirty), each piece being about 1 6 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 



136 PRACTICAL POINTS IN NURSING. 

long, SO that when the pad is made it will be 4 inches 
wide and 16 inches long. These pads are soaked thor- 
oughly in corrosive sublimate (i : 1000), then dried, and 
kept in an antiseptic towel. When the pads are applied 
they should be pinned to the abdominal bandage back 
and front ; when removed they must be burned. Prepa- 
rations should also be made for sterilizing the doctor's 
aprons and instruments. Plenty of hot water should be 
at hand. 

Other things that will be needed are — a pail, a fountain 
or Davidson syringe, safety-pins, scissors, a glass cath- 
eter, vaselin, stimulants, a fan, ergot (fluid extract), cor- 
rosive tablets, carbolic acid (i : 20) ; a binder of stout 
cotton about \\ yards long and from 16 to 18 inches 
wide ; a basket for the baby if there is no crib (a clothes- 
basket, even a foot-tub, has been brought into use, Hned 
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- 



THE PATIENT, 1 37 

ger-nails, by clothing, instruments, or anything that is 
used about the patient that is not perfectly clean and 
sterilized. Hands must be washed in antiseptic solution 
each time anything is done for the patient before and 
after delivery. After birth the womb is like one large 
wound ; even the most minute portion of septic material 
will be absorbed, and may cost the patient her life. 

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

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

Stages of Normal Labor. — Labor is divided into 
three stages : First stage, from the beginning of the pains 
to the dilatation of the mouth of the womb ; second stage, 
from the complete dilatation of the mouth of the womb 
to the birth of the child ; third stage, from the birth of 
the child to the birth of the placenta. 

First Stage. — The pains, which are caused by the con-, 
traction of the muscles of the womb, are very severe, 
and they increase in intensity and duration as labor ad- 
vances. The first sign of labor is pain in the lower part 



138 PRACTICAL POINTS IN NURSING. 

of the back, which pain gradually comes forward to the 
front of the abdomen, extends down the thighs, and is 
of a bearing-down character. The pain at first is slight, 
but it increases until it reaches its height, then gradu- 
ally disappears. When the pain is at its height the 
mouth of the womb is stretched, and as the pain passes 
off it closes and the membranes recede. These pains at 
first occur regularly, about every twenty minutes or half 
hour, and this regularity helps to distinguish true labor- 
pains from colic-pains, which are irregular. During the 
dilatation the mouth of the womb may be very slightly 
torn and the discharge of mucus be slightly tinged with 
blood ; this is called the " show," and the physician must 
at once be notified. When the dilatation has reached a 
certain extent the bag of waters breaks. In this, the first 
stage, the patient may sit down or walk about, but she 
must be instructed not to bear down. 

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

The stage of expulsion now begins: the pains change; 
they are stronger, are more frequent, and force the child 
out of the womb through the vagina. At the end of 
each pain the head of the child goes back, or " retreats," 



THE PATIENT. 1 39 

and the patient may think that something is wrong ; but 
finally the head reaches a point where it does not retreat, 
and at last slips out. There is then a little rest, during 
which time the nurse can wipe the eyes of the child with 
a cloth wet with sterilized (boiled) water and cleanse 
its mouth. Another severe pain now comes, and th^- 
shoulders and the rest of the body are born, accom- 
panied with a rush of amniotic fluid and of blood 
from the placenta. This discharge may cause faintness 
due to the blood leaving the brain, for, the pressure upon 
the abdominal organs being removed, the blood-vessels 
are dilated, and the blood rushes to them ; there may 
also be a chill, owing to a certain amount of nervous re- 
action. The womb now contracts on the placenta, which 
accomplishes its separation, thus shutting off the supply 
of oxygen to the child. This causes the child to gasp, 
and respiration is started. 

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

Third Stage. — After the birth of the child there is 
usually a rest of about fifteen or twenty minutes, when 
the pains begin again, and the after-birth and membranes 
are expelled This is the third stage. When the child 
is born the womb contracts, and it can be felt like a 
round hard ball. The physician may ask the nurse to 
hold the womb; this is best done with the left hand. 
The abdomen is depressed so as to allow the womb to 
rest in the palm of the operator's hand, the fingers being 
then behind and the thumb in front of the womb ; in 
this way the womb is firmly grasped. After the phy- 
sician has tied and cut the cord he generally holds the 



140 PRACTICAL POINTS IN NURSING. 

womb until the placenta comes away ; after the bed has 
been cleaned the pad and binder are applied. If the baby 
is all right, it is wrapped in the receiving blanket and put 
away and the nurse attends to the mother. 

After all is over the womb gradually decreases in 
size and returns to its normal condition (involution), 
which usually takes from six to twelve weeks ; but 
when involution is not complete, when the womb re- 
mains large and does not return to its normal shape, this 
condition is called subinvolution^ which may result in 
inflammation of the lining membrane of the womb. 

Duration of Labor. — The duration of an ordinary 
normal labor is from seventeen to twenty-four hours for 
a first child, but is less long for a second. The pains, 
as a rule, begin in the evening, the larger number of 
births taking place during the small hours of the 
morning. 

Conduct of Normal Labor. — Now, one may not al- 
ways get a favorable state of affairs. The baby may be 
born before the physician comes, 
which accident is not uncommon 
with women who have borne chil- 
dren before. 

The patient should be put to 
bed on her left side ; the perineum 
should be supported to prevent 
the head emerging too suddenly, 
sJ„":rfHrr.rltV;t which support win relievethe strain 
gers of one hand against the upon the pcrittcum and Icssen the 
*^"'^" ' danger of its being torn. This reg- 

ulation of the expulsion is done by the nurse standing 
behind the patient at the left side of the bed and laying 
her right hand on the external genitals, which will bring 




THE PATIENT. I4I 

the fingers on the left, the thumb on the right side, and the 
palm of the hand pressed against the perineum (Fig. 36). 
The head is to be pushed rather upward, so that the 
chin of the child will rest against its chest and relieve 
the strain on the perineum. When the head is born 
the nurse should see if the cord is wound around 
the child's neck ; if so, it should be slipped over the 
head from behind ; if this is not done quickly, the cir- 
culation of blood in the cord will stop and the child 
will die. 

If there is a membrane over the child's face, 
it must be torn immediately or the child will suf- 
focate. This is known as being born with a veil 
or "caul," which is due to the child being born with 
high rupture of the membranes. The eyes, nose, 
and mouth of the child must be cleared of mucus. 
The perineum must again be supported when the 
shoulders are being born, because it is stretched more 
than when the head passes through, and there is 
more danger of its being torn. Moreover, if it was 
slightly torn when the head was born, the tear may be 
made considerably larger. If the child does not cry 
and its mouth and nose are perfectly clear, it may be held 
by the ankles, head down, and a few sharp spats be given 
on the soles of the feet; this procedure may relieve the 
air-passages of mucus and give the shock which will 
start respiration. If this does not make it cry, then the 
cord may be tied tightly in two places — the first liga- 
ture being \\ inches from the child, and the second 
\\ inches from the first — and cut between the two liga- 
tures. The child should then be put first into hot and 
then into cold water, or artificial respiration may be prac- 
tised by placing the child upon the bed with its back 



142 



PRACTICAL POINTS IN NURSING. 



slightly arched by means of a folded towel or sheet. 
The nurse grasps a forearm in each hand, presses the 
arms lightly against the lower part of the chest to effect 
expiration, the arms are then slowly lifted above the head, 
which movement causes inspira- 
tion by raising the ribs and ex- 
panding the chest. These move- 
ments should be repeated ten 
times a minute. This is Sylves- 
ter's method, but it is of little value 
here. 

Schultze's method is very good. 
The child is held by the upper arms and shoulders, with 
its back to the nurse. It is then swung upward with the 
head downward above the nurse's head ; the child is held 
in this position while the nurse counts five, when the first 
position is resumed (Fig. 38). The first movement tends 




Fig. 37.— Diagram showing li 
gation of the cord (Wilson). 




Fig. 38. — Schultze's method of artificial respiration (Hirst). 



to elevate 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 



THE PATIENT. 1 43 

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

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

The soiled sheet and rubber cloth are removed by 
folding one side as closely as possible up to the back 
of the patient ; the binder is arranged on the bed, the 
farther end being rolled up and placed next the patient, 
so that when she is turned over on the other side she 
rests on the clean permanent bed and the binder. The 
soiled sheet and rubber are removed and the binder 
straightened out. The nurse should keep up the con- 
tractions of the womb for about an hour longer, when 
it will be safe to pin the binder tightly about the hips, 
beginning at the bottom and working upward. The pin- 



144 PRACTICAL POINTS IN NURSING. 

ning should be done evenly, the pins being about \\ 
inches apart. The binder may be fitted to the waist by 
taking in darts at the sides, and perineal straps may be 
applied to prevent it slipping up. The binder should 
extend from the hips to the waist-line. An antiseptic 
napkin should be laid over the genitals. The patient 
may be given a drink of milk or a cup of weak tea, 
which is generally preferred; when everything 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. 

Management of the Puerperium. — The room should 
be kept bright and cheerful, the air fresh and pure. The 
nurse should keep a record of the temperature, pulse, 
respirations, sleep, amount of diet the patient takes, and 
the condition of the bladder, bowels, and lochia. 

The length of time that the patient remains in bed 
depends upon the amount of progress made and whether 
or not there is any blood in the lochia. The sitting up 
in bed will be gradual. Some physicians have the 
patient propped up in bed on the third day, though as a 
rule she does not leave her bed until the second week. 
The return to the customary mode of living is gradual. 
The period of lying-in is usually about four weeks. The 
patient must not be allowed to sit up in bed without the 
physician's orders, because sitting up or excitement of 
any kind may bring on a hemorrhage. 

Catheterization. — The nurse should see that the patient 
urinates six hours after labor; she should not wait for 
the patient to express a desire to do so, but should 
remind her. There may at first be a little difficulty in 
urinating, but before passing the catheter the nurse 
ahould try any of the means usually resorted to in in- 



THE PATIENT. 



H5 



ducing the urine to flow — hot water in the bed-pan, the 
sound of running water from a faucet or a pitcher, or 
allowed to run down over the parts (cold water succeeds 
with some women), or hot cloths placed over the lower 
part of the abdomen ; or the patient may turn over on 
her hands and knees : if these means fail, the nurse must 
then resort to the catheter. (See p. 73). 

Lochia. — The lochia are the discharges that follow 
childbirth ; for the first few days they are a bright red, 
which gradually becomes paler and paler until they are 
almost transparent, and finally cease. The lochia may 
last two weeks or longer, the length of time differing 
with each patient. Any odor or departure from the 
normal must be promptly reported. 

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

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

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

Temperature and Pulse. — The temperature may rise 
slightly during the first twenty-four hours after child- 
birth ; then it should descend to normal, and so remain. 
A rise of temperature after childbirth may be due to 

constipation, exhaustion after labor, nervousness, or 
10 



146 PRACTICAL POINTS IN NURSING. 

threatened abscess of the breasts ; or it may indicate 
sepsis. Should sepsis be indicated, other symptoms, 
such as decrease of the lochia, offensive odor from the 
discharges, and distention of the abdomen, will be pres- 
ent. The pulse may, on the contrary, be found very 
low, sometimes as low as 50 beats. A low pulse is not 
at all serious, but must be noted. 

After-pains are caused by the womb contracting, and 
they generally last four or five days. Nursing will often 
produce severe pains, because of the sympathetic rela- 
tion between the breast and uterus, and by putting the 
child to the breast involution is hastened. 

Lactation. — The child must be put to the breast six 
or eight hours after birth, after the mother has rested. 
The milk does not generally appear until the third day 
after delivery, but the breast contains a secretion called 
" colostrum," which acts as a laxative and clears the 
bowels of the child ; putting the child to the breast early 
also teaches him to nurse and assists in forming the nip- 
ples. The breasts must be nursed alternately regularly 
every two hours during the day, and the nipples must be 
washed before and after each nursing with water to which 
a little borax has been added. If the nipples are soft 
and tender, they may be hardened by bathing them with 
equal parts of alcohol and water. 

Care of the Breasts. — If the breasts are sore and pain- 
ful, this condition must be reported to the physician : in 
the mean time the nurse may rub the breast with warm 
sweet oil and apply gentle massage, massaging from the 
base toward the nipple. The pulse and temperature 
should be taken. A cracked nipple must promptly be 
attended to, the child nursing from the other breast ; the 
nipple must be kept perfectly clean ; the milk must be 



THE PATIENT. 147 

drawn from the sore-nipple breast with a breast-pump 
(Fig. 39), and the breast massaged gently to relieve the 
tight feeling. 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 composi- 
tion. Alcohol, such as beer or porter, does not make 




Fig. 39. — Breast-pump. 

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 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 (Fig. 40). 
This bandage holds up the breasts. The muslin compress 
is arranged in exactly the same way, though only two 
pieces are needed (each folded and about 6 inches wide), 
one small piece to pass under the back, the second piece 



148 PRACTICAL POINTS IN NURSING. 

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




Fig. 40. — The Y-bandage applied (Boston Lying-in Hospital). 

Pathology of the Puerperium. — Some of the com- 
pHcations which may arise after childbirth are hemor- 
rhage, puerperal insanity, eclampsia, and phlegmasia 
dolens. 

Hemorrhages. — Hemorrhage after childbirth is called 



THE PATIENT. 



149 



" post-partum hemorrhage," and is due to the womb re- 
laxing. The symptoms of post-partum hemorrhage are 
restlessness or tossing of the patient in bed, faintness, 
pallor, a demand for air, a sense of dizziness, shortness 
of breath, and a weak, rapid pulse. The restlessness 
alone should put the nurse on her guard and lead her 
to investigate. The nurse should put one hand on the 
abdomen and feel for the womb by pressing on the ab- 
domen ; if the womb is found, grasp and squeeze it hard, 
squeezing out the clots ; the womb may not be found, 
owing to its relaxed condition, or it may be found large 
and firm, owing to the formation of a blood-clot which pre- 
vents the womb contracting and keeps the blood-vessels 
open. The nurse should call for assistance and send 
some one for the family physician. If he lives at a dis- 
tance, the nurse is justified in sending for the nearest 
physician. The assistant should be directed to elevate 
the foot of the bed (to send the blood back to the heart 
and brain) and to bring the basin of antiseptic solution, 
vinegar, gauze, or a clean handkerchief The nurse 
should wash her free hand in the antiseptic solution and 
clean out the clots from the womb ; then the gauze or 
handkerchief should be soaked in the vinegar, be carried 
well up into the uterine cavity, and squeezed. The vin- 
egar will flow back over the walls of the womb and the 
vagina and cause the blood-vessels to contract. This 
treatment should be continued until the bleeding stops. 
Ergot may in extreme cases be given hypodermatically, in- 
jected either into the upper part of the thigh or the abdo- 
men. A hot douche of water and vinegar, equal parts, its 
temperature being about 1 18° F. or 120° F., will also con- 
tract the blood-vessels. The nurse should see that the blad- 
der is empty; she should also watch for collapse and give 



150 . PRACTICAL POINTS IN NURSING. 

stimulants. Morphia (^ grain) may be given to secure 
rest. Kneading of the womb must be kept up all the 
time with one hand. The appHcation of ice is not ad- 
visable, because ice may not be 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 in which prompt action, a calm 
and collected mind, and a steady hand are absolutely 
necessary. It is always a safe plan to have close at hand 
vinegar, very hot water, a syringe, and gauze or clean 
soft rags which have previously been sterilized in the 
oven for a number of hours after delivery, in case this 
accident should happen. The nurse is then prepared for 
prompt action, for it does not take long for a patient to 
bleed to death. 

Septicemia. — Puerperal septicemia is caused by neglect 
of antiseptic cleanliness on the part of the attendant (see 
p. i8i). It begins with a chill or a continued chilly feel- 
ing, followed by a rise of temperature and accelerated 
pulse, a bad odor from, and probably suppression of, the 
lochia, cold, clammy sweat, anxious expression, and dis- 
tention of the abdomen. The smallest rise of temper- 
ature should make the nurse watchful ; she should notify 
the physician, move the patient's bowels, give a vaginal 
douche of i : 5000 corrosive sublimate, and apply tur- 
pentine fomentations to the abdomen. The patient 
should be stimulated if necessary. 



THE PATIENT. 15I 

Insanity. — The treatment of puerperal insanity or mel- 
ancholia lies in keeping the patient perfectly quiet and 
preventing her from harming herself The air of the 
room must be kept fresh and pure ; the patient's strength 
supported with nourishing food ; baths may be givxn 
to promote activity of the skin; the bowels must be 
kept open ; and any article or any person that tends to 
excite the patient must be removed from her sight. The 
baby is taken from the breast when the symptoms first 
appear, and must be taken from the room. Bed-sores 
must be guarded against, and a strict watch must be 
kept over the patient ; if allowed to be up and around, 
she must not be permitted to go out of the nurse's sight. 
With a little tact the nurse can manage this surveillance 
without letting the patient think that she is being 
watched. The causes of puerperal insanity are many, 
and a good recovery depends chiefly upon the nursing. 

Eclampsia [Convulsions). — In event of convulsions the 
nurse must send at once for the attending physician, and 
put something in the mouth of the patient to prevent 
her biting her tongue. A hot pack or a vapor-bath may 
be given, and ice be applied to the head. 

Phlegmasia Dolcns. — Phlegmasia dolens, or milk-leg, is 
due to a blood-clot forming in a vein. There is swelling 
of the affected limb and pain, and its surface is white and. 
drawn. The disease may be ushered in with a chill or a 
chilly feeling and a rise of temperature and pulse. The 
patient must be kept on her back, and the limb be ele- 
vated and kept warm by wrapping it in cotton-wool. 
Recovery takes place with the absorption of the clot. 

Thrombosis. — Thrombosis is a clot of blood in a vein 
obstructing the circulation. It is generally caused by 
the patient walking, or even standing, too soon after an 



152 PRACTICAL POINTS IN NURSING. 

illness. Clotting may also take place after childbirth. 
There is swelling of the part, which swelling goes down 
as the clot is absorbed. But if absorption does not take 
place, if the clot is swept onward in the circulation of 
the blood to the right side of the heart, sudden death 
results from the obstruction of the pulmonary artery. 
This process is called embolism. 

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

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



III. NURSING IN GYNECOLOGIC CASES. 

Preparation for Gynecologic Examination. — To pre" 
pare a patient for examination the genital parts should 
be cleansed and the bladder and bowels be emptied. 
The womb lies between the bladder and the rectum, and 
the distention of either of these organs will alter the 
position of the womb. A douche must not be given 
before an examination, because the surgeon will want 



THE PATIENT. I 53 

to see the character of the discharge. All bands around 
the waist and the corset must be loosened ; a single tight 
band around the waist will crowd down the contents 
of the abdomen and displace the uterus. Around the 
patient is thrown a sheet, beneath which she can raise 
her clothing above the waist, and then step upon a chair 
and thence to the edge of the operating-table without 
there being the slightest exposure. 

For the examination there is needed a small table cov- 
ered with a shawl, a rug, and a comfortable or blanket ; 
over these a sheet is spread and a pillow is placed for 
the patient's head. There should be at hand a sheet to 
cover the patient ; a chair by the table for her to step 
upon ; a table, covered with a towel, on which are placed 
two bowls, one containing corrosive-sublimate solution 
(i : 1000), and the other containing warm water; a piece 
of soap (castile) or vaselin ; and towels. 

Positions for Examination. — The three positions for 
examinations, and also for operations, are the dorsal, the 
Sims, and the knee-chest. 

Dorsal PositioJt. — The patient lies upon her back with 
the knees drawn up and separated ; the hips are brought 
down near the edge of the table and the heels placed in 
the stirrups for support. If stirrups are not at hand, the 
feet may be held by assistants, one on each side. The 
patient should then be draped with a sheet, using diago- 
nal corners to wrap about the feet ; one of the remaining 
corners will then cover the body and the other hang in 
front, completely covering the patient's legs, and avoiding 
all exposure until the doctor is ready to make the ex- 
amination (Fig. 41). Then the corner of the sheet that 
hangs in front may be thrown back while the doctor 
examines, and dropped again when he is through. This 



154 PRACTICAL POINTS IN NURSING. 

same method of draping may be efficiently used with a 
patient during labor and delivery. 

Sims' Position. — In the Sims position (Figs. 42, 43) 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 



Fig. 41. — Dorsal position, with patient arranged for examination. 

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 PA TIE XT. 



155 



The thighs are flexed upon the body, the right knee 

being so bent that it hes . ^^ ..^..*„,^^ 

just above the left, and the 

feet rest upon a board ex- ^ 

tending from the right-hand 
comer of the table (Fig. 42). |j| ji 
The patient \s covered with 
a sheet, and the buttock- 
are covered with two tow- 
els, one to cover each side, 
their upper ends being 
tucked under the clothine, 
the lower ends being tucked 
between and under the legs, 
thus simply exposing the 
entrance to the vagina (Fig. 

43)- This position is one Fig. 42.— Sims' position for tamponing and 
in which a practical illuS- curetting (Dickinson). 

tration is needed before one can fully understand how to 
place the patient, and also how to arrange the towels. 





Fig. 43. — Arrangement 



wels for examina 



n tne ^Mins position. 



Kncc-chcst Position. — In the knee-chest position (Fig. 
44) the patient first kneels on the edge of the table, then 



156 



PRACTICAL POINTS IN NURSING. 



bends forward and rests her chest on a low pillow, her 
head lying just beyond, so that her back slopes down 
evenly, her arms clasping the sides of the table. The 
clothing is drawn above the waist, and the patient is cov- 
ered with a sheet. In this position the abdominal organs 
are thrown down toward the diaphragm ; the vagina may 
be readily distended with air by separating its sides, so that 
an unobstructed view of the vagina and the cervix may be 
obtained. 




Fig. 44.— Knee-chest position. 



Preparation for Operation. — For gynecologic opera- 
tions the nurse makes her preparations in the same 
manner as for abdominal operations, using the same 
antiseptic precautions. In an emergency, when a slight 
operation is to be performed with the patient in bed, 
there will be needed a table or a chair covered with a 
sterilized towel or sheet for the instrument-tray, bowls, 
hot and cold water, a fountain syringe filled with cor- 
rosive-sublimate solution (i : 3000) and a wide board 
or an ironing-board for insertion between the mat- 
tress and sheet (thus making a hard surface for the 
patient to lie upon), a chair for the surgeon, soap, and 
a nail-brush. 



THE PATIENT. 157 

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 




Fig. 45. — Table equTpped with basins, brushes, antiseptics, etc. for the physician's 
use (Dickinson). 

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, 



158 PRACTICAL POINTS IN NURSING. 

SO that the water used in bathing the external parts is 
conducted by the cloth into the pail or the tub. When 
holding the patient's limbs the nurse should let the heel 
of one foot rest in the palm of her hand ; the knee of 
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- 
lum, it should be held with her right hand in the exact 
position in which the surgeon has placed it (Fig. 46) ; 



Fig. 46. — Arrangement of towels for examination, showing introduction of the specu- 
lum with patient in the Sims position. 

her left hand, being passed over the patient's thigh, 
should raise the right buttock. 

After-care. — The after-care of gynecologic cases lies 
mainly in procuring absolute rest and quiet. The pa- 
tient must see no visitors without permission from the 
surgeon. The limbs are generally tied together for the 
first few days, especially after an operation on a lacerated 
perineum, to prevent the external stitches (sutures) giving 
way in case the patient should toss about. 

The genital parts must be kept perfectly clean, and 
strict antisepsis must be observed, as septic material 



THE PATIENT. I 59 

readily finds access. After passing the catheter the nurse 
should be careful that when removing it the urine does 
not drop on the stitches ; the parts are afterward sprayed 
with the ordered solution and dried. When giving 
douches the nurse must insert the tube carefully and 
away from the stitches, and after the douche is over 
she should softly wipe the vulva dry with sterilized 
gauze or cotton. The same care must be used when 
giving enemas, so that the rectal and vaginal stitches 
are not broken by the tube. The patient must be 
instructed not to strain w^hen 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 sur- 
geon will probably order the packing to be removed. 

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

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

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



l60 PRACTICAL POINTS IN NURSING. 

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

IV. DUTIES OF THE NURSE IN GENERAL 
SURGICAL CASES. 

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

Preparation of the Operating'-rooni. — 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 
will not see the preparations ; some patients, however, 
will take a great interest in all that is going on, while 
others will be exceedingly nervous. The nurse should 
remove from the room all movable furniture ; lay oil- 
cloth, or newspapers covered with a sheet, over and pin 
securely to the carpet, and across the window fasten a 
curtain or newspapers, so that the operation cannot be 
viewed from the opposite side of the street. The re- 
maining furniture and window-frames should be washed 
with carbolic-acid solution (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 



THE PATIENT. l6l 

light is to be preferred, and, if possible, it should be far 
away from the bath-room for aseptic reasons. All un- 
necessar)^ 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 (i : 20) and exposed to the action of the sun and air 
for about twelve hours, when the windows are to be 
closed, the room thoroughly dusted with a damp cloth^ 
and not again disturbed. The kitcJien makes a good 
operating-room ; it is warm, hot and cold water is close 
at hand, and one is not afraid of soiling carpets or 
hangings. 

Operatmg-table. — The operating-table should not be 
wider than 25 inches, nor higher than 37 inches, because 
if low and wide the surgeons will have to stoop and 
bend forward. A kitchen table or a dining-room table 
with the leaves let down, and a small table at one end 
for the patient's head, will make a good narrow ope- 
rating-table; or three chairs, with two planks, a leaf 
from an extension table, or an ironing-board laid across 
them, may suffice. 

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

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

Preparations for the Operation. — The evening be- 
fore the operation the nurse should boil a wash-boiler 
full of water and set it in covered pitchers to cool, the 
11 



1 62 PRACTICAL POINTS IN NURSING. 

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 — ■ 
one for the instruments, the other for the assistant — which 
can be improvised in the same way as was done for the 
operating-table (p. i6i) 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 i : 20 solution), 
and the syringe be filled with the solution, strychnin tab- 
lets (-2^5- grain), a small tumbler, a Davidson or a fountain 
syringe, common table-salt for salt-solution, sheet-wad- 
ding, absorbent cotton, bandages, sterilized gauze, safety- 
pins, rubber tubing for a tourniquet, two new nail-brushes, 
castile soap, green soap, a razor, hot-water bottles, two 
blankets, alcohol, matches, and twelve gauze sponges 
of various sizes — three 2 inches square, three 4 inches 
square, three 6 inches square, and three 8 inches square. 



THE PATIENT. 1 63 

Sterilization. — Sterilization may either be dry or moist ; 
moist heat is preferable, because it is more thorough and 
more penetrating than dry heat. For dry sterilization 
the clothing and dressings are placed in covered tin 
pans in the oven, the temperature ranging from 160° to 
212° F. For moist or steam sterilization an ordinary 
wash-boiler is used. Water is poured in to the depth 
of about 6 inches ; sticks or bricks, placed crosswise, are 
built up above the level of the water, and upon them rest 
the clothing and dressings. 

For both these methods the heat must be continued 
for fully one hour before the operation. The instru- 
ments are wrapped in a towel and allowed to boil for 
ten minutes in a tin pail or a kettle of boiling water to 
which has been added 2 teaspoonfuls of washing-soda 
to each pint of water, to prevent them from rusting. 
There must be left hanging out of the kettle one end 
of the towel, by which to lift out the instruments. The 
water must boil some time before the instruments are 
placed in it. 

Operative Position. — The most popular position for ab- 
dominal operations is the Trendelenburg (Fig. 47). This 
position is one in which the knees of the patient are con- 
siderably higher than the head, the body slanting upward 
from the shoulders ; the intestines are thus thrown down 
toward the diaphragm, giving the surgeon a clear view 
of the pelvic organs. In the absence of a Trendelenburg 
table the position can readily be obtained by raising the 
lower end of the operating-table and placing chairs or 
boxes under its feet ; or a wooden chair or a high box 
can be secured to the operating-table and covered with 
sterilized sheets. 

Preparation of Patient. — If the nurse has from 



164 



PRACTICAL POINTS IN NURSING. 



twenty-four to thirty-six hours in which to prepare the 
patient for operation, she should give the patient, the day 
before the operation, a full bath and a cathartic of either 
castor oil, citrate of magnesium, 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 may not digest it thoroughly, and 
its curds may remain in the intestines and act as an irri- 



THE PATIENT. 1 65 

tant. Gruel is best given ; it is nourishing and easily- 
digested. 

The part to be operated on must be shaved (if the 
patient is very nervous it is generally well to leave this 
operation until she is partly etherized). After the shaving, 
the part is thoroughly cleansed with soap and water and 
a nail-brush, then with ether, which removes all oily and 
fatty substances, then with warm corrosive-sublimate so- 
lution (i : 1000), after which cleansing a pad of sterilized 
gauze, absorbent cotton, or a towel is wrung out of the 
solution, applied over the part, and held in place with a 
sterilized bandage and perineal straps. This pad is not 
removed until the surgeon is ready to operate. The 
patient must be instructed not to put her fingers under- 
neath the dressing or to disturb it in any way. 

No definite rules can be laid down for the surgical 
bath, as surgeons differ in their method of preparing 
patients for operation. The bath may be given in the 
manner just described, while some surgeons will direct 
the application of a poultice of green soap, which is re- 
moved early on the morning of the operation, the part 
being scrubbed with hot water and a brush to remove 
the soap, and a warm corrosive-subHmate poultice (i : 
1000) applied. 

On the morning of the operation the patient should 
be given a simple enema to clear the bowels, and a 
sponge-bath ; the nurse should then put on the patient 
a clean under-vest, night-gown, and stockings, and braid 
the hair in two braids ; she should also remove from the 
patient all rings and ear-rings ; also false teeth, whether 
a whole or a partial set, as there is danger of their being 
swallowed, and put them away in a tumbler of cold 
water. Two hours before the operation the patient 



1 66 PRACTICAL POINTS IN NURSINC. 

may be given a stimulating enema of whisky (i ounce) 
and warm water (2 ounces). This enema may be fol- 
lowed in one hour with atropin (yj-^ of a grain), which 
acts as a sedative and lessens the irritability of the stom- 
ach caused by the ether ; it also lessens the secretions of 
the mouth and throat and prevents the throat filling up 
with phlegm. Both these stimulants should be given by 
enema, because if given by the mouth they might stay in 
the stomach unabsorbed, and the patient would vomit 
them when under ether. No food must be given after 
midnight, unless the operation is to be performed late in 
the day — about noon-time or in the afternoon — in which 
case the patient may have, six hours before, beef-tea, 
gruel, or coffee. Milk should not be given, as it is very 
apt to curdle and stay in the stomach, and, should the 
patient vomit while under ether, the curds may get into 
the larynx and trachea and choking result. The cath- 
eter should be passed before etherization if the operation 
is abdominal, even if the patient has urinated a few min- 
utes before, and the nurse should be sure that the blad- 
der is empty. 

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

Duties of the Nurse in Emergency Cases. — We will 
consider the preparation for an emergency operation in a 
very poor family, where there are no conveniences. We 
will presume the case to be one of appendicitis, and that 
the nurse has been called in the night. While the sur- 
geon is making his examination of the patient the nurse 
should start a fire and put on the wash-boiler, to make 
sure of plenty of boihng water ; she should then get six 
sheets and twelve towels, if possible. There may be no 



THE PATIENT. 1 6/ 

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 (i : looo) 
until the surgeon is ready to use them. 

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

After the surgeon has made the examination the part 
must be shaved, washed, and a corrosive towel applied ; 
an enema should be given to clear the bowels, also a 
stimulating enema, and the urine should be drawn. 
While the patient is being etherized the nurse may ar- 
range the tables and wash a flat bake-pan or meat-pan 
for the instruments. If sponges have been forgotten, a 
clean sheet can be torn up and folded into flat sponges. 
China basins can be used for the antiseptics, the sponges, 
and the surgeon's hands ; china pitchers for hot and cold 
water ; a wash-tub for the soiled water ; and hot bricks 
or beer-bottles for heaters. No matter how poor the 
family, the kitchen can be cleaned and prepared as an 



1 68 PRACTICAL POINTS IN NURSING. 

operating-room in a few minutes. Boiling water kills 
germs on contact, and where there are no means of 
sterilizing the sheets and towels, they can be soaked 
first in boiling water and afterward in corrosive-subli- 
mate solution (i : 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. 

Absolute silence must be maintained while the ether 
is being administered, as any conversation may be heard 
by the patient. Whatever is said by the patient when 
going under ether or coming out must be kept abso- 
lutely secret. Care must also be taken when the patient 
is coming out of ether that the operation is not dis- 
cussed. Many patients have been made miserable 
through carelessness on this point ; for, while they could 
hear everything that was said by the nurses, they were 
totally unable to make any sign by which the nurses 
would know that they could hear. Death from ether is 
slow — by paralysis of the respiration — the signs of dan- 
ger being a blue and livid color of the skin, the respira- 
tions being low, shallow, and gasping. Ether affects 
people differently, and no definite rules can be laid 
down. Ether should be given slowly; in other words, 



THE PATIENT. 



169 



the cone should not be filled with ether and put over 
the face, entirely smothering the patient. The nurse 
should show the patient how to inhale it, slowly and 
deeply, and also instruct the patient to close the eyes, 
because ether is an irritant to the eyes. About 2 tea- 
spoonsful of ether are poured into the cone, which the 
nurse should hold a little distance from the patient's face, 
and as she becomes accustomed to the ether and under 
its influence the cone may be brought nearer ; the stran- 
gling sensation of which so many patients complain is 
then in a measure avoided. Ether generally first pro- 
duces choking and coughing, followed by excitement ; 
this is followed by the muscles becoming rigid, the face 
blue, and the breathing stertorous or snoring ; this stage 
passes away, the muscles become relaxed, and the patient 
is in a state of insensibility. 

The lower jaw must be kept forward by placing the 
thumbs behind the angles of the jaw. Pushing the jaw for- 
ward and upward, which brings the upper behind the under 
teeth, pre\'ents the tongue slipping back and obstruct- 
ing the larymx, and gives 
free access of air to the 
lungs (Fig. 48). Should 
the tongue slip back, it 
may be pulled forward 
with the fingers or with 
a pair of forceps. Fre- 
quent inspirations of 
fresh air should be 
given. When com- 
pletely etherized only 
a small quantity of the drug is needed to keep the 
patient under its influence. The mucus should be 




Fig. 48.— Method of pushing the lower jaw 
forward to prevent obstruction to breathing. 



lyo PRACTICAL POINTS IN NURSING. 

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 after the respirations 
have ceased. The nurse should speak out if the pulse is 
growing rapid, feeble, irregular, or intermittent ; if the 
respirations are becoming low, rapid, or gasping ; if the 
face is becoming pale or blue, or the pupils are grad- 
ually dilating. 

If the patient seems inclined to vomit, the ether should 
be pushed, which will generally ward it off; should she 
vomit, her head should be turned to one side, to allow 
the matter more easily to escape from •the mouth. One 
will see from the above that the giving of ether requires 
the undivided attention of the etherizer ; no one can ether- 
ize and see the operation at the same time. Nausea and 
vomiting after ether may continue for two or three hours 
or longer. Should it persist until the following day, it 
may be due to shock or to some cause other than ether. 
Very hot water will often check vomiting, or crushed 
ice, black coffee, small doses of brandy, champagne and 
ice, or aromatic spirits of ammonia. Cocain, \ grain 
every two hours for five doses, has been successful in 
severe cases ; also a mustard plaster over the stomach 
and the washing out of the stomach. Patients who take 
chloroform do not suffer from nausea so much as do 
those who take ether. 



THE PATIENT. I7I 

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

Chloroform is similar in its action to that of ether ; it is 
pleasanter to take, and the patient is under its influence 
quicker, though it is more depressing on the heart than 
ether, and for this reason the patient is not allowed to 
rise until all effects have passed off To give chloro- 
form, a few drops may be sprinkled on a handkerchief, 
a towel, or a small wire framework covered with flan- 
nel, or the drops may be sprinkled on a piece of absorb 
ent cotton placed in a tumbler, which is held a little dis- 
tance from the patient's face. The same symptoms are 
to be watched for as those in ether. Death from chlo- 
roform is almost always sudden, from paralysis of the 
heart : the pupils become dilated, the face becomes pale, 
and the pulse becomes flickering. 

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

On first going to the operating-room the hands and 
forearms of the nurse are to be thoroughly washed and 
scrubbed for ten minutes, and the finger-nails thor- 
oughly cleaned, thus removing the germs from the 
hands. The hands are then rendered absolutely sterile 
by putting them first into a saturated solution of per- 
manganate of potash until they are of a deep-brown 



172 PRACTICAL POINTS IN NURSING. 

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 subHmate (i : 
500), which reaches the corners and crevices in the fin- 
ger-nails that cannot be reached by the brush. 

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

The nurse next puts on a sterilized gown. If there 
are no gowns — as in an emergency case, for instance — 
three sterilized sheets (see p. 167) will answer for gowns 
for surgeon, assistant, and nurse. The nurse now puts 
her hands again through the different solutions, and 
stands ready to get anything that may be called for. 

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



\ 



THE PATIENT. 1 73 

that she does not understand, she should so inform the 
surgeon, who will always be perfectly willing to make 
the duty clear. 

The pails, bowls, and pitchers, and the tray for instru- 
ments must be washed inside and out, and filled with 
sterilized hot water, which is conveyed from the boiler to 
the pail by means of a perfectly clean pitcher or a tin 
ladle. The pads and rubbers to be used, also the ope- 
rating-table (the patient is- generally etherized in bed), 
must be thoroughly washed with the corrosive-sublimate 
solution (i : 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 fresh sponge or a sponge of a certain size is sud- 
denly called for ; she should then take the soiled sponge 
from the surgeon with her left hand and give him the 
fresh sponge with her right. She should not, while wait- 
ing to hand a fresh sponge, rest her hands or forearms on 
the pail ; and if she has to stop to get something for the 
surgeon or to get fresh water, her hands must again be 
washed in the antiseptics before touching the sponges. 
If she is to sponge the wound, she should wipe swiftly 
and firmly. She should count the sponges before the 
surgeon begins to sew up the wound, and should be 
very sure that she has the exact number employed in 
the operation. 

Arranging the Patient for Operation. — When the 
patient is brought into the operating-room and placed on 
the table, the clothes must be removed from the part to 
be operated upon, to prevent their getting soiled. If the 
part to be operated upon is the head or the chest, the 



174 PRACTICAL POINTS IN NURSING. 

night-gown must be pushed well down under the shouU 
ders ; if it is a breast, an arm, or a leg, the gown should 
be opened down the front and be pushed to the opposite 
side; if it is the abdomen, the gown and under-vest 
must be brought well up under the shoulders and the 
under-vest be turned up so as to hold the arms in posi- 
tion across the chest. 

Sterilized blankets are tucked about the chest and the 
feet, the bandage and pad are removed from the part, 
and the latter is again thoroughly cleansed with soap 
and water and disinfectants. Sterilized sheets and towels 
are then arranged about the part. A table for the in- 
strument-tray is placed at the surgeon's right side, also 
a chair or table on which is placed a pail or bowl of 
water for his hands. A table for the pails or bowls for 
sponges is placed at the opposite side of the table, at the 
assistant's right hand, and the operation is begun. 

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

Sequels of Operation. — Shock. — After an operation 
the nurse must watch for two things — shock and hemor- 



THE PATIENT. 



175 



rhage. Shock is great depression of the vital organs of 
the body produced through the nervous system, brought 
on by injury or surgical operation. The greater the in- 
jury 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 
to suffering stand shock better than those whose nervous 
system is in a high degree of activity. Shock is modi- 
fied by mental conditions ; it is aggravated by fear, de- 
spondency, or depressed mental conditions of any kind, 
while it is diminished by cheerfulness, hope, joy, etc. 

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

The symptoms of shock are a weak, rapid, and irregu- 
lar pulse ; sighing ; rapid, irregular, shallow respiration ; 
temperature normal or very little below ; pale face with 
a pinched look ; cold, clammy skin ; the mind dull. 



\j6 PRACTICAL POINTS IN NURSING. 

There may be involuntary movements of the bowels and 
urine through loss of muscular power; nausea and 
vomiting. 

The treatment of shock consists in lowering the patient's 
head and elevating the arms and the foot of the bed, to 
promote the supply of blood to the vital centres ; in ap- 
plying heat to all parts of the body — the sides, between 
the legs, and to the feet — and a mustard plaster over the 
heart ; in administering stimulants of whisky, brandy, or 
pure alcohol hypodermatically ; in giving hot coffee or 
salt-solution by the rectum and very high up. An enema 
of \ ounce of turpentine, a raw ^gg well beaten up, and 
3 ounces of warm water is a powerful stimulant. 

It must be remembered that in severe shock the func- 
tion of absorption of the stomach and intestines is almost 
wholly suspended, and anything given by the rectum 
must be given very high up. When the respiration of 
the patient is fast failing, everything depends on maintain- 
ing the heart's action. To this end artificial respiration 
must be persistently practised. When the depression is 
deepened by hemorrhage, hypodermoclysis or intravenous 
infusion of normal salt solution must be resorted to. Ex- 
ternal heat is a powerful heart-stimulant, and often when 
the heart's action threatens to fail it may be restored by 
heat over the heart and by hot fluids taken into the stomach. 

Strychnin is a powerful heart-stimulant, and, if at hand, 
^ grain should be given every half hour for four doses. 
Tincture of digitalis in 15-minim doses may be given 
every half hour for four doses. Ether alone, or mixed 
with an equal part of alcohol, has a more rapid stimulant 
action than alcohol. Recovery may be rapid or very 
slow ; then we get what is called " reaction " — the pulse 
becomes more full, slow, and regular, the temperature 



THE PATIENT. 1 77 

rises, the body becomes warm, and a general improve- 
ment takes place. 

Collapse is an extreme degree of shock, and almost 
invariably ends in death. 

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

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

Treatment of Hemorrhage. — The two things to be 
remembered in the treatment of hemorrhage ^xq position 
and pressure. The part from which the blood is coming 
should be elevated and the patient's head lowered, to pro- 
mote the supply of blood to the vital centres. If the 
nurse can apply pressure by putting her finger on the 
artery, she should do so, or she may plug the wound 
tightly with sterilized gauze or a compress, and hold 
it there until the arrival of the surgeon, who must im- 
mediately be summoned. The patient is to be kept 
perfectly quiet on her back. If symptoms of shock 
supervene, heat is to be applied to all parts of the 
body by warm blankets and hot-water bottles. Stimu- 
lants are to be given only if the pulse is failing. When 
the hemorrhage has been excessive, hypodermoclysis or 
intravenous infusion is often resorted to, the fluid that 
the body has lost being thus replaced. 
12 



178 PRACTICAL POINTS IN NURSING. 

Hypodermoclysis is the subcutaneous injection of so- 
called normal or physiologic saline solution. It is 
employed generally to replace blood lost by hemorrhage, 
but also for many other purposes, such as to counteract 
different conditions of poisonings, as uremia, septicemia, 
etc. Transfusion is the intravenous injection of blood 
from another person — a method of treatment for hemor- 
rhage formerly in vogue, but now fallen into deserved 
disrepute. The solution usually employed, and known 
as normal or physiologic saline (or salt) solution, consists 
of a 0.6 per cent, solution of sodium chlorid or common 
salt. It may be prepared by adding i^ teaspoonfuls (a 
dram and a half) of common salt to a quart of boiling 
water. A solution a little stronger (0.75 per cent.) is 
probably better ; this may be made by adding two tea- 
spoonfuls (two drams) of salt to a quart of boiling water. 
The amount of solution usually injected varies from eight 
ounces to a quart or more. The parts used for injecting 
are the chest (beneath the mammary gland), the abdom- 
inal walls, the peritoneal cavity (known as intraperitoneal 
infusion and employed usually after abdominal opera- 
tions), the arm, the thigh, the rectum (known as entero- 
clysis), and the veins (intravenous infusion). The instru- 
ments required for hypodermoclysis are a large needle 
(much resembling a hypodermic needle), rubber tubings 
and a glass funnel, or a fountain syringe may be utilized. 
All the instruments must be rendered thoroughly aseptic, 
and the site of the injection must previously be steril- 
ized. The solution should have a temperature of about 
100° F. ; it must be absolutely sterile, and it should be 
filtered before being used. 

Continuous Enteroclysis {Murphy Method). — This is the 
slow injection of normal salt solution into the rectum in 



THE PATIENT. 1 79 

order that a large quantity of the fluid may be absorbed 
into the circulation. It is used in shock from serious 
hemorrhage, and in various surgical conditions in which 
large amounts of toxic substance are present in the cir- 
culation. The normal salt solution is diluted one-half. 
Instead of a colon-tube a rubber catheter is used, and 
this is introduced to the length of from 4 to 6 inches. 
The irrigation can is hung so as to be only a few inches 
above the level of the bed, and the fluid is allowed to 
flow very slowly. It should take from one and a half 
to two hours for the administration of half a gallon of 
the fluid. When all the fluid has been taken, the tube 
should be allowed to remain for a few minutes to prevent 
the expulsion of the fluid. 

After-treatment of the Patient. — Rest. — The after- 
treatment of every surgical operation consists in perfect 
rest of the patient on the back for a certain length of 
time, to prevent the ligatures giving way and to lessen 
the likelihood of irritation of the stomach and vomiting. 

The diet following operations is liquid until after the 
third day and the bowels have moved ; then a light diet 
is given, such as cream toast, a soft-boiled ^^%, custard, 
buttered bread with the crust removed, cocoa, etc. ; solid 
diet is afterward gradually resumed. 

After-treatment in Amputations. — After the amputation 
of a thigh the stump must slightly be elevated on a pil- 
low and a cradle be used to keep off the weight of the 
bed-clothes. A careful watch should be kept for hemor- 
rhage. When a breast has been amputated, the arm is 
confined to the side by a bandage. The arm will become 
very tired ; this tired feeling can be relieved by putting 
under the arm a small pillow, upon which it can rest. 

After-treatment in Abdominal Operations. — After ab- 



l8o PRACTICAL POINTS IN NURSING. 

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

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

Bladder a7id Bowels. — The catheter should be passed 
every six or eight hours if necessary, according to direc- 
tions. The passage of gas by the rectum is a very good 
sign, as it shows that the bowels have regained their 
normal tone and that there is no obstruction. 

Drainage-tube. — If a drainage-tube is in the abdomen 
and the care of it is left to the nurse, she must each time 
before draining thoroughly scrub and sterilize her hands. 
The syringe must be washed first with boiling water, the 
water being passed through it several times, then with 



THE PATIENT. l8l 

corrosive-sublimate solution (i : looo), followed with boil- 
ing water ; the syringe is then to be laid in the corrosive 
solution until the nurse has washed her hands a second 
time and unpinned the dressing covering the tube. The 
rubber tube attached to the syringe is passed down 
the centre of the drainage-tube to the bottom, then with- 
drawn a little, so that only the fluid will be drawn up, 
and not the tissues of the pelvis. The syringe piston is 
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 ^^^x^i^x gauze drainage, a piece of twisted 
gauze being put into the tube, that sucks up the fluid. 
This gauze is changed at stated intervals, and the tube 
is cleaned with a small piece of sterilized cotton or gauze 
fastened on the end of a pair of long fine forceps ; then a 
fresh twist of gauze is inserted. With both these meth- 
ods the amount of fluid drawn and its character must be 
reported. When the drainage-tube is to be removed, 
the nurse should observe the same precautions as she 
would for a dressing. 

Hysterectomy. — The after-care of a hysterectomy, which 
is the complete removal of the womb, the ovaries being 
usually at the same time removed — hystero-oophorec- 
tomy — either through the vagina (vaginal hysterectomy) 
or through the abdomen (abdominal hysterectomy), is 
the same as after any abdominal operation. 

Septicemia. — Septicemia is blood-poisoning caused by 
the entrance of germs into the body through the agency 
of unclean hands (especially dirty finger-nails), instru- 



1 82 PRACTICAL POINTS IN NURSING, 

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

Septicemia (or septic peritonitis) may develop within 
several hours or several days after the receiving of a 
wound, either by operation or by accident. The earliest 
symptoms may be those of local disorder, such as the 
discharge of pus from a wound or manifestations of peri- 
tonitis. The septicemia (and pyemia) usually is mani- 
fested by an initial chill, high fever (103-104° F.), fol- 
lowed by severe perspiration. The appetite is lost, nausea 
and vomiting may occur, the patient emaciates rapidly, 
and becomes restless, sometimes stuporous and delirious. 
The chills recur at intervals, daily or on alternate days, 
and perspiration becomes profuse. The pulse is rapid, 
120 to 140 per minute, and should the patient not im- 
prove, it becomes weak and thready. In the event of peri- 
tonitis the abdomen is distended, tender, and very rigid. 

Treatment of Septicemia. — The nurse should send at 
once for the surgeon, and in the mean- time try to move 
the patient's bowels with high enemata of turpentine, 
glycerin, oil, salts, melted vaselin, butter, lard, or mo- 



THE PATIENT. 1 83 

lasses, or soap and water if there is nothing else at hand. 
The encmata 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 result is 
usually fatal. All the symptoms deepen. The surface of 
the body is cold and clammy ; the face is pinched and 
sunken and has a dusky hue ; the restlessness increases, 
also the thirst, which is very great, and to the last the 
patient calls for water, which is vomited immediately after 
being taken, but which it is cruel to withhold. The mind 
is usually clear to the end. 

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



184 PRACTICAL POINTS IN NURSING, 

is both a disinfectant and a deodorant), charcoal, or 
lime. 

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

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

Corrosive sublimate and carbolic acid are the best dis- 
infectants and antiseptics, but the corrosive cannot be 
used for the instruments or the clothing, on account of 
its discoloring properties ; it is used in solutions of from 
I : 500 to I : 10,000. 

Carbolic acid does not discolor clothing or instru- 
ments, it having this advantage over corrosive sublimate, 
but it irritates and benumbs the hands. The strengths 
of the solutions used are from 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 i : 20, i : 40, i : 60, or 



THE PATIENT. 1 85 

I : 80, I ounce of the 95 per cent, solution is added to 
20, 40, 60, or 80 ounces of water. 

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 surgicaf 
dressings. 

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

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

Creolin is not so poisonous as the two above-named 
drugs, but it cannot be used for instruments, because of 
its yellow color, which prevents their being seen at the bot- 
tom 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\ teaspoonfuls of creolin are added to i pint of water. 

Boric acid is an unirritating and non-poisonous anti- 
septic ; a 4 per cent, solution is generally used. 

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

Permanganate of potash is an antiseptic used to 
cleanse the hands and other parts before operation, fol- 
lowed by a solution of oxalic acid to remove the stain. 



1 86 PRACTICAL POINTS IN NURSING. 

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

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

Condfs fluid, which contains 16 grains of perman- 
ganate-of-potash crystals to i ounce of water, is both a 
disinfectant and a deodorant. 

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

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



THE PATIENT. 



187 



Absolute 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 disinfectant is heat — either dry heat (baking) 




hiG. 4y. — Interrupted suture (Bernard 
and Huette). 



Fig. 50. — Continued or glover's suture 
(Bernard and Huette). 




Fig. 51. — Button-suture (Bryant). 



or moist heat (steam). Water 
of a temperature of 212° F. will 
kill most germs on contact. 

Suturing". — Sutures, which are 
used to bring the edges of a 
wound together, are of silver 
wire, silk, catgut, silkworm gut, 
etc. The interrupted suture (Fig. 49) is made by passing 
catgut or silk through the skin from one side of the 
wound to the other ; then both ends are drawn together 
and tied in a double knot. The continuous suture (Fig. 
50) is the ordinary over-and-over stitch from one end of 
the wound to the other. The button suture (Fig. 5 l) is 
made by passing wire across the bottom of the wound, 
bringing out the ends about i inch from the edge of the 
wound, and securing each end with a button. 

Ligation. — Ligatures, which are used for tying large 
blood-vessels, are of heavy twisted silk, silver wire, silk- 
worm gut, or catgut. 

Sterilizing Sutures. — The catgut is soaked for twelve 
hours in corrosive-sublimate solution (i : 1000), and after- 
ward, for twenty-four to forty-eight hours, in oil of juniper. 
The spools are then transferred to covered glass jars con- 



1 88 PRACTICAL POINTS IN NURSING. 

taining sufficient absolute alcohol to completely cover the 
catgut. The alcohol is changed every two weeks. Other 
methods of sterilizing have their advocates, and should 
the matter be left to the nurse, she should obtain specific 
directions from the surgeon. 

Gauze Sponges. — The sponges most commonly used 
are gauze pads, the cut edges being folded over and 
loosely hemmed, and little gauze bags, made by wrap- 
ping cotton waste in squares of gauze, the corners being 
brought together and stitched firmly at the top. Gauze 
sponges are never employed more than once. Those 
used in operations are afterward destroyed; those not 
used are re-sterilized, placed in sterilized towels, and de- 
posited in covered glass jars which are not uncovered 
until called for at an operation. 

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



IV. ACCIDENTS AND EMERGENCIES. 

I. Surgical Accidents. 
Fractures. — A fracture is the breaking of a bone into 
two or more pieces. A simple fracture is a single break 
without injury to the flesh. A compound fracture is a 
single break with injury to the flesh. A fracture is said 
to be comminuted when the bone is broken into several 
pieces. An impacted fracture is one in which one frag- 



ACCIDENTS AND EMERGENCIES. I 89 

ment is driven and fixed into another. A grccn-stick 
fracture is one in which the bone is bent and partially 
broken. It occurs chiefly in young children. 

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

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

Bone-repair. — The repair of a broken bone is very 
interesting. Following the fracture, the ends of the bone 
become surrounded by and embedded in extravasated 
blood and certain products of inflammation. These 
gradually become thickened or solidified (** organized ") 
and infiltrated with Hme salts, forming what is called the 
" callus." This callus, which is an imperfect bony tissue 
that cements and unites the broken ends of the bone, 
hardens, and is gradually converted into more or less 
perfect bone. The process of repair is generally fairly 
complete in about six weeks ; but it may be prolonged 
to many months, and in some cases it may not occur 
at all. 

Ma?iageine?it of Fractures. — The management ol a 
broken bone until the arrival of a surgeon consists in 
securing perfect rest. If a leg be broken, the patient 
should be laid on a stretcher, a door, or a shutter; a 
splint may be improvised with an umbrella, a walking- 
stick, a thin board, books, newspapers, or a coat rolled 
up and tied to the side of the leg with handkerchiefs 



190 



PRACTICAL POINTS IN NURSING: 



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 




Fig. 52. — Treatment of a fracture of the leg without splints (after A. S. Morrow). 

be opened at the seams, which can easily be sewed up 
again. To remove the boots, one hand should be 
placed at the ankle to steady the hmb, and with the 
other hand the boot may be removed. If the foot is 
injured or if there is much pain, the seam of the boot 




Fig. 53. — Treatment of a fracture of the patella (after A. S. Morrow). 

must be cut open. Garters must be removed before the 
stockings, and the suspenders unfastened in front and 
behind before the trousers are removed. Work should 
be quiet and steady, as there is danger of converting a 
simple into a compound fracture through the broken 



ACCIDENTS AND EMERGENCIES. I9I 

ends of the bone running through the skin. If there is 
shock, heat is to be applied and stimulants given. 

The bed is to be made in the usual way, with a board 
underneath the mattress to prevent it sinking in the 
middle. A pillow should be placed around the hmb 
and fastened with safety-pins, and a sand-bag should be 
placed on each side of the limb to keep it in position. 
Sand-bags are made of stout ticking, cotton, or any 
material that is sufficiently fine to prevent the sand from 
escaping into the bed. They should be long enough to 
extend from below the foot to above the knee, and be 
about 6 inches wide. The sand must be thoroughly 
dry, and the bags be filled about three parts full. The 
limb should be elevated on pillows ; the toes must point 
upward. 

Before the arrival of the surgeon the nurse must get 
the part and the patient as clean as possible. She 
should have ready cotton or gauze bandages of different 
widths (from 3 to 6 inches) ; sheet-wadding bandages 
(about 4 inches wide), which, if a plaster-of-Paris band- 
age is applied, will be put on first to protect the skin ; 
sheet wadding ; plenty of warm water ; towels ; corro- 
sive-sublimate solution (i : 1000) or carbolic-acid solu- 
tion (i : 20); sheets to cover the surgeon and to protect 
the bed and the floor. If sheets cannot be had, news- 
papers may be used for the bed and floor and a large 
apron for the surgeon. 

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



192 



PRACTICAL POINTS IN NURSING. 



A broken arm after being dressed (Fig. 54) should be 
put in a wide sling (Fig. 55) made with a large handker- 
chief folded diagonally, the ends tied around the neck, 
the point turned up above the elbow and fastened with 
safety-pins. 




Fig. 54. — Splint for a fractured arm. 

For a broken jaw the mouth should be closed firmly 
and bandaged with a folded handkerchief or a four-tailed 
bandage (Fig. 56). 

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





Fig. 55. — Handkerchief sling 
for a broken arm. 



Fig. 56. — Four-tailed bandage 
for the jaw. 



Dislocations. — A dislocation is the displacement of the 
bone or bones of a joint by some external violence, such 
as a fall or a blow. A compoimd dislocation is one in 
which there is a wound connecting with the joint. The 
patient should be put to bed on his back, the part ban- 
daged, and ice appHed to prevent inflammation. 

Dislocation of the lower jaw ^ which is sometimes caused 
by yawning, can generally be overcome by the nurse 
wrapping her thumbs in a handkerchief and placing them 



ACCIDENTS AND EMERGENCIES. 



193 



in the patient's mouth on the lower back teeth and press- 
ing down and back, when the bone will generally slip 
into its place (Fig. 57). 

Sprains. — A sprain is the wrenching of the ligaments of 
a joint ; there may also be rupture of the fibers and blood- 
vessels. The limb should be placed first in moderately 
hot water, and the temperature gradually be raised until it 
is as hot as the patient can bear, the limb remaining in the 
water for about half an hour; 
or hot fomentations may be 
applied and the limb be 
placed in a comfortable posi- 
tion. Strapping with adhe- 
sive plaster strips (see p. 205) 
is useful in treating sprains. 

Surgical Dressing's. — 
Surgical dressings are easily 
prepared from gauze or 
cheese-cloth and absorbent 
cotton, or they may be pur- 
chased at any drug store in 
sterile packages ready for use. 
In an emergency, pieces of 
old linen or soft cotton may be used instead of gauze. If 
prepared by the nurse, the following, which are necessary 
for an ordinary dressing, should be made up into pack- 
ages and wrapped in pieces of muslin cloth and sterilized 
by steam. This list represents articles as they should 
be put up in separate packages : 

2 towels ; 

6 squares of gauze, folded with raw edges in, for direct 
application to the wound ; 

6 cotton sponges ; 

I cotton and gauze pad for abdominal dressings. 
13 




Fig. 57. — Method of reducing a disloca- 
tion of the jaw (Makins). 



194 PRACTICAL POINTS IN NURSING. 

A number of packages of each may be made and all 
sterilized in a steamer or wash-boiler (in case a regular 
sterilizer is not at hand). There should be put in the 
bottom of the boiler two bricks or blocks of wood, upon 
which is placed a frame that will answer for a tray to 
hold the dressings and keep them out of the water, yet 
allow free penetration of the steam. By filling the boiler 
with water to barely cover the bricks or blocks and put- 
ting on the stove to boil sufficient steam will be gener- 
ated to kill any bacteria on the dressings and render them 
sterile for use. Boiling should be continued for at least 
half an hour, and then the packages may be dried out in 
a warm (not hot) oven. 

When small drains are needed, strips may be cut from 
the wrists of rubber gloves that have been laid aside, 
boiled, and put in carbolic-acid solution (i : 40) to keep 
until used. 

Surgical dressings may be applied either 7noist or dry^ 
as the condition requires or the surgeon directs. 

For moist dressings, the sterile gauze is wrung out of 
any warm solution that is ordered and placed as a com- 
press on the part, then covered with rubber tissue and 
held in position with a bandage. 

A dry dressing consists of sterile gauze applied to the 
wound, which may be dusted with some antiseptic powder 
as the surgeon directs. This is held in place with a ban- 
dage or with strips of adhesive plaster. 

The instruments to be sterilized and kept ready for 
ordinary dressings are — a pair of scissors, a hemostat, 
tissue forceps, a probe, and a director. Bandage scissors 
are needed to cut bandages and adhesive plaster. 

Managejnent of Surgical Dressings. — Before beginning 
to do a surgical dressing the nurse should see that every- 
thing is ready. She should try to remember the favorite 



ACCIDENTS AND EMERGENCIES. 1 95 

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 solu- 
tion (i : 1000) for the hands, a basin of carbolic-acid 
solution (i : 20), and one of alcohol (95 per cent.) for 
the instruments, towels, and a pail or a basin for the 
soiled dressings and discharges. If asked to prepare a 
wound for the surgeon's inspection, the nurse must wash 
her hands with soap and water and corrosive-sublimate 
solution, having first covered any cut or scratch. She 
should then remove the bandage and dressing, which, 
if it adheres to the wound, may be wet with corrosive- 
sublimate or carbolic-acid solution, after which it will 
easily come off The nurse should wash toward, not 
away from, the wound, and cover it with a cloth wet in 
carbolic-acid solution until the surgeon is ready to 
inspect it. To remove a plaster begin at each end and 
work toward the wound. Putting one hand on the skin 
and pressing firmly down will prevent the peculiar tear- 
ing feeling of which a patient will complain. The marks 
of the plaster can be removed with alcohol, ether, tur- 
pentine, or soap and water, care being taken that the 
solution used does not enter the wound. 

Bandages. — Bandages are to retain dressings and 
splints in position, and also to apply pressure. Almost 
any kind of household muslin or gauze may be used for 
a bandage. Gauze is the best, on account of its elasti- 
city; it can be applied to any irregular surface, and it 
is not necessary to reverse a gauze bandage. Shaker- 
flannel cut on the bias is used where greater strength is 
required and to make firm pressure. 

Rubber Bandage. — Rubber or elastic bandages are to 



196 



PRACTICAL POINTS IN NURSING. 



prevent hemorrhage and to prevent or reduce swelling. 
The rubber bandage is put on from below upward, with- 
out reverses. It must not be drawn too tight nor be 
left on too long, or paralysis from pressure on the nerves 
of the part may result, or the circulation will be interfered 
with or entirely cut off Rubber bandages should be 
rolled up quite loosely and be kept in a dark, moist 
place, or they become brittle and break into pieces. 

Roller-bandages. — Roller-bandages are from \ inch to 
6 inches wide and from 2 to 8 yards long. The selvage 
must always be removed, the bandage rolled very tightly 
and evenly by hand or on a regular bandage-roller, and 
the loose threads of the edges trimmed off 

In applying a bandage the nurse should hold the 
bandage in one hand, and, taking the loose end in the 
other hand, should so apply it to the part to be bandaged 
that the outer surface may be against the skin, and that 
the bandage will lie close to the limb (Fig. 59). All band- 
ages must lie smoothly and their pressure be uniform. A 





Fig. 58. — Bandaging an ankle. Fig. 59. — Bandaging a leg, showing meth- 

od of reversing the bandage. 

bandage should always begin from the ijiiier side of a 
limb, and thus bring the turns to its outer side (Fig. 58). 
A bandage must not be put on too tightly, as there is 
considerable danger of inflammation or of gangrene 
through the circulation being interfered with or being 



ACCIDENTS AND EMERGENCIES. 1 97 

entirely cut off". It should fit snugly to the part, and an 
equal amount of pressure should be maintained. Inflam- 
mation and gangrene (death of a part) are often caused 
by tight bandaging. The fingers or the toes must be 
/eft exposed, so that one can see if the circulation is car- 
ried on all right. They should feel warm to the touch, 
and the color should disappear upon pressure and reap- 
pear when the pressure is removed. If they are cold, 
numb, swollen, or have a livid appearance, the bandage 
should be loosened. If in compound fracture the patient 
has pain, the pulse and temperature should be taken and 
the surgeon be notified. The bandage or dressing must 
not be removed unless the splints are pressing unevenly 
or displacement has occurred, or the fingers and toes are 
congested or swollen and there is danger of gangrene. 

When taking off a bandage it should be rolled up 
loosely in the hand as it is unwound, thereby keeping it 
all together. 

The simplest forms of bandaging are the spiral and 
the figure-of-8 bandage. 

The spiral bandage consists in covering a limb by a 
series of spiral turns, each turn overlapping the one 
below for about one-third its width. In most limbs the 
enlargement at the upper part prevents the application 
of a spiral bandage without making a reversed turn in 
it. Without this turn only one edge of the bandage 
would come in contact with the part, the other would 
stand freely away from it. The reverses are made by 
placing a finger on the lower edge of the bandage to 
hold it firmly in position, and folding the bandage down- 
ward upon itself (Fig. 59). The turns should not be 
made over the prominence of a bone, and where possible 
should be made on the outer side of a limb. At the 



198 



PRACTICAL POINTS IN NURSING. 



moment of making the turn the bandage should be held 
quite loose, and after the turn has been made it can be 





making the turn the 



Fig. 60.— Figure-of-8 bandage. Fig. 61. — Bandaging a wrist. 

pulled as tight as necessary. In 

hand should be held a little above the limb, and care be 

taken not to unroll more bandage than is necessary. 

The figure-of-8 bandage (Fig. 60) 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. 




Fig. 62. — Desault's bandage : a, first roller ; b, second roller; c, third roller. 

The figure-of-8 bandage needs very few reverses ; still, 
they must be employed should occasion require them. 

The Desault bandage (Fig. 62) is applied in the treat- 
ment of fracture of the clavicle. 



ACCIDE.WTS AND EMERGENCIES. 



199 



Fig. 63. — Four-tailed bandage. 



Divided Bandages. — The four-tailed bandage {y'vg. 
63) is useful for dress- 
ings about the face (Fig. 
56), the scalp (Fig. 71), 
and the knee. A inany- 
iailed bandage (Fig. 64) 
is applied to a limb 
which requires frequent 
dressing, and consists of 
a piece of linen or muslin 
the length of the limb 
and wide enough to go 
one and a half times 
around. The muslin is torn from each side, in strips 
about 2 inches wide, to within about 3 inches of the 




Fig. 64.— Many-tailed bandage. 





Fig. 65. — The Scultetus bandage. 



Fig. 66. — T-bandage. 



middle. The central part of this bandage is placed under 
the limb, and the tails are drawn to the front over the 
dressing and tied ; beginning at the lowest pair, the ends 
are brought up and the next pair tied over them. 

The Scultetus bandage (Fig. 65) is used for bandaging 
the abdomen, and is made by taking two pieces of flan- 



200 PRACTICAL POINTS IN NURSING. 

nel or of cotton, each i yard long and 4 inches wide, 
the two pieces being placed 4 inches apart ; across them 
are sewed five other pieces of the same length and width, 
each piece being overlapped by the one above it by one- 
half its breadth. This bandage is placed under the pa- 
tient's back, the cross strips are folded over the abdomen 
from below upward, and the lower ends of the vertical 
strips are brought up between the thighs and pinned to 
the front of the bandage. This keeps the bandage from 
wrinkling and retains it in position. 

J-bandage. — The T-bandage (Fig. 66), which is to 
secure dressings on the anus or the perineum, is made 
of two strips of bandage, each about 5 inches wide. To 
the middle of one strip, which is to go around the waist, 
the end of the other strip is sewed, and is passed be- 
tween the thighs and fastened in front to the waist band- 
age with safety-pins. 

Handkerchief Bandages. — Handkerchief bandages 
(Figs. 67-72), which are very useful in emergencies. 




Fig. 67.— Handkerchief Fig. 68. — Three-cornered Fig. 69. — Four-cornered 

bandage for perineum and bandage for arm. bandage for arm. 

hip. 

consist of large handkerchiefs or of pieces of linen or 
muslin, each about 32 inches square. The triangle is 
made by cutting the square diagonally, so that two 



ACCIDENTS AND EMERGENCIES. 



!0I 



three-cornered pieces is the result. A cravat is made by 
folding in the sharp corner toward the base of the tri- 
angle until a bandage about 3 inches wide is formed. 




Fig. 70.— Various forms of handkerchief bandages : a, for the chest : b, for the shoul- 
der, hand, and arms ; c, double bandage to prevent motion of the arm. 

Muslin cut in the form of a Maltese cross is used to 
apply a dressing snugly over an amputation-stump. 





FlGS. 71, 72. — Four-tailed bandage for the head. 



Figs. 73 and 74 give a very good idea as to the 
various applications of roller-bandages. 

Plaster-of- Paris Bandage. — Plaster-of-Paris bandages, 
which are intended to prevent all motion in a part, are 
made by sprinkling gauze or cotton bandages with 
dentists' plaster of Paris ; these bandages are loosely 
rolled and kept in a covered jar or a tin box to ex- 
clude the air. 




Fig. 73. — I. Demi-gauntlet bandage; 2. Gauntlet bandage; 3. Spica of the thumb ; 4. Spiral 
reverse bandage of the upper extremity; 5. Recurrent bandage of a stump; 6. Spiral reverse 
bandage of the lower extremity (from Att American Text-Book of Surgery). 

202 




ViG. 74. — I. Figiire-of-8 bandage of the ankle ; 2. Method of covering the heel; 2. Recurrent 
bandage of the head: 4. Crossed figure-of-8 bandage of both eyes; 5. Barton's bandage, or figure- 
of-8of the jaw; 6. V'elpeau's bandage (from An American Text-Book 0/ Surgery). 

203 



204 PRACTICAL POINTS IN NURSING. 

When needed the rolled bandages are placed in warm 
water to which has been added a little salt, to help the 
plaster to set more rapidly ; they remain in the water 
until the water-bubbles cease, when they are wrung out 
by holding the bandage at each end, thus preventing the 
plaster coming out at the sides, which happens if the 
bandage is taken in the hand and squeezed in the middle. 
A little plaster cream should be prepared, to be applied 
over the bandage after its application to fill up any crevices. 
The cream must be constantly stirred or it will gradually 
thicken and become hard. The limb is first enveloped 
in a thick layer of sheet wadding, then the prepared 
bandages, after having been thorou^ly wet, are applied 
in the usual manner. After the bandage has been aj> 
plied the dressed limb is exposed to the air until the 
bandage is dry and hard ; after this the limb is placed 
between sand-bags, covered with the upper bed-sheet, 
and the weight of the blankets is supported by a cradle. 

Another method of making the plaster bandage is to 
shake the plaster into cold water until the mixture is of 
the consistency of cream ; the plain mushn or gauze 
bandage is unrolled in a basin of water, re-rolled in the 
basin containing the plaster cream, and then applied ; but 
this method is only resorted to when the powdered band- 
ages are not prepared. The cream must be constantly 
stirred or it will gradually thicken and become hard. 

If the bandage is applied to the upper part of the 
thigh, where it is likely (especially with children) to get 
wet with urine or soiled with fecal discharge, it may be 
kept clean by giving it a coat of varnish. 

Silicate -of -so da Bandage. — A silicate-of-soda dressing 
consists in protecting the limb as in the case of a plaster- 
of-Paris bandage, after which bandages saturated with 



ACCIDENTS AND EMERGENCIES. 20 5 

silicate of soda are applied. Another way is to bandage 
the limb with muslin bandages and paint each layer with 
the silicate. From three to five layers of bandage are 
generally applied. The disadvantage of this dressing is 
that it takes too long .for it to dry thoroughly; it is 
readily removed with water. 

Starch Bandage. — A starch bandage is made by mix- 
ing starch in the way it is ordinarily prepared for laundry 
purposes, applying a bandage over the limb, and painting 
the starch over the bandage ; strips of pasteboard are 
soaked in the starch, laid along the hmb for support, and 
another starch bandage is applied over the pasteboard. 

Chalk-and-giim Bandage. — A chalk-and-gum bandage 
is applied in the same way as the starch bandage. The 
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. 

Strapping" with strips of adhesive plaster is employed 
to secure support and uniform pressure in sprains and 
for producing immobility of the parts in fractured ribs 
and in pleurisy. 

Strappi7ig of joints is done for the treatment of sprains 
of the ankle, knee, wrist, and elbow. Strips of adhesive 
plaster about one inch wide are firmly applied in suffi- 
cient number to cover the joint, each strip overlapping 
the previous one and extending about two-thirds around 
the joint (Figs. 75, 76). 



2o6 



PRACTICAL POINTS IN NURSING. 



Strapping of the Chest. — Strips of adhesive plaster 
about two inches wide and long enough to reach from 




Fig. 75. — Strapping an ankle-joint (after A. S. Morrow). 

the spine to a little beyond the middle line of the chest 
are employed. One end of the strip is fastened to the 




Fig. 76. — Strapping the ribs (after A. S. Morrow). 

skin over the spine behind and is stretched forward 
around the chest to the middle line in front. Each 



ACCIDENTS AND EMERGENCIES. 207 

strip is applied in succession in the same man- 
ner from below upward, overlapping about one-third 
of the previous strip, until the side of the chest is 
covered. 

Splints. — Splints are used to keep a broken bone in 
its proper position. A splint should fit above and below 
the seat of fracture, care being taken that it does not 
press upon any prominent part. There are a large 
variety of splints which are adapted for every part of the 
body, but perhaps the commonest are the coaptation 
splint, which can be adjusted to any part, and the plaster- 
of-Paris splint. 

Splints may be improvised with cardboard, gutta- 
percha, leather, felt, tin, wood, an old hat, a coat rolled 
up, an umbrella, a walking-stick, or newspapers. The 
cardboard, leather, or gutta-percha is first soaked in hot 
water, after which it will easily mould to the part ; such 
splints are perforated to allow the escape of perspiration. 
They should be covered with a compress or with sheet 
wadding of three or four thicknesses, brought smoothly 
over the edges and stitched firmly or held in place with 
strips of adhesive plaster. 

Plaster-of- Paris Splint. — A plaster-of-Paris splint is 
made by taking flannel, linen, or muslin (folded to three 
or four thicknesses) to envelop the limb, and stitching 
through the middle of the folds after the manner of 
stitching the leaves of a book. The folded material is 
soaked in the plaster-of-Paris cream, laid on a board, 
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. 



208 



PRACTICAL POINTS IN NURSING. 



This bandage is readily removed by making a line 
with a knife and dropping water along the line from 
a medicine-dropper or a spoon to soften the plaster, 
after which the bandage can be cut with scissors and 
removed. 

Extension. — Extension (Fig. 77) is used to prevent 




Fig. 77. — Extension apparatus. 

the shortening of a limb. To prevent the extension- 
apparatus gradually puUing 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 3 inches wide 
and long enough to reach from above the knee to below 
the foot, leaving a loop. A piece of wood (4 inches long 
and I inch thick), having a hole pierced through its cen- 
tre, is inserted in the loop beneath the foot and fastened 
in place. The adhesive-plaster strips are placed along 
the sides of the leg to above the knee, and further se- 
cured by a bandage. One end of a stout cord is passed 
through the hole in the wood and knotted. The cord is 
carried over a pulley attached to the foot of the bed and 



ACCIDENTS AND EMERGENCIES. 209 

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, h. 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. 
Occasionally the granulations grow too rapidly and pro- 
ject above the surface of the skin. This condition is 
commonly called " proud flesh," which is removed either 
with nitrate of silver or with the knife. Granulations are 
sometimes pale and flabby and have to be stimulated. 

14 



2IO PRACTICAL POINTS IN NURSING, 

Occasionally a wound healing by granulation will heal 
from the top instead of from the bottom and sides. 
When this process of repair occurs the wound is kept 
open with gauze packing, a little of which is removed 
each day as the wound heals up from the bottom. Only 
an incised wound heals by first intention ; other wounds 
heal by granulation. Healing under a blood-clot, of 
which we so often hear, occurs when an aseptic blood- 
clot remains in a sterile wound. The blood-clot grad- 
ually becomes organized and serves as a scaffolding for 
the new tissue which is thrown out from the surround- 
ing parts. When the wound heals the surface clot breaks 
up, is brought away with the dressings, and a firm scar 
is seen. If the wound has become infected, the clot may 
be swept away with the pus, and the wound then heals 
by granulation. 

Treatment of IVomids. — In the absence of a .physician 
steps must be taken to arrest the hemorrhage (see p. 
214), to clean the wound, and to apply a temporary 
dressing. Remember to clean the hands thoroughly 
before touching a wound, and to bring nothing in contact 
with it which is not sterile or at least clean. If there is 
hair about the part, it should be cut away or shaved for a 
distance of several inches from the cut edges. The skin 
should then be washed with soap and water and followed 
by some antiseptic solution, such as carbolic acid (i : 100) 
or corrosive sublimate (i : 1000). All splinters, pieces of 
glass or clothing, or other foreign bodies should be care- 
fully removed. For temporary dressing simply cover the 
wound, without handling it, with a piece of gauze, linen, 
or lint, and apply a bandage. 

Suppuration, which is a process following infective in- 
flammation, consists in the formation of pus. Should 
the condition not result in recovery, but the infective or 



ACCIDENTS AXD EMERGENCIES. 211 

septic material become absorbed into the system, erysip- 
elas — a local condition, or septicemia, a general condi- 
tion of blood-poisoning-, or pyemia, septicemia with the 
general formation of abscesses — may result. 

Erysipelas. — Erysipelas is an acute specific febrile dis- 
ease due to a germ known as the streptococcus, that 
gains access to the body through a wound, frequently by 
means of unclean instruments, sponges, dressings, or 
hands. The symptoms are an initial chill, malaise, high 
temperature, and a peculiar swelling, redness, and in- 
flammation of the skin and subcutaneous tissues. There 
is usually a sharp line of demarcation between the in- 
flamed skin and the surrounding healthy skin. 

Py>eniia. — Pyemia is blood-poisoning together with the 
formation of abscesses. The symptoms are severe chili, 
followed by profuse perspiration, rise of temperature and 
pulse, nausea, vomiting, and diarrhea, and pain at the 
point where the abscesses are 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 injur}^ 
The earliest symptom is stiffness of the neck, after which 
the muscles of the face and jaw become rigid, so that the 
patient cannot open his mouth. This condition is com- 
monly called " lockjaw." Gradually the other muscles 
are affected by spasms, which are very severe, and the 
face has a peculiar grinning expression. If the body is 



212 PRACTICAL POINTS IN NURSING. 

bent forward, the condition is called " emprosthotonos ;" 
if the head is stretched backward and the spine arched, 
it is called " opisthotonos." 

The treatment of tetanus consists in keeping the pa- 
tient perfectly quiet in a darkened room, care being taken 
to disturb him as little as possible. Nourishment, stimu- 
lants, and medicine may be given by the rectum if nec- 
essary. Morphia may be given subcutaneously. The 
bowels must be kept open, and retention of urine may 
be relieved by catheterization. The number of spasms 
must be counted and the degree of their severity be 
noted. The pulse is rapid and weak, and the temper- 
ature is slightly elevated. The exhaustion is extreme, 
due to loss of food and sleep. An acute attack may 
result in death from asphyxia or exhaustion in from 
three to five days, the mind, as a rule, being clear to 
the end. 

Gangrene is the mortification or death of a part, pro- 
duced by the stoppage of the circulation in that part. 
It results from obstruction to an artery or a vein ; it may 
follow severe frost-bites or a severe form of inflamma- 
tion in a weakened part; it is common in diabetes. 
The germs destroy the vitality of the part, and spread 
until they meet with parts strong enough to resist their 
action ; then a line of demarcation is formed. There are 
two forms of gangrene, moist and dry. 

Moist gangi'ene may be produced by an accident when 
the injury is extensive, the part devitalized, and the return 
of venous blood obstructed or cut off. The symptoms 
are first pain and intense burning in the part; red skin- 
coloration which changes to a purple or a greenish-black ; 
there is a fetid odor; the part is swollen and soft; the 
skin is raised in blisters ; there is a watery discharge ; 



I 



ACCIDENTS AND EMERGENCIES. 213 

and the line of demarcation marks the Hving from the 
dead part. 

Dry gangrene, or "senile gangrene," as it is called, is 
due to an impaired condition of the circulation in parts 
at a distance from the heart, such as the toes, where the 
circulation is not very vigorous, or to a diseased condi- 
tion of the arteries, whereby the supply of arterial blood 
is cut off. 

The symptoms are numbness and tingling in the part ; 
the color of the skin gradually changes to a dark red, 
then to purple, and finally the .part destroyed becomes 
black, dry, wrinkled, and resembles in appearance the 
limb of a mummy. When the progress of the disease 
is arrested a hne of demarcation is formed. The de- 
pressed and lowered condition of the patient must be 
met with stimulants and nourishing food, and thorough 
antisepsis be observed. 

Abscess. — An abscess is a collection of pus occurring 
in any of the tissues or organs of the body, and is one 
of the terminations of inflammation. It may be acute or 
chronic (cold), circumscribed or diffused. 

Boil. — A boil (furuncle) is a localized inflammation of 
the skin and subcutaneous tissues, frequently about a 
sebaceous gland, forming a small painful swelling with 
pus-formation and ending in the expulsion of a necrosed 
centre or " core." A blind boil is a non-suppurating swell- 
ing that gradually subsides, the contents being absorbed. 

Carbuncle. — A suppuration of the subcutaneous tis- 
sue, most generally situated under the thick skin at the 
back of the neck, is a carbuncle. It is distinguished 
from a boil by being larger and of longer duration, in 
having no central core, in having several points of sup- 
puration, in being less defined and prominent, but more 
extensive in its sloughing. 



214 PRACTICAL POINTS IN NURSING. 

The treatment is surgical, antiseptic dressing, and good 
nourishing food. 

Ulcer. — An ulcer is an open sore, attended by dis- 
charge, generally due to certain difficulties obstructing 
the heahng process. 

Fistula. — A fistula is an abnormal opening between 
an internal part and the surface of the body, or between 
two organs of the body, such as the bladder and vagina 
or the vagina and rectum. 

The treatment is surgical ; fresh air, good food, and 
tonics are essential. 

Sinus. — An opening upon the surface of the skin, 
ending in the cavity of an abscess, is a sinus. It is gen- 
erally 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. 

Hemorrhag'es. — It is impossible to be too thoroughly 
prepared to meet the emergency of hemorrhage, as the 
care and responsibility of the patient rest entirely upon 
the nurse until the arrival of the surgeon. 

Hemorrhage may be external or internal. The bleed- 
ing may come from the arteries, the veins, or the capil- 
laries. Arterial blood is bright red, and bursts out in 
spurts with each beat of the heart. Venous blood is 
dark ; the stream is steady, flowing to the heart. Cap- 
illary blood is of an intermediate shade, and oozes. 
Capillary hemorrhage is dangerous only when a num- 
ber of capillaries give way at one time. 



ACCIDENTS AND EMERGENCIES. 215 

Hemorrhage is also primary, recurrent (intermediate), 
or secondary. Primary hemorrhage is that which takes 
place when an incision is made. Recurrent or ijiterynedi- 
ate hemorrhage is that which takes place during the first 
twenty-four or forty-eight hours after an operation, and 
which is due to the force of the circulation of the blood 
after reaction has set in, to the displacement of clots 
through restlessness, or to the slipping of a ligature. 
Secondary hemorrhage takes place between the first day 
and the complete healing of the wound, about the time 
the ligatures or sloughs separate. It is generally caused 
by diseases of the walls of the arteries, by a ligature not 
being strong enough or being tied too loosely, or by the 
too rapid absorption of a catgut ligature, or by sepsis, 
the germs eating their way through the walls of the 
blood-vessels, which become so thin that they cannot 
stand the force of the blood pumping through them, and 
finally burst. Children do not stand the loss of blood 
well, but they rapidly recover as a rule. Adults in 
health stand the loss of blood well ; old people do not, 
neither do they quickly recover. 

Symptoms. — The symptoms of hemorrhage are rest 
lessness, faintness, demand for air, weak and rapid pulse, 
subnormal temperature (96° or 97° F.), anxious expres- 
sion, pale face, cold extremities, feeble, sighing respira- 
tions, sometimes a rnist over the eyes, and a roaring in 
the ears. 

Treatment. — The treatment of hemorrhage consists 
of position and pressure. The bleeding part should 
be elevated to promote the supply of blood to the 
vital centers; pressure may be applied with the finger 
on the artery, or the wound may be plugged with 



2l6 PRACTICAL POINTS IN NURSING. 

sterilized gauze or with a handkerchief; morphin (gr. J) 
may be given to secure rest and quiet, stimulate the 
heart, and contract the blood-vessels. The patient is to 
be kept perfectly quiet, to allow the blood to coagulate 
in the vessels, and plenty of fresh air should be given. 
Alcoholic stimulants must be given very cautiously, as 
they excite the heart's action and irtcrease 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 
stop hemorrhage. A pad of cotton is put in the joint — 
the hollow of the elbow, under the knee, or in the groin ; 
against this pad pressure will be made when the limb is 
bent. Ice and very hot water are also used in hemor- 
rhage, heat being the better, as it stimulates the blood- 
vessels and causes the blood 4:o coagulate, while ice par- 
alyzes the vessels, stopping the hemorrhage for a while ; 
but when the ice is removed and reaction from the cold 
sets in, and the circulation is restored, the blood-vessels 
dilate wider than before and the bleeding begins again. 
Moreover, with the application of ice, which is seldom 
clean, there is the danger, if it be put on a raw surface, 
of introducing germs into the system. Fainting has a 
tendency to check hemorrhage, as it permits the blood 
to coagulate. 

Venous hemorrhage is checked on the side of the 
wound that is away from the heart. The limb should 
be elevated slightly and pressure applied. 



ACL IDE NTS AND EMERGENCIES. 2 1/ 

A tourjiiqnct made of a piece of compress or a knotted 
handkerchief tied and twisted with a stick, the knot or 
some round smooth object being over the artery (Figs. 
']% and 79), will stop the circulation to a part, but it 





Figs. 78, 79. — Impromptu tourniquets for compressing an artery with a handkerchief 
and a stick. 

cannot remain on longer than half an hour or the part 
may die. Position, pressure, and morphin are the best 
remedies for hemorrhage. The first two can always be 
had, and morphia sustains the heart's action, secures rest 
and quiet, and contracts the blood-vessels. 

The other methods of stopping hemorrhage — tor- 
sion, ligation, cauterization, acupressure — belong to the 
surgeon. 

When much blood has been lost the patient suffers 
greatly with thirst, which is often extreme on account of 
the amount of fluid that has been taken from the body. 
For this reason there may be given to drink, in small 
quantities, cold water, which will relieve the thirst and 
also make up for the amount lost by resorption. The 
patient should be fed well and often and in small quan- 
tities. 

Bleeding from the palm of the hand may be controlled 
by clasping a clean handkerchief and holding the hand 
high above the head. 



2l8 PRACTICAL POINTS IN NURSING. 

Hemoptysis. — In hemorrhage from the lungs (hemopty- 
sis) the blood is bright red, and frothy from its admixture 
with air. In treating hemoptysis the head and shoulders 
are elevated and an ice-bag or an ice poultice is applied 
to the chest ; crushed ice may be given the patient to 
swallow. Equal parts of vinegar or lemon-juice and 
water, given in teaspoonful doses, or a quarter of a tea- 
spoonful of dry salt, will contract the blood-vessels. 
Rest and quiet will be obtained by the administration of 
morphin (gr. |-), chloral (gr. x), or bromid of potassium 
(gr. xx). 

Hematemesis. — Bleeding from the stomach (hemateme- 
sis) is treated in the same way as that from the lungs. 
The blood in this case is vomited, is of a dark-red color, 
and contains particles of food. The feces are of a very 
dark color, through the blood having passed into the 
intestines. It is always well to examine the nose and 
throat, because the bleeding may not come from the 
stomach, but from the nose, the blood having passed 
down the throat into the stomach. 

Epistaxis. — For nosebleed (epistaxis) the head and arms 
should be elevated, and pressure with the fingers should 
be made on the nostril from which the blood is coming, 
or a small piece of lemon or a small piece of cotton 
wrung out of vinegar and inserted will contract the 
blood-vessels. The patient should not blow the nose, 
as it will disturb the formation of clots. Ice may be 
applied to the back of the neck and to the forehead. 

Burns and Scalds. — Burns and scalds are the same in 
effect. A burn is caused by dry heat — fire or heated 
metals ; a scald is caused by moist heat — heated fluids 
or steam — and is apt to be extensive, because the fluid 



ACCIDENTS AND EMERGENCIES. 219 

spreads over a larger surface than a burn ; a burn, how- 
ever, is deeper. Burns are of three degrees : 

1. Inflammation without bhsters, or destruction of the 
epidermis without penetrating the true skin. 

2. Inflammation of the skin resulting in the formation 
of blisters, the latter caused by an outpouring of the 
water of the blood, that lifts the outer skin from the 
true skin. 

3. Partial or complete destruction of the nerves and 
blood-vessels of the part. Their vitality is destroyed. 

A bum of theyfrj-/ 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 w^ork is thus thrown upon the kid- 
neys, which become inflamed, -and death may occur from 
nephritis, which is inflammation of the kidneys. 

Burns of the second degree may end fatally if exten- 
sive, because the superficial blood-vessels are destroyed ; 
consequently, more blood is driven to the internal or- 
gans of the body, which become very much congested, 
and acute inflammation sets in, which may result in death. 
Death from burns of the second degree may occur from 
shock, exhaustion after long-continued suppuration, which 
follows the separation of the sloughs, also septicemia or 
tetanus (lockjaw). 

The result of a burn of the third degree is nearly 
always fatal in the old or the young, and is determined 
by the part affected and by the age and health of the 
patient. Burns of the abdomen, the head, and the chest 
are more severe than those of the extremities, because 
they are nearer the vital organs. 



220 PRACTICAL POINTS IN NURSING. 

Shock is always present in burns of the first degree, 
though not so great as in those of the second and third 
degree, and the reaction after shock may result in in- 
flammation of any of the vital organs. 

Pain is severe in slight burns, because the nerve-end- 
ings are exposed ; it is less severe in deep burns in which 
there is total destruction of the part. 

Edema of the Glottis. — Edema, or dropsy of the glottis, 
is caused by the inhalation of steam or the drinking of 
scalding liquids. Edema is a pouring out of the watery 
part of the blood into the tissues, and the effusion may 
increase with great rapidity. Death by suffocation may 
occur within a very short time. The symptoms of edema 
are gradual loss of voice, difficulty in breathing, and 
blueness of the surface of the body (cyanosis) from in- 
sufficient oxidation of the blood, gasping respirations, 
and a flickering pulse. Tracheotomy or intubation is 
generally performed. There may be inflammation with- 
out edema, and this may develop into bronchitis and 
pneumonia. 

The treatment of burns and scalds consists in first at- 
tending to the shock by the appHcation 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 burn is slight and no blis- 
ters have formed, the part is to be dressed with a satu- 
rated solution of ordinary baking-soda or dusted with 
either baking-soda, flour, or starch, and the air excluded, 
because air is an irritant. If blisters have formed, they 
should be opened, the fluid being allowed to run on to a 
piece of cotton, and then dressed with either carbolic- 



ACCIDENTS AND EMERGENCIES. 221 

acid solution (i : 40), sodium-bicarbonate water, sweet 
oil, vaselin, zinc ointment, or Carron oil (equal parts of 
linseed oil and lime-water), and the air excluded. 

A raw surface should not be dusted with flour, starch, 
or any other powder, because these substances harden 
and form crusts, which are painful to remove. The 
dressing should be removed only when really necessary, 
on account of the extreme pain, and only one part at a 
time should be exposed and dressed. If the dressing 
adheres to the part, it should not be pulled off, but 
should be wet, so that it will come off without causing 
the patient much pain. The bed should be made up 
with old sheets and old pillow-cases. The patient's 
strength should be maintained with a nutritious diet 
and stimulants, and the thirst relieved with crushed 
ice. The bowels should be kept open, and the nurse 
should watch for retention of urine. 

Complications of Burns a?id Scalds. — Some of the 
complications are delirium, meningitis, ulceration of the 
duodenum (the first part of the small intestine near the 
stomach), which may result in perforation of the intes- 
tine and cause peritonitis, inflammation of the lungs and 
kidneys or intestines, and retention or suppression of 
urine. Great distortion or deformity is often caused by 
contraction of the healing skin. The scars are densely 
white. To prevent deformity, the parts are put in splints 
in the best possible position ; skin-grafting is often re- 
sorted to, and in some cases amputation is performed. 

Sunstroke. — The symptoms of sunstroke are a tem- 
perature of from 105 to 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 



222 PRACTICAL POINTS IN NURSING. 

beach and put in the water ; the head may be kept cold 
by bathing it, or by the application of handkerchiefs 
wrung out of the water. If a cold bath is impossible, 
the patient may be douched with cold water from a 
hose-pipe or from pails, and cold cloths be kept on the 
head. Enemata of ice-water are very good. The cold- 
water treatment must be continued until the temperature 
has fallen, after which the patient should be put to bed, 
and, if there is depression, be given stimulants moder- 
ately. Should the temperature begin to rise, the above 
treatment should be renewed. 

Heat-exhaustion. — Heat-exhaustion is caused by too 
long exposure to a very high temperature ; the blood 
leaves the brain and the surface of the body, and goes 
to the large blood-vessels of the abdomen. The symp- 
toms are those of shock. The treatment is the same as 
that for shock : hot bath if possible, or heat applied to all 
parts of the body ; stimulants of alcohol or strong coffee. 

Lightning'-stroke. — For a lightning-stroke the treat- 
ment is the same as that for shock. 

Fainting-. — The head of a person in a faint should be 
lowered and the feet raised, the blood being thus sent 
back to the brain. Plenty of air, the clothing loosened 
about the neck and chest, and a little cold water dashed 
over the face, are usually sufficient to restore conscious- 
ness. A method often practised is to place the patient 
on a chair, and to push the head down between the 
knees, the hands hanging down by the side. The pa- 
tient is kept in that position until the face becomes red, 
being then able to rise and walk about. This position 
restricts the abdomen and shuts off the blood-supply to 
the lower extremities, the blood going to the brain. 
Strong ammonia should not be held to the nostrils of 



ACCIDENTS AND EMERGENCIES. 



223 



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 




fiG. 80.— Artificial respiration: first movement, inspiration (Murray). 

sent for. Little can be done for loss of consciousness 
from heart-failure, beyond stimulating a flagging pulse, 
until the arrival of medical assistance. 



^ 



% 




Fig. Si.— Artificial respiration : second movement, expiration (Murray). 

Dro\yTiing. — In asphyxia from drowning, if the person 
when taken from the water is breathing, he should be 
removed, if possible, to a near-by house, and put into a 



224 



PRACTICAL POINTS IN NURSING. 



hot bath, which will act as a stimulant ; or heat may be 
applied directly over the heart and other vital organs, 
the head and. shoulders be raised, stimulants given, and 




Fig. 82. — Artificial respiration : expiration, assistant exerting pressure on the chest 
(Murray). 

the body briskly rubbed. This can be done until the 
arrival of a physician. In all cases of suffocation the 
throat must be cleared, so that fresh air can reach the lungs. 




Fig. 83. — Expressing- water from the stomach and lungs (Murray). 

Artificial respiration is the imitation, as nearly as possi- 
ble, of natural breathing. We breathe from sixteen to 



ACCIDENTS AND EMERGENCIES. 22 ^ 

eighteen times a minute ; this number of chest move- 
ments must not be exceeded, or the lungs cannot ex- 
pand to fill thoroughly with air nor contract to expel 
the air. 

To produce artificial respiration in case of drowning or 
of suffocation, the patient's clothing is first removed and 
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 rolled-up coat, or a piece of wood should be 
placed under the shoulders. The arms near the elbows 
should now be grasped and be swept around horizon- 
tally, away from the body, until the hands meet over the 
head (Fig. 80) ; 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 
over the pit of the stomach (Fig. 81); 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. 

15 



226 PRACTICAL POINTS IN NURSING, 

Accidents from Electricity. — Great caution should 
be observed in approaching a person who has received an 
electric shock and is still in contact with the current. 
The current must be turned off before touching the 
body. Medical aid must be got at once. In the mean- 
time friction and external heat should be applied to the 
extremities. Give artificial respiration if breathing has 
ceased. The burns are to be treated like those of fire 
(p. 220). 

Retention of Urine. — Retention of urine is due to the 
patient's inability to pass urine, owing to shock, paralysis, 
hysteria (commonly known as hysterical retention), or 
other causes, which, if not relieved, may result in rupture 
of the bladder or uremic poisoning through resorption. 
The patient should be put into a hot bath if possible, 
which will act as a stimulant, relieve the pain, contract 
the muscular coats of the bladder, and also produce per- 
spiration. If the bath is impossible, a hot poultice or 
fomentation should be applied over the bladder, or cath- 
eterization may be practised and a simple enema be 
given. 

Head-accidents. — For all accidents to the head, the 
part is to be bathed with warm water and firm pressure 
with a clean compress be made until the arrival of a 
physician. 

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. 



ACCIDEXTS AXD EMERGEXCIES. 22J 

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 apoplex}*. In both 
these injuries, until the arrival of a physician, who should 
be sent for at once, the patient should be placed in bed 
with the head slightly raised ; the room should be dark- 
ened and cold applied to the head. If there is shock, heat 
is to be applied, but stimulants are not to be given with- 
out orders from the doctor. 

Cuts and Bruises. — For a cut or a bruised finger, the 
part is to be washed thoroughly with an antiseptic solu- 
tion or with boiled sterilized water, then ^\^th dilute alco- 
hol or with hamamelis (witch-hazel), and the part bound 
up with clean cotton and a bandage. For treatment of 
wounds, see p. 210. 

Foreign Bodies. — A foreign body in the ear should 
be removed at once. If the obstruction be an insect, 
the patient should lie on the side with the attected 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 ver\' 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 
syringed. If the obstruction is a button, a stone, or cot- 
ton, one may try to syringe it out; but nothing else 
should be attempted, or the obstruction may be pushed 
farther in. A foreign body in the nose, if it can be seen, 
may be removed with a bent hair-pin or with forceps. 

An obstruction in the throat may be removed by the 
drinking of water, the swallowing of a piece oi bread. 



228 PRACTICAL POINTS IN NURSING. 

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 i7i the eye may be removed by having 
the patient look down ; a pencil or some similar thin 
body is then placed across the upper lid, and the lashes 
are seized and the lid turned over ; the exposed particle 
is then wiped off. 

Insect Bites and Stings. — Insect or mosquito bites 
are treated by bathing the part with dilute or pure vin- 
egar or with a solution of carbolic acid (i :4o). 

Dysmenorrhea. — Dysmenorrhea, or painful menstrua- 
tion, very often calls for prompt treatment, which consists 
in hot mustard foot-baths, rest in bed, the application of 
hot flaxseed poultices, or turpentine or mustard fomenta- 
tions to the lower part of the abdomen, and a hot-water 
bottle to the back and one to the feet. Drinks of hot 
ginger-tea or of gin will increase the circulation. It may 
be mentioned that painful menstruation is often the re- 
sult of tight lacing : the abdominal organs are crowded 
down upon the womb, the bladder, and the rectum, and 
the womb is forced down out of its normal position, the 
free escape of the blood thus being prevented. Expo- 
sure to cold during menstruation is another cause. A 
normal menstruation should be painless. 

Vomiting'. — To relieve vomiting a mustard plaster or 
an ice poultice over the stomach is very good. If the 
vomiting is caused by constipation, a Seidlitz or a Ro- 
chelle powder will generally stop it. 

Flatulence. — Flatulence is relieved by lo 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. 



ACCIDENTS AND EMERGENCIES. 229 

Intoxication. — Ordinary intoxication requires only 
rest and sleep. If the patient is exhausted, an emetic 
may be given. He should then be covered warmly. 
For the diagnosis of intoxication from apoplexy, see p. 
288. 

Toothache. — Toothache may be relieved by oil of 
cloves, oil of peppermint, or creasote applied on cotton 
and inserted in the cavity of the tooth. 

Insomnia. — Insomnia, or sleeplessness, considered as 
an emergency, may be relieved by the application of 
heat to the abdomen, and to the feet if they are cold. 
Should the patient sleep the first few hours of the night, 
then awake, and remain so during the early morning 
hours, a light meal, such as a cup of hot cocoa and a 
cracker, or even a glass of hot milk, will induce sleep 
by drawing the blood-supply from the brain to the stom- 
ach, and at the same time the blood will be replenished 
by substances formed in the process of digestion, that 
have a soothing effect. Wakefulness is increased if there 
is a light in the room, because the brain cannot rest un- 
less there is darkness : to procure this the room should 
be darkened as much as possible and a handkerchief 
folded over the patient's eyes. 

Sunburn. — Sunburn is painful, and may be relieved 
by any kind of oil or by a wash made of sodium bicar- 
bonate, and by excluding the air. 

Burns by Acids and Alkalies. — A burn by an acid 
should be treated by pouring over the burn a solution 
of sodium bicarbonate and water or plain water to dilute 
the acid; the part is then dressed as for an ordinary 
burn. For a burn by an alkali, for instance, quicklime, 
an acid is applied, such as lemon-juice or vinegar. For 
burns of the eye with an acid or an alkali the eye should 



230 PRACTICAL POINTS IN NURSING. 

be washed immediately with warm water to dilute the 
substance and to prevent its being absorbed; vaselin or 
any of the oils then should be applied. 

Frost-bite. — Frost-bite is due to extreme cold. The 
vitality of the part is lowered and the circulation in it 
ceases. Exposure to intense cold may cause death, 
owing to the action of the skin and the superficial blood- 
vessels being cut off; as a consequence, the internal 
organs are very much congested, which condition is 
followed by congestion of the brain, causing drowsiness, 
stupor, and coma, and ending in death. 

The treatment of frost-bite consists in rubbing the part 
with snow or with ice-water, which will gradually dilate 
the contracted blood-vessels and start up the circulation 
m the part. The patient must be kept in a cold room. 
As the temperature of the part and of the body rises, the 
patient should be rubbed gently with equal parts of alco- 
hol (or vinegar) and water, and the temperature of the 
room be slowly increased ; or the patient may gradually 
be removed to a warmer room. The part should be 
exposed to the air for a while and then covered. Hot 
drinks and stimulants are to be given if necessary. 

The return to heat must be gradual, as the sudden 
reaction of the circulation in the part may result in 
intense inflammation and gangrene. Should inflamma- 
tion set in, cloths wet in equal parts of alcohol (or vine- 
gar) and water may be applied. 

Chilblains. — Chilblains are caused by exposure to 
cold, followed by a sudden return to heat. The treat- 
ment is the same as that for frost-bite. Patients 
after one attack should wear woollen stockings and 
gloves. 



accidents and emergencies, 23 i 

3. Accidental Poisoning. 

Poison Defined. — A poison is a substance which, when 
taken into the body, produces either disease or death. 
Any substance causing death when taken into the stom- 
ach is a poison. Poisons may also enter the circulation 
through the broken skin. 

Classification and Action of Poisons. — Poisons are 
divided into two classes — irritants and narcotics. The 
irritant poisons act on the stomach and bowels, and the 
symptoms of all such poisons are generally the same. 
Coming in contact with the lips, mouth, throat, and 
stomach, they produce a burning sensation and give rise 
to vomiting and pain in the stomach and abdomen, the 
pain being increased upon pressure, and by purging. 
The effects of the poisons are chiefly upon these organs, 
which they irritate and influence. After all irritant poi- 
sons, demulcent drinks, such as flaxseed tea, white of 
eggs, glycerin, sweet oil, starch-water, or warm milk, 
should be given to soothe the inflamed mucous mem- 
brane. Narcotic poisons act upon one or more parts of 
the nervous system, producing headache, giddiness, 
numbness, stupor, and paralysis, and often convulsions 
and death. They have not the burning taste of irritants, 
and rarely give rise to vomiting and purging. 

What to Do in Case of Poisoning-. — The first thing 
to do in all cases of poisoning is to ascertain what kind 
of poison has been taken, either from the symptoms pro- 
duced or from the vomited matter. If this detection is 
impossible, the stomach is to be emptied — that is, if the 
drug has been taken by mouth — to prevent the poison 
being absorbed ; the antidote (a remedy to counteract 
the effect of the poison) is then to be given. If the 



2 32 PRACTICAL POINTS IN NURSING. 

poison has been absorbed, medicines are given to coun- 
teract its effect on the temperature, the respiration, or 
the circulation. Vomiting may be induced by giving 
mustard and warm water, salt and warm water, tepid oil 
and water (a tablespoonful to a cup of water), warm 
water, or by running the finger down the throat, or by 
tickling the throat with a feather. Vomiting is gener- 
ally easier if the stomach is full of food or of fluid. 
Should the stomach be empty, a quantity of fluid should 
be given before the emetic. 

When emetics are administered, they should be given 
quickly and not more than half a pint at a time, or the 
walls of the stomach may become paralyzed through 
over-distention. After vomiting, the patient should drink 
plenty of milk or water, and the bowels should be 
cleared, in case the poison has entered the intestines. 

A few of the most common poisons and their anti- 
dotes are the following : 

Irritant Poisons. — Carbolic Acid. — Any soluble sul- 
fate, such as sulfate of magnesium (Epsom salts) or 
sulfate of sodium (Glauber's salts), as a chemical anti- 
dote ; wash out the stomach with a solution of a soluble 
sulfate or with dilute alcohol; fixed oils; demulcent 
drinks, such as flaxseed tea ; counteract the collapse with 
hot applications to the extremities, heart-stimulants, such 
as strychnin, caffein, etc. 

Carbonic Acid. — Removal of patient from the room ; 
artificial respiration ; cold douche to the face and 
chest ; inhalations of ammonia, amyl nitrite, or oxygen ; 
enema of strong coffee ; bleeding and hypodermoclysis ; 
friction ; stimulants, etc. 

Oxalic, Acetic y and Tartaric Acids. — Calcined magne- 
sium, carbonate of calcium, chalk, hme-water or plaster 



ACCIDENTS AND EMERGENCIES. 233 

or whitewash scraped from the wall (in an emergency) ; 
stomach-tube ; mucilaginous and demulcent drinks ; 
heart-stimulants. 

Prussic Acid {Hydrocyanic Acid, Cyaiiid of Potassium). 
— Usually the patient dies promptly ; if he lives for a 
half-hour he is likely to recover. Use emetics or the 
stomach-tube ; dilute hydrogen peroxid or potassium 
carbonate and follow with sulphate of iron ; artificial 
respiration ; hypodermoclysis and intravenous infusion 
of normal salt solution ; stimulants. 

Mineral Acids {Sulphnric, Nitric, Hydrochloric, and 
Phosphoric). — Magnesium, whiting, chalk, lime-water, 
sodium carbonate or bicarbonate; milk, white of ^gg, 
plaster or whitewash scraped from the wall (in an emer- 
gency) ; demulcent drinks, stimulants ; and morphin to 
relieve pain. 

Alkalies {Ammonium, Caustic Soda, Caustic Potash). — 
Acids, such as vinegar, acetic acid, tartaric acid, citric 
acid, lemon-juice mixed with water or some bland oil ; 
fixed oils ; white of Qgg ; milk ; morphin to relieve the 
pain. 

Arsenic and Paris Green. — Stomach-tube or emetic ; 
the chemical antidote, the freshly prepared hydrated 
oxid of iron, made by precipitating the solution of the 
tersulfate of iron (or the tincture of the chlorid of iron) 
with ammonia. Mix and strain, and give the precipitate ; 
magnesium ; demulcent drinks ; morphin and stimulants 
if necessary. 

Corrosive Sublimate. — Stomach-tube or emetics ; white 
of ^gg (chemical antidote); milk or flour and water; 
atropin ; stimulants. 

Ergot. — Stomach-tube or emetics ; nitroglycerin or 
amyl nitrite ; stimulants. 



234 PRACTICAL POINTS IN NURSING, 

lodm. — Stomach-tube or emetics ; boiled starch or 
boiled flour paste ; demulcent drinks ; morphin and stimu- 
lants if necessary. 

Phosphorus. — Stomach-tube or emetics ; sulfate of cop- 
per, as emetic and chemical antidote ; water containing 
small amount of oil of turpentine ; stimulants ; no oil or 
fats, as they favor absorption of the phosphorus. 

Ivy Poisoning. — The intolerable itching may be relieved 
by plain water, baking soda and water, lime-water, lead- 
water and laudanum, grindelia robusta, etc. 

Narcotic Poisons. — Aco7iite. — Stomach-tube or emet- 
ics ; stimulants — ammonia, ether, strychnin, atropin, digi- 
talis ; external heat ; artificial respiration. 

Alcohol. — Stomach-tube or emetics ; strong coffee, caf- 
fein, strychnin; aromatic spirit of ammonia; cold 
douches ; artificial respiration ; electricity. 

Atropin and Belladonna. — Tannic acid followed by 
stomach-tube or emetics ; physiologic antidotes — mor- 
phin, physostigmin, and pilocarpin ; strong coffee or tea ; 
artificial respiration ; stimulants. 

Chloral. — Stomach-tube or emetics ; strong coffee ; 
strychnin ; artificial respiration ; electricity ; stimulants. 

Digitalis. — Stomach-tube or emetics ; tannic acid ; 
strong tea ; cathartics ; stimulants. 

Opium, Morphin, Laudanum, and other Preparations 
of Opium. — Stomach-tube or emetics ; dilute solution of 
potassium permanganate ; tannic acid ; strong coffee or 
tea ; caffein ; atropin ; strychnin ; alcohol ; oxygen ; artificial 
respiration ; tongue traction ; cold douches ; keep patient 
awake ; electricity ; etc. 

Nux Vomica and Strychnin.— ^\.om'd.<z\v-i\x\it or emetics ; 
tannic acid ; inhalations of ether or chloroform ; chloral ; 
potassium bromid ; oxygen ; artificial respiration ; amyl 
nitrite; heart-stimulants. 



ACCIDENTS AND EMERGENCIES. 235 

Amyl Nitrite. — Fresh air; hcart-stiniulants ; respiratory 
stimulants ; atropin and morphin hypodermically. 

Ptomain Poisoning (Tainted Meat, Fish, Cheese, Ice Cream, 
Mushrooms, etc.). — Stomach-tube or emetics ; cathartics ; 
atropin ; opium or morphin if necessary; stimulants. 

Bites of Rabid Animals. — Poisoned bites by a mad 
dog or by serpents should be treated by having the 
poison sucked out of the wound (unless there is an 
abrasion on the nurse's lip), and the wound afterward 
washed with plain warm water. Further spread of the 
poison may be prevented by placing a tight ligature about 
the part above the point of injury. Such a ligature, how- 
ever, must not be left for any length of time, but should 
be loosened at intervals. The patient must be taken at 
once to a physician, who will cauterize the wound. The 
patient must be given stimulants in moderate quantities 
to sustain the system. The state of the pulse must be 
taken as a guide to indicate when the proper amount of 
stimulation has been reached. 

Hydrophobia or rabies is a disease which is sometimes 
communicated to man through the bite of a dog having 
the disease. The disease develops about six weeks after 
the wound is received. The symptoms are depression 
and irritability, followed by marked excitability and sen- 
sitiveness of the nervous system, with spasm of the mus- 
cles of the throat. There is generally some fever. The 
final stage is marked by paralysis and coma. The im- 
mediate treatment of the wound is as given above. The 
Pasteur treatment consists of hypodermic injections of a 
specially prepared serum. The most important feature 
of the nursing of rabies consists of securing extreme 
quiet in a darkened room. 



236 PRACTICAL POINTS IN NURSING. 

In all emergencies the nurse must keep perfectly calm ; 
she should think what has happened and what should 
be done, and then do it quietl-y. If she gets excited and 
loses her presence of mind, the life of the patient may 
be lost. When notifying the physician or surgeon 
she should send a written, not a verbal message, and 
should state clearly what has happened, so that he will 
fully understand and come prepared : he should also be 
informed of what is being done by the nurse. 



V. NURSING IN SPECIAL MEDICAL 
DISEASES. 

Infectious and Contagious Diseases. — Infectious dis- 
eases are diseases caused by the introduction into, and the 
growth and multiplication within, the body of microor- 
ganisms (known also as germs and bacteria). Those 
infectious diseases readily communicable from one person 
to another are known as contagious diseases. But inas- 
much as both terms, infectious and contagious, are fre- 
quently confused, the diseases in question are now often 
spoken of as communicable and non-communicable, or 
transmissible and non-transmissible, infectious diseases. 
Every infectious disease is caused by a specific germ — a 
germ that produces that disease and no other. Exposure 
to an infectious disease does not always result in pro- 
ducing that disease ; the mere presence of the active 
specific cause of the disease is not sufficient to produce 
the disease — the germs must find conditions in the indi- 
vidual suitable for their growth and multiplication. 
Some persons by nature seem to be able to withstand 
the germs of certain diseases ; these persons are said to 



NURSING IN SPECIAL MEDICAL DISEASES. 237 

be naturally immune to that disease. After a person has 
had one of the infectious diseases, such as typhoid fever 
or small-pox, etc., he usually does not get the disease 
again ; this person is said to be actively immune to that 
particular disease. Again, a person Hkely to be exposed 
to the germs of diphtheria, for instance, may be given a 
dose of diphtheria antitoxin — a so-called immunizing 
dose ; such a person is said to be passively imynune to 
that disease. In health most persons are able to with- 
stand the attacks of most bacteria, but if their vitality 
becomes lessened from any cause they may readily suc- 
cumb. Thus, a person with a local inflammation of the 
throat is more likely to contract diphtheria than is a well 
person. The germs of typhoid fever require a suitable 
condition of the bowels and the general system before 
they can give rise to typhoid fever. The bacteria of 
consumption, or pulmonary tuberculosis, do not find in 
healthy lungs conditions suitable for their growth. 

Bacteria may gain access to the body by way of the 
gastro-intestinal tract (by means of food and drink), the 
respiratory tract (being inhaled), the genito-urinary tract 
(by means of unclean catheters, etc.), and the skin 
(through wounds, the bites of insects, such as mosqui- 
toes, etc). On finding conditions suitable for their 
growth, the bacteria require some time to develop suffi- 
ciently to give rise to the symptoms of the particular 
disease. The time intervening between the introduction 
of the germs into the body and the development of the 
first symptoms of the disease is known as the period of 
incubation ; this varies considerably in different diseases. 
The first symptoms of the disease are known as the 
symptoms of the period of invasion. Following this 
comes the period of fever, which also varies much in dif- 



238 PRACTICAL POINTS IN NURSING. 

ferent diseases. This is followed by the period of defer- 
vescence — the period during which the fever falls either 
by crisis or by lysis. And, finally, there is the period of 
convalescence, the period of recovery of health. 

Though germs occur widespread throughout the body, 
many of them show a special predilection for certain 
localities. Thus, the diphtheria bacillus occurs in the 
throat, the typhoid bacillus in the intestine, the pneu mo- 
coccus (of pneumonia) in the lung, etc. In general it 
may be said that the local symptoms of infectious dis- 
eases are due especially to the local action of the germs, 
and that the general symptoms, such as the fever and the 
constitutional symptoms, are due to the absorption and 
circulation through the body of a poison, called a toxin, 
that the germs manufacture. The germs of the different 
infectious diseases leave the body through the gastro-in- 
testinal tract (the stools, vomit), the respiratory tract 
(the exhalations, expectoration), the urine, and the skin. 
The germs of diphtheria leave the body through the 
breath, and the discharges from the nose and throat ; 
those of pneumonia and consumption (tuberculosis) with 
the expectoration ; those of scarlet fever and measles 
with the breath, discharges from the nose and throat, and 
the skin, including the desquamation ; those of whoop- 
ing-cough with the breath and expectoration ; those of 
small-pox with all the discharges ; and those of typhoid 
fever with the stools, the urine, the expectoration, etc. 

Infectious diseases may be transmitted from one person 
to another by direct contact with the sick person or with 
a corpse of one dead of the disease ; by indirect contact, 
such as going into a room inhabited by a person ill with 
an infectious disease ; and especially by means of fomites, 
which are substances, such as clothing, letters, dishes, 



NURSING IN SPECIAL MEDICAL DISEASES. 239 

carpets, hangings, children's toys, etc., to which the 
microorganisms adhere. Recently it has been found that 
infectious diseases may be transmitted by means of in- 
sects. Thus, malaria probably is exclusively transmitted 
in this manner : the mosquito bites a malarious patient, 
sucking some of the malarial germs. These develop in 
the body of the mosquito, and subsequently are injected 
into another person when bitten by the mosquito. For- 
merly the term miasmatic disease was used in connection 
with malaria — implying that the cause of the disease is 
to be found in foul air, such as prevails about low, 
marshy grounds. We now know that it is such locdities 
that favor the development of the mosquito. The " ex- 
anthemata " are infectious diseases characterized by an 
eruption — such as scarlet fever, measles, chicken-pox, 
small-pox, etc. 

We guard against the spread of contagious diseases 
by isolating the patient in a room at the top of the 
house, because the air there is purer, and because if the 
patient be on any of the lower floors the poison might 
spread upward through the house ; by the utmost clean- 
liness, by keeping the air pure, by the faithful use of dis- 
infectants, and by hanging a sheet wet with some disin- 
fectant, or even with plain water, before the door of the 
room, so that when the door is opened the germs in the 
air coming from the room will come in contact with the 
wet sheet and cling to it ; by having separate dishes and 
utensils for the room and the patient, and separate bed- 
linen and body-linen, and by thoroughly disinfecting the 
stools, the urine, and the expectoration before disposing 
of them. The very best way to treat the latter is to mix 
them with sawdust and then burn them. 

Typhoid Fever. — Typhoid fever is an acute infectious 



240 PRACTICAL POINTS IN NURSING. 

disease due to the typhoid bacillus which gains entrance 
to the body by means of infected water, milk, or other 
articles of food. The infection always comes from a 
previous case of typhoid fever in which sufficient precau- 
tions were not taken against the spread of the disease. 
It is also called enteric fever, slow fever, low fever, and 
nervous fever, and is characterized by ulceration of cer- 
tain parts of the bowels. The period of incubation is 
from two to three weeks. 

Symptoms. — Some of the symptoms are headache, 
aching pains in the back and the limbs, loss of appetite, 
increasing weakness, nausea, sleeplessness, depression, 
a chilly feeling, nose-bleed, slight diarrhea, gradual rise 
of temperature and increase of pulse, coated tongue, 
stupor, and delirium. There may be coma vigil, the 
patient lying perfectly quiet with his eyes open, but 
paying no attention to what is going on around him. 

The temperature gradually rises morning and evening 
until it reaches 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 
than that of the evening. During the fourth week the 
temperature is almost normal in the morning, and rather 
irregular. A sudden drop would indicate hemorrhage 
or perforation of the bowels. The pulse is generally 
rapid, and in severe cases may be dicrotic. 

About the second week rose-colored spots appear on 
the chest, the back, and the abdomen. These spots are 
slightly elevated and disappear upon pressure. Each 
spot lasts about three days, a few fresh ones appearing 
every day or two until the third week, when they dis- 



NURSING IN SPECIAL MEDICAL DISEASES. 24 1 

appear. The eruption may be absent in the old and the 
very young. The third week is an anxious week, as then 
very often the symptoms are at their worst. The patient 
may have a relapse, which is another course of the fever ; 
but generally the duration of the disease following a 
relapse is not so long as the first attack. It is, however, 
a very serious time, the patient's strength being very low. 

The nursing consists in keeping the patient quietly in 
bed, the bed-linen 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 urine, 
and the smallest portion of fecal matter or urine can 
produce the disease in another person. There may 
be diarrhea, the movements being loose and yellow- 
ish 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 
or a solution of carbolic acid (i : 20). Corrosive subli- 
mate is not so good, as it hardens the albuminous mate- 
rial which covers the outside of all fecal masses, and 
thus protects the inside from its action. In the absence 
of all disinfectants boiling water may be used, or the 
movements may be mixed with sawdust and burned. 
The feces must not be emptied near a well nor any place 
where the water-supply would become contaminated. A 
disinfectant should be poured into the bed-pan before it 
is carried to the patient, and on its removal it should be 

16 



242 PRACTICAL POINTS IN NURSING. 

covered with a cloth wet in carbolie-acid solution. Bed- 
linen and body-linen soiled with fecal matter must be 
thoroughly boiled. 

Sometimes there is a constant dribbhng of urine 
through over-distention of the bladder. This trouble is 
easily remedied if the catheter be passed. There may 
be retention or suppression of urine. Retention exists 
when the bladder is full of urine, the patient being 
incapable of urinating ; in suppression the bladder is 
empty, no urine having been secreted by the kidneys. 

The nurse should report any cough, the character of 
the expectoration, and nose-bleed ; also delirium, which 
very often occurs, and which may be mild, active, or 
violent. She should be very kind and gentle, but firm ; 
she should not leave the patient alone for a single mo- 
ment^ but should wait until some member of the family 
can relieve her or bring what she needs. She should 
report any symptoms of pain in the ear, discharge from 
the ear, or deafness, which is not uncommon. The 
mouth of the patient must be kept perfectly clean ; it 
should be washed at least three times daily to prevent 
the collection of sordes, a dark -brown accumulation on 
the teeth, gums, lips, and tongue. 

The diet will be hquid food, which is easily digested ; 
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 be digested, as may readily be de- 
termined by the presence of milk-curds in the dejections, 
this fact should be reported to the doctor. 



NURSING IN SPECIAL MEDICAL DISEASES. 243 

A few words may be said here about the drinking of 
milk. Many patients will drink half a glass, and often a 
whole glass, of milk at one time, and soon afterward will 
complain of a feeling of indigestion and want very hot 
water to drink. Milk curdles as it is swallowed, and if a 
large quantity is drunk at once, it forms in the stomach 
a large hard mass, and the juices of the stomach can 
act only on the outside of it; whereas if the milk is 
drunk in little sips, it forms a loose mass of small lumps, 
and the juices of the stomach can work around and 
through them, and thus dissolve the whole in a very 
little time. The doctor may order the milk diet to be 
alternated with beef-tea, chicken-broth, oyster-broth, cof- 
fee, or cocoa. Oysters contain an amount of albumin, 
are very nourishing, are easily digested, and are often re- 
tained when all else fails. One oyster, fresh from the 
shell, may be given every hour or half hour. It should 
be remembered that the patient's mouth and lips are very 
often parched and dry ; therefore they should be mois- 
tened 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 
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 toxins and the worn-out material 
generated in the body by the fever. 

The temperature is reduced by means of tepid spong- 
ing, the cold pack, and the tub-bath (see pages 89, 90, 
99). Besides reducing the temperature, baths soothe and 



244 PRACTICAL POINTS IN NURSING. 

quiet the patient, and stimulate the nervous, cardiac, and 
respiratory systems. 

Complications. — Some of the complications of typhoid 
fever are pneumonia, hemorrhage, peritonitis, perfora- 
tion, and diarrhea. 

Two of the most dreaded complications of typhoid 
fever are hemoi'rhage and perforation, and it is the lia- 
bility to these two complications that makes it absolutely 
necessary for the patient to keep perfectly quiet, not ris- 
ing for anything without direct orders from the doctor, 
be the case ever so mild, as sitting up causes pressure 
upon the ulcerated part, and might result in perforation. 
Purgatives must not be given by a nurse on her own 
responsibility, as they might irritate the bowels and 
cause perforation. 

Hemorrhage. — The intestines, though very thin, are 
supplied with large and small blood-vessels. In typhoid 
fever the intestines are in some parts ulcerated : one of 
the ulcers may eat its way into a blood-vessel and cause 
hemorrhage, which is indicated by a sudden fall of tem- 
perature, a small, rapid pulse, a pale face, an anxious 
expression, restlessness, demand for air, faintness, and 
blood in the movements. 

With children ulceration of the bowels is less likely 
than with adults, consequently the dangers of hemor- 
rhage and perforation are less. The rash may be absent, 
but the brain-symptoms are marked, and generally the 
temperature rises suddenly. In very old people the rash 
may also be absent. 

Treatmefit 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 



NURSING IN SPECIAL MEDICAL DISEASES. 245 

lowered. Ice or ice-cold cloths may be applied to the 
abdomen. Upon the doctor's orders morphin (gr. -J^) may 
be given hypodermatically ; 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 
peritoneal cavity, causing inflammation of the peritoneum, 
known also as peritonitis. The symptoms of peif oration 
are sudden and sharp pain in the abdomen, which is dis- 
tended and tender, vomiting, a fall of the body-temper- 
ature, a small, rapid pulse, and all the symptoms of col- 
lapse. 

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, if permission from the doctor has been 
secured, morphin (gr. -J-) to secure rest and quiet and to 
relieve the pain. 

The nurse must be calm, cheerful, and equal to any 
emergency. Whatever happens, she should not let her 
patient know, either by word or by look, that there is 
anything wrong ; she must remember that the patient is 
watching her very closely, and is guided by the expres- 
sion of her face. 

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 teaspoonfuls of salt to a pint of whisky), or by pow- 



246 PRACTICAL POINTS IN NURSING. 

dering the back with oxid of zinc, fuller's earth, pow- 
dered starch, corn-starch, bismuth, or borax. If the skin 
breaks, the part should be covered with the white of ^^'g. 
When the urine and the feces are passed involuntarily 
or when there is much skin moisture, rubbing the back 
with olive oil or vaselin will prevent the moisture from 
being absorbed. In the absence of alcohol, the parts 
should be kept perfectly clean with soap and water ; the 
sheets should be kept dry and free from wrinkles ; pres- 
sure should be removed and the position of the patient 
should be changed often. 

Convalescence. — During convalescence there may be a 
temporary rise of temperature, due either to excitement, 
change of food, or constipation. The diet should be 
light, such as custards, puddings, cream-toast, soft-boiled 
eggs, and jellies. A return to solid diet should be made 
only with the doctor's permission. Very few visitors 
should be allowed. The nurse should be faithful in the 
use of disinfectants, and should never go to her meals 
without first washing her hands thoroughly with soap 
and water and a brush. The germs enter the body by 
the mouth ; hence by the thorough washing of her hands 
before eating the nurse will guard against the germs of 
the disease — typhoid or any germ-disease of which she 
has the care — being swallowed with the food. 

Walking Typhoid Fever. — " Walking " typhoid fever, 
as a rule, is of a mild character ; the patient refuses to 
give up and go to bed. Still, there is always the danger 
of grave symptoms developing and resulting in death. 

Scarlet Fever. — Scarlet fever is synonymous with 
scarlatina. It is an acute infectious contagious disease 
characterized by high temperature, rapid pulse, head- 
ache, vomiting, sore throat, and rash. The tongue is 



NURSING IN SPECIAL MEDICAL DISEASES. 2\J 

coated, which coating after a few days disappears and 
the papillae become prominent and bright red — the 
" strawberry tongue," as it is called. The bowels are 
constipated, the urine scanty and high-colored. On the 
second day of the disease the rash appears. It be- 
gins as small red dots on the chest and neck, and 
gradually extends until the whole body is a bright scar- 
let. About the fifth day the temperature begins to fall, 
and gradually decreases, the eruption fades, and desqua- 
mation or peeling begins. Very often large scales will 
come off the hands, the feet, and the abdomen. This 
peeling lasts for two or three weeks. 

In the malignant form the rash comes out late, the 
temperature is very high, and death often takes place in 
from two to three days ; while in the simple form the 
rash is present, but there is very little throat trouble. 
With children scarlet fever is often ushered in with 
convulsions. 

The treatment of scarlet fever lies in isolating the pa- 
tient in a room as far away from the family apartments 
as possible, and in removing all unnecessary articles 
from the room. If two adjoining rooms can be used, 
the medicines, dishes, disinfectants, etc. should be kept 
in the second room ; if only one room is available, a 
screen may be improvised by covering a clothes-horse 
with a shawl, a blanket, or a sheet, and behind this screen 
everything may be kept. A small table may be placed 
outside the room, and provided with a slate upon which 
the nurse writes her requirements, the things needed 
being left for her on this table. 

The nurse should keep the air of the room perfectly 
pure and the temperature at 65° F. When ventilating 
the room, she should take care that the air does not 



248 PRACTICAL POINTS IN NURSING. 

blow from the sick-room into the other rooms of the 
house. A sheet wet with some disinfectant should be 
hung over the door. Nothing must leave the room 
without first being washed in a disinfectant or in boiling 
water. The diet is liquid. The patient should be given 
to drink plenty of pure cold water, which will flush out 
the kidneys and aid in eliminating the worn-out mate- 
rial generated in the body. 

Baths or cold packs may be ordered to reduce the 
fever, followed by oiling of the body with cocoa-butter, 
sweet oil, or vaselin. This treatment, besides reducing 
the fever, will assist the peeling and prevent the scales 
of skin flying about, and thus act as a preventive against 
the spread of the disease. The nurse should have every- 
thing ready before beginning the bath, and the bed- and 
body-linen thoroughly aired before being changed. 

The nose, mouth, and throat of the patient should be 
kept perfectly clean. Soft rags should be used to wipe 
away the fecal discharges, and they should be burned as 
soon as used ; if this is impracticable, they should be 
thrown into a pail of disinfectant. If the throat is 
ordered to be sprayed, the nurse should stand a little 
to one side when spraying, so that the patient will not 
cough in her face. 

The ears of the patient should be watched very closely, 
and any pain or discharge should be reported to the 
physician. Inflammation of the middle ear, a very com- 
mon condition after scarlet fever, and deafness, are often 
due to carelessness on the part of the nurse. If the pain 
is severe, one may, until the arrival of the doctor, try hot 
flannels or a bag, made in half-moon shape, filled with 
salt and heated. This bag should be applied around 
the ear, never over it, because the heat might cause the 



NURSING IN SPECIAL MEDICAL DISEASES. 249 

walls of the canal to swell, which would bring them 
together. Dry heat will give great relief. 

Complications. — Uremia, dropsy, and nephritis (inflam • 
mation of the kidneys) are complications very apt to 
appear. The urine must carefully be watched and meas- 
ured. The nephritis and dropsy may be due to cold 
taken during a bath or during convalescence, either 
through carelessness of the nurse or obstinacy of the 
patient. The dropsy appears as puffiness of the face, the 
eyelids, and the limbs, and is associated with paleness, 
headache, and smoky-colored urine. With children uremia 
is very often ushered in with convulsions. Uremia is 
caused by the retention in the body of certain waste 
products that should be eliminated by the kidneys. The 
symptoms of uremia are headache, suppression of urine, 
nausea, and the odor of urine in the breath; unless 
relieved, these symptoms are followed by convulsions, 
coma, and death. The pulse is slow and full, later weak ; 
the temperature is subnormal. 

Uremic convulsions may be relieved by a hot pack or a 
hot-air bath, venesection (if the doctor orders), and hypo- 
dermoclysis. 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. 

N Delirium, must at once be reported. Should it set in 
after the physician has made his visit, cold may be 
applied to the patient's head. 

Depression must be met with stimulants. The patient 
should be well nourished, as the fever is very exhausting. 

Convalescence. — The patient will probably require iso- 
lation for four weeks, be the case ever so mild. A thor- 
ough bath and a complete change of clothing must be 



250 PRACTICAL POINTS IN NURSING. 

given before he goes into another room. Some doctors 
like the patient to be in an adjoining room for two weeks 
before mingling with the family. The patient must be 
kept away from all draughts. The convalescence is 
slow and must be guarded. 

Typhus Fever. — Typhus fever is an acute contagious 
disease caused by an infecting germ and influenced by 
overcrowding, bad food, bad air, and impure drinking- 
water. 

Symptoms. — Typhus fever begins abruptly with a chill, 
followed by high fever, severe pain in the head, the back, 
and the limbs, muscular weakness, and great prostration. 
The temperature rapidly rises, and about the third or 
fourth day it is 104 or 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 typhus does not appear in successive 
crops, it does not disappear upon pressure, it begins to 
fade from the end of the first week to about the middle 
of the second week, and is much darker. 

In severe cases death may take place in a few days 
from coma or from heart-failure, while in mild cases the 
improvement begins about the end of the second week, 
the temperature falls suddenly, and convalescence is rapid. 



A LB SING IN SPECIAL MEDICAL DISEASES. 25 I 

Treatmeitt. — The patient is to be isolated, and disinfec- 
tion of the clothing and the excreta must be thoroughly 
effected. The exhaustion, which is extreme, is met with 
stimulants. Bed-sores and heart-failure are to be guarded 
against. All visitors are to be excluded, and the patient 
is to be kept bodily and mentally quiet. The nurse must 
not hesitate to feed the patient by the rectum if it be- 
comes necessary. The high temperature is treated with 
cold baths or packs ; the headache and delirium are 
treated with cold applied to the head and absolute quiet 
maintained. The air of the room must be kept fresh and 
pure, and the temperature even. 

The complications of typhus fever are catarrhal pneu- 
monia, inflammation of the kidneys, and swollen paro- 
tid glands. 

Small-pox. — Small-pox is an acute contagious dis- 
ease. The varieties are — discrete, confluent, malignant, 
and varioloid or modified small-pox. 

Symptoms. — The disease begins with a chill, high fever, 
vomiting, intense pain in the back, limbs, and head, sleep- 
lessness, and a full and rapid pulse (from 100 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 
appear on the forehead and face, and consists of small, 
round, elevated red spots, which feel like shot. When 
the eruption appears the temperature falls and the pa- 
tient feels very comfortable. The eruption gradually 
spreads over the entire body. On or about the sixth 
day these small hard spots become clear vesicles or 
blisters, and two or three days afterward they change to 
pustules ; then the secondary chill sets in, the tempera- 
ture rises to 104 or 106° F., with a corresponding 



252 PRACTICAL POINTS IN NURSING. 

increase in the pulse. Pus oozes from the pustules, 
which in about three days dry up and form crusts hav- 
ing an offensive odor. After a week or so these crusts 
fall off and leave the " pock-marks." There is delirium, 
the face is swollen, the features are disfigured and often 
unrecognizable, the bowels are constipated (though there 
may be diarrhea), and the urine is scanty. The second- 
ary fever in a mild case may gradually subside on the 
third or the fourth day, and convalescence set in. 

In the confluent form the pimples are very abundant 
and they run together; there is a fetid discharge from 
the nose and the throat. The symptoms are more severe 
than in the discrete form. 

The malignant form ends in death in a few days, 
before the rash appears. Varioloid, or the modified 
form, occurs in a person who has either been vaccinated 
or has had a previous attack. 

The nursing consists in isolating the patient and using 
every precaution against the spread of the disease. 
Members of the family must protect themselves by vac- 
cination ; the air of the room must be kept pure, and 
the temperature even (about 65° F.). The fever may be 
treated by cold baths or packs, and pains in the limbs 
and back, either by ice or by heat — whichever is the 
more comfortable to the patient. The pitting can to a 
certain extent be prevented by darkening the room, 
keeping it thoroughly ventilated, covering the patient's 
face with a mask soaked in either carbolic-acid or corro- 
sive-sublimate solution, or by applying some simple oint- 
ment which will relieve the pain and heat. To prevent 
scratching, the patient's hands may be tied up in soft 
cloths. 

When the crusts fall off they must be burned. The 



NURSIXG IN SPECIAL MEDICAL DISEASES. 253 

eyes, nose, and mouth must be kept clean, being 
washed several times a day. The diet consists of 
milk, broths, egg-nog, oysters, 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 eveiything that can be burned 
must be so destroyed, and the room and the furniture be 
fumigated and disinfected several times (see p. 263). It 
is a dread disease, and the germs, like those of scarlet 
fever, are very long lived. 

Chicken-pox. — Chicken-pox or varicella begins with 
slight fever and there may be restlessness and vomiting. 
Before the end of the first twenty-four hours the erup- 
tion appears on the face and chest ; later upon the ex- 
tremities and back. At first the eruption consists of ele- 
vated spots widely scattered, but these quickly form vesi- 
cles or blisters. The eruption appears in crops lasting 
two or three days and it very rarely pustulates. The 
vesicles dr}^ up an4 form crusts which fall off in a few 
days. 

N2irsi}i^e:-'T\\Q disease is contagious as long as the 
crusts are present ; the patient should, therefore, be iso- 
lated. The body should be sponged every day and the 
'jrusts well oiled. Cleansing and airing of the room 
when the patient has recovered is the only disinfection that 
is necessary. For the itching mild solutions of carbolic 
acid may be applied. 

Measles. — Measles begin with all the symptoms of a 
severe cold. About the third day the rash appears on 
the face and forehead, and then spreads over the body. 
It consists of small red spots of different sizes, slightly 
elevated. The temperature rises to 102° F., and in- 



254 PRACTICAL POINTS IN NURSING. 

creases when the eruption appears. At the end of two 
or three days the eruption fades, the temperature sud- 
denly falls, and desquamation, or peeling, begins in the 
form of a fine branny powder, very unlike the peeling 
seen in scarlet fever. 

The Nursing. — The patient is to be isolated, as the 
disease is contagious ; the temperature of the room 
should be even (about 70° F.), and the room must be 
slightly darkened on account of the condition of the 
eyes. Baths should be given to assist the peeling. The 
diet is either liquid or of light food, according to the 
amount of fever. The bowels must be kept regular. 
The eyes, nose, and mouth must be kept perfectly 
clean. The patient must be guarded against exposure 
to draughts, and must be kept in bed, be the case ever 
so mild, until the peeling is over. After the patient has 
left the room any tendency to cough must be reported. 
Disinfection and fumigation should be practised as for 
scarlet fever (see pp. 248, 263). 

Complications. — Some of the complications are pneu- 
monia, bronchial catarrh, and inflammation of the eyes, 
nose, throat, and ears. 

German measles or rubella is an acute conj;agious 
disease resembling scarlet fever and measles, but differ- 
ing from them in its short course, slight fever, and free- 
dom from bad consequences. It usually affects children. 

Symptoms. — The disease begins with drowsiness, slight 
fever, and sore throat. The lymphatic glands of the 
neck become swollen. The eruption appears on the first 
or second day and may resemble that of scarlet fever or 
measles. It begins on the face and rapidly spreads over 
the entire body, but fades so rdpidly that the face may 
be clear before the limbs become affected. 



NURSING IN SPECIAL MEDICAL DISEASES. 255 

Nursing. — The disease is contagious, so that the patient 
should be isolated, the general treatment being the same 
as in measles. Alternating hot and cold fomentations 
may be applied to the swollen glands. 

Malaria. — Malaria is an infectious disease marked by 
paroxysms of chill, fever and sweating, and by enlarge- 
ment of the spleen and depraved nutrition. It is caused 
by the presence in the blood of the malarial parasite, 
which is transmitted from the sick to the well by the bite 
of a species of mosquito known as the anopheles. 

As commonly seen the disease appears in three varie- 
ties : intermittent fever, remittent fever, and chronic ma- 
laria. Intermittent fever is the commonest form, and is 
characterized by normal intervals between the paroxysms. 
These latter are marked by chill, fever, and sweat, occur- 
ring in regular order. In the remittent form there is 
little or no recession of the fever. In chronic malaria 
there is varying fever, anemia, a sallow appearance of the 
skin, and enlargement of the spleen. 

Nursing. — In the cold stage or chill the patient should 
be well covered, and hot-water bags should be placed at 
his feet and in the axilla. The hot stage should be 
treated w'ith sponge baths or alcohol rubs and with cold 
compresses to the head. The patient should be screened 
from mosquitoes so that the disease may not be carried 
to others. 

Hygiene. — In malarial regions the wn'ndows should be 
carefully screened, and care used in protecting people 
when asleep by means of mosquito netting. 

Diphtheria. — Diphtheria is an extremely infectious 
disease, the germs of which have their seat in the throat. 
The poison is carried through the body, and may give 
rise to certain forms of paralysis, which is partly due to 



256 PRACTICAL POINTS IN NURSING, 

the action of the poison on the nervous system, and 
partly to its interference with the nutrition of the va- 
rious tissues of the body. 

The temperature ranges from 100° to 105°, or 106° F. 
in severe cases, with a correspondingly increased pulse. 
The tonsils are red, swollen, and covered with membrane. 
This membrane may be of a gray or a yellowish-white 
color, and gradually change to a dull gray. When 
the membrane extends to the nose and the larynx, this 
condition will be manifested by an offensive discharge 
from the nose and nose-bleed, and by a gradual loss of 
the voice and difficult breathing. Soft cloths should be 
used to wipe away the discharges from the nose and the 
mouth ; these cloths must be burned or thrown into a 
disinfectant as soon as used. The discharges are highly 
infectious. All cuts and scratches of the nurse's hands 
should be covered, as the smallest amount of discharge 
that may get on any raw surface is capable of producing 
blood-poisoning. 

The Nursing, — The patient must be isolated. The 
room is to be properly ventilated, and the temperature 
of the room should be 65° F. Moist air may possibly 
be ordered, which can readily be secured by keeping pans 
or kettles of boiling water in the room, or, if there is a 
fire in the room or furnace-heat, by wringing sheets out 
of water and hanging them up to dry. 

Steam inhalations may be ordered for the throat, or 
gargles or sprays. Peroxid of hydrogen is very com- 
monly used for the destruction and elimination of the 
false membrane, and if the throat is not very sensitive, 
this drug may be used undiluted, applied with a swab. 
If this cannot be done, the throat may be sprayed with 
one part of peroxid of hydrogen to 4 parts of water. 



NURSING IN SPECIAL MEDICAL DISEASES. 257 

A glass atomizer must be used, because the peroxid of 
hydrogen decomposes when in contact with metal. 

The antitoxin treatment for diphtheria is the injection 
into the body (generally into the broad of the back) of 
antitoxin serum, by means of a large hypodermic syr- 
inge. The operation is performed by the attending physi- 
cian. The wound is sealed with a collodion dressing. 

The nourishment and stimulants must faithfully be kept 
up. Often the throat is so swollen that the patient cannot 
swallow, and resort must be had to nasal or rectal feeding. 
Crushed ice or ice-cream will prove very grateful to the 
patient, besides helping to reduce the inflammation. The 
ice-cream adds to the amount of nourishment taken, as 
it is made of milk and eggs. Paralysis of the muscles 
of the throat is not uncommon, and the patient must not 
return to solid diet without permission from the doctor. 
There may also be temporary paralysis of the muscles 
of the eyes and of the Hmbs. 

The nurse must watch the urine ; it will be high-col- 
ored and scanty, and there may be retention, owing to 
paralysis of the bladder. The depression is very great, 
and heart-failure often occurs through sudden sitting up 
or sitting up too soon. The patient must not be allowed 
to sit up without direct orders from the doctor. 

The nurse must guard herself by good, nourishing 
food, fresh air, and the faithful use of disinfectants. The 
germs are less likely to infect the lining membrane of 
the throat and larynx if these parts are in a healthy 
condition ; but when the tonsils are inflamed the germs 
find the conditions necessary for their development, and 
diphtheria is the result. When the case is ended thor- 
ough disinfection is necessary. 

Tracheotomy is often performed in diphtheria when the 

17 



258 PRACTICAL POINTS IN NURSING. 

larynx is obstructed through extension of the diphtheritic 
membrane and there is danger of suffocation. It is also 
performed in membranous croup for the same reason as 
that in diphtheria. With the instruments the nurse has 
very little to do, but she must have at hand plenty of hot 
water, 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 




Fig. 84. — Position of patient for tracheotomy (from An American Text-Booh of the 
Diseases of Children). 

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 (Fig. 84). 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 
rush of air and mucus ; then the silver tube (Fig. 85) 
will be inserted and secured by the tape, which is passed 



NURSING IN SPECIAL MEDICAL DISEASES. 259 

through the slits on each side of the shield, and carried 
round the neck and tied at the side (Fig. 85). 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 




Fig 



Tracheotomy : a, tracheotomy-tube ; b, tracheotomy-tube in position. 



the air does not first go through the nostrils and become 
warmed before reaching the lungs, but it goes directly 
to the lungs through the tube. This protection is 
further effected by folding a light muffler of gauze over 
the aperture of the tube. The patient may be fed by 
the rectum if necessary. 

Everything should be made ready before beginning to 
cleanse the inner tube, which should not be kept out 
longer than necessary. If the tube is oiled a little, its 
removal will be facilitated and the mucus prevented from 



26o 



PRACTICAL POINTS IN NURSING. 



accumulating. The discharge should be noticed — if it be 
thin, dry, or moist. A small piece of flannel or of cot- 
ton-wool spread with vaselin and placed between the 
tube and skin will protect the edges of the wound 
against the pressure of the tube and prevent irritation 
and chafing. 




Fig. 86. — Intubation 



inserting the tube (from An American Text-Book of the Dis- 
eases of Children). 



Should the tube suddenly be coughed out, it should 
quickly be replaced ; if this is impossible, a small cath- 
eter may be inserted or a small rubber tube, which can 
be kept in position by means of a safety-pin run through 
the end of the tubing, a cord or tape being slipped 
through each side of the pin and tied around the neck. 
Should either of these measures fail, then the part should 



NURSING IN SPECIAL MEDICAL DISEASES. 26 1 

be kept wiped out with absorbent cotton, and the patient 
raised in the best breathing position possible until the 
arrival of the doctor, and stimulants be given if neces- 
sary. 

Intubation. — This, as the above operation, is performed 
when the larynx is obstructed either from acute or 
chronic disease or from a foreign body. The duties of 
the nurse in intubation will be, in case the patient is a 
child, to hold the child upright in her arms, with its 
knees placed firmly between her own, while an assistant 
stands behind her chair and holds the head in the proper 
position (Fig. Z6). The patient should be fed well ; he 
will swallow better with the head to one side. Ice-cream, 
crushed ice, and all foods in small amounts may be 
given. 

If the tube is coughed up or swallowed, the doctor 
must be informed. If swallowed, it will probably pass 
through the bowels without any trouble. It may not be 
necessary to reinsert the tube; however, it is always 
well to ask the doctor what to do under such cir- 
cumstances. 

Gonorrhea. — Gonorrhea is an infectious disease which 
affects most frequently the mucous membrane of the 
genital organs, producing inflammation with a profuse 
discharge, which at first is serous, but later becomes thick 
pus. 

Nursing. — The nurse must constantly keep in mind 
the infectious nature of the discharge and the possibility 
of acquiring the disease herself or of transmitting it to 
others. Gonorrheal inflammation of the eyes is a very 
serious condition. After each contact with infected cloth- 
ing, bed-linen, or utensils, the hands should be carefully 
cleansed and disinfected. All bed- and body-linen from 



262 PRACTICAL POINTS IN NURSING. 

patients having gonorrheal discharges should be dis- 
infected. 

Syphilis. — Syphilis is a general disease affecting the 
blood and all the tissues of the body. It is transmitted 
by inoculation, the virus entering the body through a 
scratch, abrasion, or any raw surface. After infection 
the symptoms appear in from ten days to three weeks, 
the first of them being the appearance at the point of in- 
fection of a small sore which becomes hard. This sore 
(called a chancre) may form an ulcer or it may dry up 
and disappear. There may be swelling in the neighbor- 
ing lymphatic glands. 

The second stage begins about six weeks after infec- 
tion. There is depression, irritability, insomnia, headache, 
glandular swelling, and the formation of characteristic 
eruptions (syphilides), which may be in the form of 
macules, papules, or pustules. Ulcers form in the 
mouth and about the anus and genitals, and frequently 
the hair falls out In spots. 

The third stage may appear at any time after six 
months from the first infection. It is marked by the for- 
mation of characteristic tumors called gummata, and 
various disorders of the bones, blood-vessels, and internal 
organs. The lymph-glands are enlarged and nervous 
disorders may develop, such as locomotor ataxia, apo- 
plexy, dementia, with frightful headache and convulsions. 

Treatment. — The medical treatment of the first and 
second stages is by mercury ; that of the third stage by 
iodids. The secretions from the sores are extremely con- 
tagious ; therefore the nurse must disinfect herself thor- 
oughly, and take great care of all utensils or dressings 
used about the patient. Rubber gloves should be worn. 
She may be directed by the physician to give the mer- 



NURSING IN SPECIAL MEDICAL DISEASES. 263 

curial inunctions called for in the treatment of the dis- 
ease (see p. 85). In that case, of course, she should 
wear gloves that do not absorb the mercury. 

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 
aired for twenty-four hours longer ; then everything, in- 



264 PRACTICAL POINTS IN NURSING. 

eluding the walls and floors, must be washed with either 
corrosive-sublimate (i : 1000) or carbolic-acid solution 
(i : 20) and exposed to the action of the sun and air for 
a number of days. 

If, when preparing the room for fumigation, a hole is 
bored through the middle of the top window-sash, and 
there is passed through this hole a piece of rope of suf- 
ficient length to extend to a window below, the sick-room 
window can be opened from the outside at the end of 
the fumigation. When closing up the cracks in the sides 
of the window care should be taken that they are filled 
in securely, so that the sulphur fumes cannot escape 
through them, but at the same time that the window can 
easily be pulled open. 

Formaldehyd fuinigatio7i has now almost entirely re- 
placed the much less certain sulphur fumigation. It is done 
by means of specially constructed apparatus (Fig.S/) which 
are fully described in the circulars issued by their makers. 
Another method of formaldehyd fumigation is by a com- 
bination of formalin with potassium permanganate crys- 
tals, which liberates formaldehyd gas. One pint of for- 
malin put in a good-sized container, to which is added four 
ounces of permanganate crystals, will produce a suffi- 
cient volume of gas to disinfect 1000 cubic feet of space. 
For each additional 1000 cubic feet, a similar quantity 
should be added. As the mixture of the ingredients 
will cause a violent boiling up, the utensil containing the 
formalin must be placed in a foot tub or other equally 
large vessel, in order to protect the floor from the over- 
flow. The crystals should not be added until the room 
is sealed and in readiness to leave for the fumigation. 

When a patient dies of a contagious disease, the body 
should be washed with a disinfectant and be wrapped in 



NURSING IN SPECIAI MEDICAI DISEASES. 265 

a sheet wrung out of the same ; the funeral must be 
strictly private. 

The dress of the nurse must be of wash material, and 
she should wear a close-fitting cap. A member of the 





Fig. 87. — Autoclaves for generating formaldehyd (i) from formalin and (2) from 
formochloral : ^.chamber for reception of the fluid; both chambers are hermetically 
sealed when apparatus is in operation ; B, lamp for supplying heat ; C, tube for con- 
ducting gas from generator into the room to be disinfected (Abbott). 



family should relieve her at meal-times and when she is 
sleeping. She should not eat nor sleep in the sick-room 
if this can possibly be avoided. She should go out for 
a while each day, no matter how tired she may be, first 



^ 



266 PRACTICAL POINTS IN NURSING. 

making an entire change of clothing, or she should go 
into an adjoining room, open the window top and bot- 
tom, and walk up and down before the open window. 

Phthisis is tuberculosis of the lungs, commonly called 
" consumption," and is infectious through the expectora- 
tions if the latter are allowed to dry, the germs of the 
disease (known as the Bacillus tuberculosis) being blown 
about in the dust. 

Foiniis of Phthisis. — There is an acute and a chronic 
form of phthisis : the aaite form at first is not unlike 
pneumonia; there is chill, a rise of temperature, profuse 
perspiration, especially at night, increasing emaciation and 
weakness, difficulty in breathing, a short hacking cough ; 
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 chj'onic form the patient may linger for years. 

Nursing. — The patient must sleep alone, and every 
precaution should be taken to prevent the spread of the 
germs. A sputum-cup (Fig. 90) containing some anti- 
septic solution should be used by the patient and be 
cleaned at least three times a day. The other excre- 
tions must also be disinfected. If the patient is able 
to go about, he should be told the importance of 
expectorating in pieces of soft cloth, which can be 
burned, and not in handkerchiefs which are to be 
washed. Kissing must not be allowed, as the infection 
can be transmitted by sores that may be on the lips; 
neither should a healthy person sleep in the same room 
with a consumptive. It is very important that cuts and 
scratches on the hands should be well covered, as there 
is danger of the sputum coming in contact with such 
injuries and of the germs entering the body through 



NURSING IN SPECIAL MEDICAL DISEASES. 267 

the broken skin. The nurse will, therefore, see how 
essential it is, when on duty in contagious cases, to 
take great care of her hands. The same precaution 
applies to the patient, all cuts and scratches being cov- 
ered, so that the sputa and excretions cannot come in 
contact with the wounds. The skin should be kept per- 
fectly clean. 

In caring for consumptives there are four elements of 
chief importance : Fresh air, rest, plenty of nourishing 
and easily digested food, and cheerful and comfortable 
surroundings. The airiest and sunniest room should be 
selected for the patient. When possible he should be 
kept out of doors all day. At night the windows of the 
sleeping-room should be kept open both winter and sum- 
mer, the patient being well covered and protected from 
draughts. When the disease is active, as indicated by 
the presence of fever, absolute rest should be maintained. 
The patient should lie on a bamboo couch in the open 
air, warmth being maintained by plenty of covering and, 
if necessary, by a hot stone or water-bottle at the feet. 
As strength is regained, exercise may be taken gradually 
and cautiously, care being taken to guard against fatigue. 
Coughing may be relieved temporarily by steam inhala- 
tions, the head being wrapped in a large towel or small 
blanket and held over a pitcher of boiling water, to which 
a teaspoonful of compound tincture of benzoin may be 
added. When the temperature is high, cold sponging is 
useful. 

Diet. — As much nourishing food should be allowed as 
the patient is capable of taking. The diet should include 
meat, milk, and eggs in abundance. Scraped raw beef 
(see p. 375) is often of particular value. Cream, butter, 
olive oil, and fat meats are desirable when the patient can 



268 PRACTICAL POINTS IN NURSING. 

digest them. Fresh fish, cereals, vegetables, and fruit may 
be taken. When there is severe indigestion, a liquid diet 
is called for. Careful preparation and dainty serving of 
the food are important, that the patient may be encour- 
aged to eat freely. 

Patients with phthisis esteem the kind attention of the 
nurse, and every effort should be devoted to making them 
as comfortable and as happy as possible. 

Simple Croup. — Simple croup or false croup is a dis- 
ease of children. It is due to a spasm of the vocal cords 
excited by congestion of the mucous membrane of the 
larynx. It begins with all the symptoms of a severe 
cold — dry cough and suppressed voice, caused by 
mucus collecting in the nostrils and larynx, which be- 
comes dry and hard ; consequently the patient is in great 
distress, and makes spasmodic efforts to breathe. 

The patient should be propped up in the best breathing 
position, and hot fomentations applied to the throat ; an 
effort should be made to produce vomiting with luke- 
warm water and salt, or by tickling the throat, or by 
running the finger down the throat, followed by any 
kind of oil, melted vaselin, mutton tallow, etc. A cold 
cloth should be wrapped around the neck and the pa- 
tient put into a hot bath (temperature from ioo° 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 moist. The attack usually 
occurs at night, and a second attack can generally be 
prevented by keeping the bowels open and by not allow- 
ing the child to sleep uninterruptedly through the night ; 
it should be given a drink of milk or of water, which 
will tend to prevent the mucus collecting. 

Membranous Croup. — Membranous croup, or true 



NURSING IN SPECIAL MEDICAL DISEASES. 269 

croup, is by most authorities considered the same as 
diphtheria. The mucous membrane Hning 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 proper nourishment and stimulants. 

Should the patient appear to be suffocating, the nurse 
may, until the arrival of the physician, try to remove the 
membrane with a cotton-stick or with her finger ; in fact, 
at such a time she will be justified in doing anything 
that will save the patient's life. Calomel fumigation (Figs. 
88, 89) often affords relief from the urgent symptoms. 

Croup Tent. — A croup tent is made by placing a 
blanket over a frame in such a way that the crib or bed 
is covered except for a small aperture for ventilation. If 
a regular frame is not at hand, a substitute can be con- 
trived by erecting broom-sticks at the four corners of the 
bed and stretching a cord around the tops of the sticks. 
An improvised tent can be made by throwing a large 
blanket over an umbrella tied to the head of the bed. 

Whooping" Coug-h. — 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 




Fig. 89. 
Figs. 88 and 89. — Croup-tent for steaming and "calomel-fumigation (Northrup) : Fig. 88, 
Croup-tent open. The fumigation-apparatus, standing on the table, consists of a Bunsen 
burner, a tripod, and a plate containing calomel. Fig. 89, Calomel-fumigation : croup-tent 
closed, nurse watching the child while fumig^ion is going on. 

270 



NURSING IN SPECIAL MEDICAL DISEASES. 2yi 

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 
and continue to play. The patient must be isolated from 
other children, and be given light and nourishing food ; 
the air of the room must be kept pure and the temperature 
even. Steam inhalations and counter-irritants to the chest 
may be ordered. Anything that seems unusual about the 
child must be reported. Should convulsions occur, a 
warm bath should be given while waiting for the doctor, 
and cold cloths be applied to the head. The disease 
may last from four to six weeks, or even longer. The 
paroxysms of coughing occur oftener at night than dur- 
ing the day, and generally, where there are a number of 
children with the disease in the same room, when one 
begins to cough the others also begin. Among the 
complications are chronic bronchial catarrh, pneumo- 
nia, diarrhea, and phthisis. Whooping cough is very 
infectious through the discharges from the nose and 
throat. 

Influenza {la grippe) is an acute infectious disease 
characterized by fever, pains in the head, back, and limbs, 
great prostration, chilliness, sneezing, hoarseness, and 
cough. 

The treatment is rest in bed and liquid diet. The pains 
in the head, chest, and limbs may be relieved with hot 
applications. Phenacetin, 5 grains in half an ounce of 
whisky every four hours, may be given. It must be 
remembered that phenacetin is v^ry depressing on the 
action of the heart, and, though some persons can take 
doses of from 15 to 20 grains, death has been known 
to result from a smaller dose. This fact is mentioned 
because the drug is very carelessly used, no thought 



2-]! 



PRACTICAL POINTS IN NURSING. 



being given to its action on the heart ; it should not be 
taken — in fact, no drug should be taken — without the 
sanction or advice of a physician. The patient must 
be guarded against draughts, and be stimulated if the 
pulse indicates heart-failure. The complications are ca- 
tarrhal and croupous pneumonia, inflammation of the 
kidneys, and heart-failure. One attack does not mean 
immunity from another. 

Tonsillitis, or inflammation of the tonsils, is due to 
infection with bacteria, and may be brought on by ex- 
posure to cold and wet, the irritation of impure air, or the 
improper use of the voice ; it also occurs in acute infec- 
tious diseases. It may be a simple inflammation or at- 
tended with the formation of whitish, cheesy masses in 
the tonsils (^follicular tonsillitis), or accompanied by 
abscess formation (^phlegmonous tonsillitis or quinsy). 
The symptoms are a dry painful condition of the throat, 
with difficulty of swallowing, a rise of temperature, chilli- 
ness, and general aching. In quinsy there is great pain 
and the patient is very much prostrated. 

Nursing. — The patient usually feels ill to an extent out 
of proportion to the local conditions. He should, there- 
fore, be made as comfortable as possible by means of local 
applications. The neck should be surrounded by hot 
packs made by taking a long towel, wringing one end 
out in water as hot as can be borne, and wrapping it 
around the neck from the ear to the shoulder, the wet 
end being next the skin. The mouth and throat should 
be washed with an antiseptic solution, such as peroxid of 
hydrogen. If the case is a severe one, liquid food should be 
given. The bowels should be kept open and free perspira- 
tion induced. Every severe case of tonsillitis, especially if 
quinsy has developed, should be treated by a physician. 



NURSING IN SPECIAL MEDICAL DISEASES. 2yi 

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 (100 to 120 or above), sharp pain in 
one side, and the patient can breathe only with difficulty ; 
consequently the respirations are quickened to thirty-five 
or forty per minute, they are shallow, and often irregular. 
There is a short dry cough, accompanied later by a rust- 
colored tenacious sputa, which must be kept for the 
doctor's inspection. The bowels are constipated, and 
the urine is scanty and high-colored. Delirium is not 
uncommon. 

About the seventh or the ninth day there may be a 
sudden drop in the temperature, profuse perspiration, and 
a general improvement may take place, while in severe 
cases a sudden drop of temperature to subnormal, small, 
rapid pulse, coldness of extremities, and a blue appear- 
ance would indicate collapse, which must be met with 
stimulants and heat to the body and a mustard plaster 
over the heart. If the patient cannot swallow, the stim- 
ulants must be given per rectum. 

Until the arrival of a physician the nurse may apply 
to the chest flaxseed or mustard poultices or fomenta- 
tions. The room must be a sunny room, having an 
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 %ithfully be followed. He 

18 



2/4 PRACTICAL POINTS IN NURSING. 

may order ice-bags or compresses, which will often give 
great relief, or hot poultices, which must be changed 
every two or three hours. Some physicians object to 
poultices on account of their weight and because of 
the frequent change fatiguing the patient, and prefer 
to envelop the chest in a cotton jacket, which can be 
removed gradually by cutting off from the bottom about 
2 inches each day. The cotton jacket is readily made by 
basting two layers of sheet cotton-wool inside an under- 
shirt. Oil silk is basted on the outside to prevent evap- 
oration of the moisture exhaled from the skin. When 
the temperature is very high, cold baths are given, 
which, besides reducing the fever, will quiet the respi- 
rations and soothe the patient. 

The diet must be liquid and nourishing — milk, broths, 
beef-juice, koumyss, egg-nog, wine whey, etc. The pa- 
tient must be kept in bed, perfectly quiet. The prostra- 
tion is often great, in which case there is danger of 
heart-failure. The disease reaches its height about the 
seventh or the ninth day. As the patient improves the 
diet is increased to soft solids — custards, puddings, cream 
toast, eggs, scraped-beef sandwiches — gradually prepar- 
ing the way for a more solid diet. Pneumonia is a self- 
limited disease; hence the nurse must do all in her 
power to support life until it has run its course. It is 
also infectious through the expectorations ; the sputum- 
cup (Fig. 90), lined with paper, which can be taken out 
and burned and the cup boiled about three times a day, 
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- 



NUJiSING IN SPECIAL MEDICAL DISEASES. 275 

sles, influenza, and typhoid fever. An acute attack begins 
with chilliness, a sore and tight feeling in the chest, in- 
creased by coughing, which at first is dry, but later is 
accompanied by a muco-purulent sputum, which becomes 
very profuse as convalescence sets in ; the temperature 
is 100 to 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 




Fig. 90— Sputum-cup : a, the cup ; b, the paper lining. 



the best breathing position possible and be given inhala- 
tions of steam. If the breathing is very difficult, the 
patient apparently dying from suffocation, an emetic 
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 liquid. The 
patient must be guarded from all draughts, the bowels 
be kept open, and stimulants be given if the pulse indi- 
cates heart-failure. 



2/6 PRACTICAL POINTS IN NURSING. 

Asthma also calls for heat over the heart and lungs, 
inhalations of steam, hot drinks, hot foot-baths, and 
plenty of fresh air. 

Pleurisy. — Pleurisy is inflammation of the pleura, the 
membrane covering the lungs. The symptoms are severe 
pain or " stitch " in the side, short, dry cough, and short- 
ness of breath, owing to the pain caused the patient in 
breathing. There may be little or no expectoration, and 
the cough may be suppressed on account of the pain 
the coughing gives the patient. Hot mustard fomenta- 
tions should be applied over the seat of the pain. If 
there be no mustard at hand, plain fomentations or 
a flaxseed poultice may be used; the patient should 
be propped up with pillows, thus making the breathing 
easier. 

If there is effusion of liquid into the pleural cavity, 
the amount of urine passed may be very small. The 
amount excreted must be measured and reported. An 
increase in the amount is a very good sign, as it shows 
that the effusion is being absorbed. The effusion into 
the cavity causes pressure upon the heart, the lungs, 
and other organs, which may be pushed out of place ; 
paracentesis or tapping is then performed, and the 
amount of liquid drawn may vary from a pint to three 
quarts. Paracentesis is performed by plunging a large 
needle or cannula and trochar through the chest wall 
and attaching the instrument by a tube to a vacuum 
pump. This operation is performed by the physician. 
The site of the puncture must be prepared as for a minor 
surgical operation. 

Empyema. — Sometimes the collection of fluid in the 
pleural cavity becomes purulent; then we have what is 
called " empyema." For this condition the pus is removed, 



NURSING IN SPECIAL MEDICAL DISEASES. 2JJ 

a drainage-tube is inserted, and an antiseptic dressing put 
on. In simple cases, when only a small opening is made 
with a large hypodermatic needle or a very small trocar, 
a piece of adhesive plaster or collodion dressing will be 
sufficient to cover the opening. The nurse of course 
prepares antiseptically for the operation. It is remark- 
able to see the great change for the better that takes 
place after the operation, providing there are no com- 
plications. 

The temperature must carefully be watched ; its rise 
may indicate a fresh collection of pus in the cavity. 
In case of emergency, when the cavity has rapidly filled 
up and the patient is in danger of dying during the ab- 
sence of the physician, the nurse will be justified in draw- 
ing off some of the fluid, but it is generally well to ask 
the attending physician, if he lives at a distance and the 
nurse is distant from other medical aid, what he would 
like her to do in this emergency. 

Heart Diseases. — In nursing patients with diseases of 
the heart, the most important point is to keep them in as 
comfortable a position as possible. All unnecessary 
loads should be removed from the heart and the patient 
must be made to lie down and keep quiet. If there is 
difficult breathing, the patient should be propped up in 
bed or in an easy chair, supported with pillows, and pro- 
vided with a rest for his arms. It is necessary to insist 
on freedom from exertion, excitement, or worry, and all 
sudden, startling noises should be avoided. Fresh air is 
important, but it must be warm. 

The action of the heart may be slowed by applying 
ice. In applying the ice-bag it should be supported, so 
that its whole weight may not be on the chest (Fig. 91). 
The bag should not lie with the rubber against the skin. 



278 



PRACTICAL POINTS IN NURSING. 



When massage is required to keep up the circulation, 
the nurse should avoid shaking or otherwise disturbing 
the patient. 

The diet requires special attention. It should be light 
but nourishing, and given in small but frequent meals. 
Since there is a tendency to flatulence in heart disease, 
foods that tend to increase this condition, such as starch 
and sugar, should be restricted. The bowels should be 
moved daily. The nurse should carefully watch the 




Fig. 91. — Application of ice-bag to chest; extemporized method of support (aft< 

Hoxie), 



patient's pulse and report any changes to the physi- 
cian. 

Angina pectoris is a neurosis of the heart associated 
in many cases with disease of the base of the aorta and 
of the blood-vessels of the heart. It is characterized by 
paroxysms of agonizing pain in the region of the heart 
and extending into the arms and neck, intense oppression, 
a sensation of impending death, pallor of the face, fol- 
lowed by profuse perspiration, etc. During the attack 



NURSING IN SPECIAL MEDICAL DISEASES. 279 

the nurse may apply heat to the chest and give alco- 
holic stimulants. 

Dilatation of the heart may occur as the result of un- 
usual exertion or from nervous excitement. It should 
be overcome by rest and stimulation. Hypertrophy is a 
thickening of the heart muscles. It may occur from 
continued overwork, as in athletics, or from chronic over- 
feeding, as in excessive beer drinking. It is accompanied 
by headache, pain in the heart, ringing in the ears, and 
flushing of the face. 

Endocarditis is inflammation of the lining membrane 
of the heart. It is usually the result of rheumatism, 
pneumonia, or scarlatina, and it frequently affects the 
valves of the heart, producing valvular disease ; that is, 
a thickening or shrinking of the valves, so that they do 
not properly close the orifices, resulting in regurgitation^ 
or flowing back of the blood. The symptoms of valvu- 
lar disease are difficult breathing, irregular pulse, pulsa- 
tion of the large veins of the neck, and blueness of the 
face. 

Pericarditis is inflammation of the membranous sac 
which surrounds the heart. It is attended with short- 
ness of breath, swelling of the legs and feet, and indi- 
gestion. Fatty heart is a condition in which the heart 
muscle contains deposits of fat. 

Acute gastritis, acute inflammation of the stomach, 
may follow the taking of too much food, of improper 
food (irritating or decomposed food), alcohol, fluids that 
are too hot, corrosive or irritant poisons, etc. 

The symptoms in mild cases are those of mild indiges- 
tion. In severer cases there occur burning pain in the 
epigastrium, nausea, vomiting, slight fever, etc. In ex- 
tremely severe cases, such as follow the ingestion of 



28o PRACTICAL POINTS IN NURSING. 

irritant or corrosive poisons, there occur, in addition to 
the foregoing symptoms, intense thirst, small, feeble, 
rapid pulse, general manifestations of collapse, and fre- 
quently death. 

Treatment of Gastritis. — A physician must be sum- 
moned, and in the mean time the nurse can apply hot 
fomentations or a mustard plaster over the seat of pain. 
If it is known that a poison has been taken within 
a short time, she should try to wash out the stomach, 
which operation, in the absence of the stomach-pump, 
can easily be done by using a fountain syringe or by 
giving large quantities of warm water to drink until the 
gastric contents become clear. The patient must be fed 
by enemata, and the stomach be given absolute rest for a 
few days, unless otherwise ordered; then the nurse should 
begin the feeding with a few drops of milk and lime-water, 
equal parts ; if this is retained, she should gradually in- 
crease the dose and the interval between the doses. 
Crushed ice, ice-cream, iced champagne, or very cold 
Seltzer water, given in very small quantities, will often be 
retained. The patient should be fed slowly, and the diet 
gradually be worked up to egg-nog, oyster-broth, raw 
oysters, arrowroot, custards, etc., though the change of 
diet must not be made without the physician's orders. 

Peritonitis is inflammation of the peritoneum, the 
serous membrane lining the abdomen. Peritonitis may 
be due to blows upon the abdomen, to inflammation of 
any of the organs in the abdomen covered by the peri- 
toneum (especially the vermiform appendix), or it may fol- 
low an operation 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 



NURSING IN SPECIAL MEDICAL DISEASES. 28 1 

in the abdomen, which is distended and tender, vomiting, 
constipation, high temperature (from loi to 103° F.), 
small, rapid pulse, and high and shallow respiration, 
owing to the pain caused by breathing. The expression 
of the face is drawn and anxious. The patient when in 
bed lies on the back with the knees drawn up, which 
position relaxes the muscles of the abdomen. A roll or 
a pillow placed under the knees will remove the strain 
that the patient has to make in order to keep up the 
knees. 

Treatment. — Poultices or fomentations are applied to 
the abdomen, and the weight of the bed-clothes re- 
lieved by a cradle. The nurse must not give purgatives 
on her own responsibility. When convalescence begins 
the patient should be fed well with nourishing food, but 
return to solids should not be made without the phys- 
ician's orders. The nurse will know at the end of a few 
days if the patient is to live or to die : if death is immi- 
nent, there will be loss of strength and collapse. 

If the peritonitis is the result of perforation of the 
bowel, as in typhoid fever, hot fomentations must be 
applied, the patient to be kept absolutely quiet, and the 
foot of the bed elevated. Gas-accumulation can be re- 
lieved by inserting a rectal tube. 

Appendicitis is inflammation of the vermiform appen- 
dix, the inflammation being sometimes due to the pres- 
ence in the appendix of foreign bodies, such as grape-, 
lemon-, orange-, or melon-seeds, or concretions of fecal 
matter; other causes are intestinal catarrh, a blow on 
the abdomen, unusual physical efforts, or cold. Ap- 
pendicitis is more common in men than in women for 
various reasons. Men work harder and are subject to 
more violence than women. The appendix is supplied 



282 PRACTICAL POINTS IN NURSING. 

with blood from one artery, a branch of the mesenteric 
artery which suppHes the cecum. Catarrhal appendi- 
citis is generally caused by extension of catarrh of the 
cecum to the appendix. If an abscess forms, an opera- 
tion is necessary or perforation may take place, re- 
sulting in septic peritonitis and death within a very few 
days. The operation is also considered in the catarrhal 
form, as the patient is always liable to recurrent attacks, 
each subsequent attack increasing the danger to life, that 
may result in perforation and general peritonitis. Per- 
foration is a dreaded complication caused by the rupture 
of an abscess into the peritoneal cavity. The symptoms 
of perforation are sudden pain, a small, wiry pulse, and 
subnormal temperature ; or there may be a rise of tem- 
perature, and the distention of the abdomen may be 
increased. 

The symptoms of appe?idicitis are severe pain, swelling, 
rigidity of the muscles, and tenderness on the right side of 
the lower part of the abdomen, rise of temperature, consti- 
pation, etc. Frequently the patient vomits at the onset of 
the disease ; later, vomiting may recur — a very bad sign. 

A patient ill with peritonitis lies in bed with both knees 
drawn up, and usually in appendicitis the same position 
is assumed, or the right knee alone may be drawn up. 

The treatment is medical and surgical. For a catar- 
rhal attack the treatment is absolute rest on the back, 
Hquid diet, an ice-bag, or hot turpentine or mustard 
fomentations or poultices. The appendix is removed 
when there is an abscess and also in case of perfora- 
tion (unless the shock is too great). 

The writer here desires to impress upon the nurse the 
absolute necessity of perfect antisepsis for this opera- 
tion, as it can only be successful when she has obtained 



NURSING IN SPECIAL MEDICAL DISEASES. 283 

thorough surgical cleanhness. The source of infection 
at all operations (not only when the abdominal cavity 
is to be opened) is often the hands of the surgeon, the 
assistant, or the nurse, and the instruments, sponges, and 
dressings; any fault or neglect on the part of the nurse, 
no matter how small, may cost the patient his life. 

The work of the nurse until the arrival of the surgeon, 
who must be summoned immediately, lies in securing for 
the patient perfect rest and quiet. The bowels must be 
moved with a soapsuds or an oil enema, gently and care- 
fully given. When the surgeon arrives he will decide as 
to the line of treatment ; if an operation is decided upon, 
everything must be prepared antiseptically as nearly as 
possible under the existing circumstances. 

The question is often asked, whether a nurse is justi- 
fied in giving morphin before the arrival of the doctor. 
A safe rule for the nurse is never to give morphin in any 
acute abdominal condition (or in any other condition) 
without specific directions from the doctor. The mor- 
phin masks the symptoms so that the physician cannot 
judge the case properly, it may stupefy the patient so 
that he cannot give clear answers to questions, and it 
frequently produces undesirable effects in case an opera- 
tion has to be performed. Usually sufficient temporary 
amelioration of the pain may be produced by an ice-bag, 
or sometimes by a hot-water bag. 

After a catarrhal attack, when the appendix has not 
been removed, the patient must be very careful with 
regard to diet and personal hygiene, and should wear 
a flannel abdominal protector, because sudden changes 
of temperature are liable to affect the bowels, which are 
very sensitive, and cause a recurrent attack. 

Dysentery is inflammation of the mucous membrane 



284 PRACTICAL POINTS IN NURSING. 

of the large intestine. The symptoms are chilliness, some 
fever, small and frequent movements from the bowels 
mixed with blood and mucus, and tenesmus, or constant 
straining and painful efforts to evacuate the bowels. Dys- 
entery begins with diarrhea, straining, griping pains in 
the abdomen, which is very tender, and the characteristic 
movements, which are very offensive and which must be 
thoroughly disinfected. 

Treatment. — The patient must be put to bed and use 
the bed-pan in his defecations ; he must not be per- 
mitted to get up, as there is danger of ulceration, 
perforation of the intestine, and peritonitis. A cathar- 
tic of magnesium sulfate, 2 teaspoonsful, or i ounce 
of castor oil with 15 drops of laudanum, should be 
given to clear the bowels of the irritating substance; 
the laudanum will relieve the pain and the desire to 
stool. Hot turpentine or mustard poultices or fomenta- 
tions should be applied to the abdomen. 

The diet should be liquid — boiled milk, gruels of 
flour, corn-starch, or arrowroot. The bed-linen and body- 
linen must be kept perfectly clean and changed often. 
Dysentery is not contagious, but if the movements are 
not disinfected, they decompose and the epidemic form 
may result. 

Cholera morbus, which is inflammation of the mu- 
cous membrane of the stomach and intestine, is caused 
by irritating food, such as unripe or decayed fruit and 
vegetables, and also by sudden changes in temperature. 
There are severe cramps in the stomach and abdomen, 
violent vomiting and purging, the discharges later resem- 
bling rice-water ; great prostration. 

Treatment. — Hot applications to the abdomen and 
body must be resorted to at once, and stimulants ad- 



NURSING IN SPECIAL MEDICAL DISEASES. 285 

ministered if necessary. Ice will relieve the intense 
thirst. A liquid diet must be given — milk, gruels, 
broths, and egg-nog. 

Acute Diarrhea. — In treating acute diarrhea the pa- 
tient must be put to bed and fed on liquid diet — boiled 
milk, corn-starch, rice and flour gruels, etc. A laxative of 
castor oil i ounce and laudanum 1 5 drops may be given 
to remove the irritant and relieve the pain. 

Uremia is caused by the retention in the blood of 
certain waste materials which should have been eliminated 
by the kidneys. 

Uremia may abruptly begin with convulsions, followed 
by coma, or there may be premonitory symptoms, some 
of which are headache, nausea, vomiting ; scanty urine 
deficient in urea ; dimness of vision ; the mind dull, deep- 
ening into stupor, followed by coma. Sometimes covul- 
sions precede the coma, which terminates in death unless 
the poison causing the attack is rapidly eliminated. The 
pulse is slow and full ; temperature subnormal. When 
the convulsions occur they may rapidly take place one 
after the other, the patient generally being unconscious 
between the attacks. The pulse during the convulsions 
may be found small and rapid, and the temperature be 
raised. 

The treatment must be prompt. If the nurse is far 
from medical aid, the first thing to be done is to put 
something between the patient's teeth to prevent the 
tongue being bitten. The patient should then be given 
a hot pack or a hot-air bath, which will increase the 
activity of the skin and also act as a sedative. 

The bowels must be moved with salts or by an enema. 
The second convulsion can be controlled by giving a 
little ether if it is at hand ; if not, then the hot bath 



286 PRACTICAL POINTS IN NURSING. 

should be repeated, hot drinks be given, heat applied 
over the kidneys and to the feet, cold to the head. 
If the pulse is weak, heart stimulants should be admin- 
istered. Uremia may occur in scarlet fever, pregnancy, 
Bright's disease, and in other diseases. 

Cerebro-spinal mening-itis is an infectious disease 
beginning with a chill, very severe headache, pain in the 
muscles of the neck and back, that very soon become 
rigid, so that the head is bent backward and the back 
is straightened; the arms and legs are flexed; vomit- 
ing, delirium, and constipation are present; there may 
be intolerance of light and sound and deafness or blind- 
ness. After a few days a spotted rash may appear. 
The disease attains its height in a very few days, and 
the tempetature may rise to 105° F. or higher, with 
convulsions, stupor, coma, and death, or the symptoms 
may gradually disappear and the case end in convales- 
cence. 

Treatment. — Ice-bags or ice poultices are applied to the 
back of the neck and spine, and it is a good plan to apply 
heat to the extremities to avoid any depressing effect from 
the cold. The diet must be liquid. If the patient can- 
not swallow, he must be fed by enemas, and the nurse 
should do all in her power to sustain life. Stimulants 
must be given if the pulse indicates heart -failure. 

Cerebral apoplexy, or cerebral hemorrhage, is caused 
by the bursting of a blood-vessel in the brain, which 
accident may be due to disease of the cerebral blood- 
vessels. The size of the clot varies, it may merely be a 
capillary oozing, or it may fill a hemisphere of the brain, 
and the amount of paralysis is due to the situation and 
the size of the clot. If the clot is small, the paralysis 
may be slight and finally disappear. 



NURSING IN SPECIAL MEDICAL DISEASES. 2^7 

The prcDionitory symptoms are headache, dizziness, 
languor, ringing in the ears, and a numb, weak feehng 
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 enemas. Stimu- 
lants must not be given unless ordered by the doctor or 
unless the pulse is feeble, as they increase the hemor- 
rhage into the brain. To obtain involuntary swallowing 
the liquid or powder is placed far back on the tongue 
and the nostrils and lips are closed. 

The nurse must watch for convulsions, which may be 
tonic or clonic. A tonic convulsion is a continued rigid 
contraction of a muscle or muscles, while a clonic con- 
vulsion consists of alternate contractions and relaxations 
of the muscle or muscles. 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 the eyes change during the day, or if they remain 
dilated or contracted, or if they are unevenly contracted. 

If recovery takes place, the patient must have nourish- 



288 PRACTICAL POINTS IN NURSING. 

ing and easily digestible food. He will need the most 
careful nursing on account of the paralysis. The nurse 
should guard against bed-sores by keeping the patient 
and the bed perfectly dry and clean. The patient must 
be kept absolutely quiet and free from all mental excite- 
ment : another shock generally follows the first, as the 
blood-vessels of the brain are in a diseased condition. A 
certain amount of paralysis usually remains, according 
to the degree of severity of the case. One patient may 
recover consciousness, be thoroughly sensible of every- 
thing that is being said and done, but be totally unable 
to speak, this difficulty lying not with the muscles of 
the tongue, but in the brain. Another patient may be 
able to utter words, but unable to connect them so as 
to make himself intelligible. Because a patient is unable 
to speak it does not follow that he is also deaf Many 
times the hearing is very acute, the faintest whisper be- 
ing heard ; hence the nurse must be very careful as to 
what she says when in the patient's room. 

Differential Diagnosis. — As apoplexy is often mistaken 
for intoxication or for opium-poisoning when the patient 
is found in the street, it will be well for the nurse to re- 
member that in apoplexy there is unconsciousness, ster- 
torous breathing, and paralysis, the movements of the 
patient being confined to the sound side of the body ; 
the pupils of the eyes may be found contracted or dilated 
or uneven. This contraction denotes irritation, and the 
dilatation denotes compression of the brain. In opium- 
poisoning the pupils are very narrowly contracted — the 
size of a pin's head; there is unconsciousness, but no 
paralysis. In intoxication the pupils may be contracted 
or moderately dilated, dilating still more as the patient 
comes to his senses. The smell of alcohol on the breath 



NURSING IN SPECIAL MEDICAL DISEASES. 289 

is of no assistance in determining the condition of the 
patient, as spirituous liquor may have been given by the 
first person who found the unconscious patient. 

Paralysis. — Hemiplegia is paralysis of one side of the 
body ; paraplegia is paralysis of the lower half of the 
body ; and monoplegia is paralysis of one limb, such as 
an arm or a leg. By paralysis is meant total loss of 
power or motion and of sensation ; that is, the patient 
cannot move the part paralyzed because there is no 
power or motion in it, neither may there be any feel- 
ing or sensation. When the loss of power is only par- 
tial, this condition is called " paresis." It will be appro- 
priate to say here that the nerves have their seat in the 
brain, and at the base of the brain they cross from side 
to side ; those at the right side supply the left side of the 
body, and those at the left side supply the right side of 
the body, so when the right side of the brain is injured 
or diseased it is the left side of the body which is para- 
lyzed, and vice versa. 

The treatment of paralysis consists in good hygienic 
surroundings. Extreme cleanliness is necessary to pre- 
vent the formation of bed-sores. Massage and electri- 
city are employed, which in some cases have effected 
partial and even complete recovery. 

There is complete helplessness of patients in this class 
of cases ; they are totally dependent upon the nurse ; 
they feel their helplessness very keenly, and also appre- 
ciate the kindness and cheerfulness with which the nurse 
does everything for them. 

Epilepsy. — Epilepsy is a disease of the nervous sys- 
tem, characterized by attacks of sudden loss of con- 
sciousness and coordination, with tonic and clonic convul- 
sions. The attack may occur either with or without 

19 



290 PRACTICAL POINTS IN NURSING. 

warning. The patient may fall to the ground entirely un- 
conscious, with a pale face and the breathing be almost 
stopped. After a few seconds this passive condition 
passes away and there follow convulsions, which cease 
after a few minutes, and the patient falls into a deep, 
heavy sleep, awakening without knowing what has hap- 
pened. The patient, however, may fall, remain uncon- 
scious, and recover in a few minutes. In the milder 
form the patient suddenly stands still or may pause in 
what she is doing, then recovers her senses and continue 
her work. After the severe attack there generally re- 
main headache, despondency, and a very tired feeling. 

Some patients have the attacks only in the daytime, 
while others have them at night. Some patients, again, 
can tell when an attack is coming on, and by doing cer- 
tain things can ward it off, as, for instance, by rubbing the 
part where the sensation is first felt, or if the thumbs or 
toes turn in by straightening them out. This sensation 
is called the "aura epileptica;" that is, the sensation 
which sometimes comes before an epileptic fit and by 
which the patient can tell when the fit is coming on. 

The treatment of epilepsy lies in first putting something 
between the patient's teeth to prevent the tongue being 
bitten ; then in loosening the clothing about the neck 
and chest, and in not restraining the patient unless the 
body movements are excessive, in which case the arms 
and legs are grasped and the movements followed. One 
can thus keep the patient from hurting herself or others. 

The nurse must notice the eyes — are they fixed ? are 
the pupils dilated ? — the color of the face, and on which 
side the convulsions began, and whether the unconscious- 
ness is complete or partial. Epileptic patients should never 
be left alone, but should be watched day and night, as a 



NURSING IN SPECIAL MEDICAL DISEASES. 29 1 

fit of temporary insanity may take the place of convul- 
sions and the patient may injure herself or others. 

The patient must be kept free from all mental and 
physical excitement, and take plenty of exercise in the 
open air. The diet may chiefly be vegetable. A free 
action of the bowels should be secured each day. 

Dropsy is an unnatural collection of fluid in the tis- 
sues or the cavities of the body. Cardiac dropsy usually 
begins in the feet and ascends. 

Diabetes is of two kinds — diabetes mellitus^ charac- 
terized by the presence of grape-sugar in the urine, and 
diabetes insipidus, characterized by the excretion of a 
very large quantity of pale urine of a low specific gravity, 
and generally free from albumin and sugar. In diabetes 
mellitus the urine is increased in quantity. Sometimes 
the amount passed in the twenty-four hours is very large, 
from 2 to 6 quarts ; the specific gravity of the urine 
ranges from 1015 to 1050. 

Nursing. — The diet should be restricted in this dis- 
ease ; everything containing starch or sugar being 
omitted, saccharin and glycerin being substituted. Meats 
of various kinds may be given, and also such vegetables 
as celery, lettuce, cauliflower, cabbage, tomatoes, green 
beans, onions, and spinach. Foods to be avoided include 
wheat bread, crackers, pastry, potatoes, oysters, liver, 
peas, beets, carrots, parsnips, turnips, sweet fruit, choco- 
late, cocoa, syrup, preserves, and malt Hquors. Fresh 
air and regular exercise are of value, but the patient 
must not be allowed to overexert himself All undue 
exposure should be avoided. 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. It is well for the nurse to 



292 



PRACTICAL POINTS IN NURSING. 



understand urinalysis to a certain extent, so that when 
she is nursing patients with urinary diseases she may be 
able to make the ordinary tests for specific gravity, albu- 
men, sugar, etc., thus facilitating the treatment in such 
cases. 

The urine is one of the excretions of the body, and 
contains waste and worn-out material held in solution, 
or " salts," as they are called, among which is urea, uric 
acid, urates, chlorids, and earthy phosphates. 

The nonnal quantity of urine passed in the twenty- 
four hours is from 30 to 50 ounces. The color is a Hght 
amber, the reaction acid, and the specific gravity (by 
which is meant the weight of the urine) averages from 
10 1 8 to 1024, or may be as high as 1030 without there 
being any disease. There is a characteristic aromatic odor. 
The amount of urine is varied at different times, 
more being passed during the day than 
the night. Food and drink increase the 
quantity. After profuse perspiration the 
amount is decreased ; while, on the con- 
trary, cold decreases the activity of the 
skin, and consequently the flow of urine 
is increased. Some diseases are charac- 
terized by an increase or a decrease in 
the amount passed ; as, for instance, one 
of the first symptoms of diabetes melli- 
tus is the increased amount of urine 
passed daily, which amount may be as 
high as 80 or 100 ounces, of a specific 
gravity ranging from 1020 to 1045, which may indicate 
an abnormal amount of sugar in the urine, and the color 
may be clear light .yellow, without any sediment. 

When there is an excess of sugar or urea, or of any of 




^ 



Fig. 92, 



1^- 



Urinometer. 



URINE. 



Plate i. 













I. 
PALE YELLOW. 












II. 
LIGHT YELLOW. 












III. 
YELLOW. 












IV. 

REDDISH YELLOW 












V. 

YELLOWISH RED, 










^mm 


VI. 

RED. 










^^^^^1 


VII. 

BROWNISH RED 










^^^^^H 


VIII. 

REDDISH BROWN 










^^^■^■|fi|iii|||^^H^^^^H BROWNISH 







"^cale of Uiinary Colors, according to Vogel (Wolff). 



NURSING IN SPECIAL MEDICAL DISEASES. 293 

the other substances in the urine, it does not follow that 
the kidneys are diseased ; they may be perfectly healthy, 
and the change be due to some nutritive or other dis- 
turbance; but when we find albumin in the urine, the 
kidneys are generally diseased. 

In acute diseases the quantity of urine may be dimin- 
ished and its color and specific gravity be high. When 
convalescence sets in the amount increases and the spe- 
cific gravity may be found below the normal. 

The odor of the urine is affected by taking certain 
foods and medicines. 

The color of the urine varies from a light amber to a 
dark red (PI. i). In nervous diseases the urine is very 
often pale, like water. In fever cases it is a high red color, 
and is generally thick and loaded with sediment, because, 
as the amount of food taken into the body is much less, 
the wasting process is more active ; hence the amount of 
solids in the urine is increased. Medicines influence the 
color. Bile may give to it a dark-brown or a greenish 
color, as will also carbolic acid ; iodoform will give to it 
a dark smoky colon 

The reaction for the twenty-four-hour amount is acid. 
After meals it may be neutral or alkaline. The reaction 
is taken with blue litmus-paper, which, if the urine is 
acid, will be turned red. If the urine is alkaline, it will 
turn red litmus-paper blue, and if it is neutral (neither 
acid nor alkaline), it will have no effect upon either red 
or blue litmus-paper. 

The specific gravity of urine is taken with the urinom- 
eter (Fig. 92). When taking the specific gravity the 
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. 



294 PRACTICAL POINTS IN NURSING. 

Tests of Urine. — To test for albumin a test-tube is 
half filled with urine and heat applied until boiling 
occurs. If albumin is present, the urine appears cloudy, 
and this cloudiness does not disappear on the addi- 
tion of a few drops of nitric or acetic acid. Another 
ready way, if nitric acid is at hand, is to pour some 
of the acid into a* small glass, incline the glass, and 
pour down the side of it an equal amount of the clear 
urine, which will spread over the acid ; if albumin is 
present, there will be a sharp white ring between the 
urine and the nitric acid. Very often we get this white 
ring when the mixed urates are present, and it might be 
mistaken for albumin ; but if urates are present and not 
albumin, the white ring, or " zone," as it is called, will 
not appear where the urine and nitric acid meet, but 
higher up, and later will spread into the urine, and if it 
is heated will disappear. When normal urine is poured 
on nitric acid a brown ring appears between the urine 
and the acid, due to the action of the acid on the color- 
ing matters. Hence, when there is an abundance of 
coloring matter the albumin precipitates may be simi- 
larly colored. 

A pretty test for sugar is to add to the urine an equal 
amount of sodii hydrate, which will make the urine 
alkaline, then add drop by drop a solution of sulphate 
of copper ; if sugar is present, the mixture turns a dark 
navy-blue color. If this mixture is boiled, there will re- 
sult a reddish-yellow precipitate ; this is Trommer's test. 
Another test is to take urine and Hquor potassae equal 
parts, and add a little bismuth subnitrate ; this solution 
when shaken and boiled, if sugar is present, will turn 
perfectly black. 

Gout. — Gout is due to the collection of sodium 



NURSING IN SPECIAL MEDICAL DISEASES. 295 

urate in the blood and joints. It is characterized 
by pain and swelHng of the great toe, and is accom- 
panied by insomnia, restlessness, irritability, and dys- 
pepsia. 

Nursing. — The affected limb should be raised so 
as to be on a level with the body, and wrapped in 
cotton-wool or covered with warm fomentations or wet 
cloths soaked in lead-water and laudanum. Water- 
drinking should be encouraged, and no more should 
be eaten than is absolutely necessary to satisfy hunger. 
Hot baths followed by massage may be ordered by the 
physician. 

Rheumatism. — 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-linen or when changing the position of the patient, 
because of the extreme pain. 

The room must be kept of even temperature (68° F.), 
and the patient be guarded against all draughts, the 
affected joints being wrapped in cotton batting. The 
diet should consist of milk, soups, egg-nog, etc. and the 
thirst relieved with Hme- or lemon-juice. 

The medicinal treatment is generally salol, salicylic 
acid, and salicylate of sodium to relieve the pain and 
reduce the temperature. When giving the sahcylates 
the nurse must watch for the physiological effects, which 



296 PRACTICAL POINTS IN NURSING. 

are noises in the ears, deafness, nausea, vomiting, perspi- 
ration, and delirium. The fever may be controlled by 
the cold pack or cold bath, or bathing with tepid water. 
Massage and electricity are often employed. 

The pain may move from joint to joint, or may affect 
only one joint. When only one joint is affected, it is 
called "monoarticular" rheumatism, and if more than 
one joint, it is called "polyarthritis." As there is great 
danger of heart-failure, the patient must not be allowed 
to rise from the bed without permission from the doctor. 
Severe cases of the disease may develop cerebral symp- 
toms : there will be restlessness, delirium, very high tem- 
perature, with a small, rapid pulse, pale and rather blue 
face, convulsions, and death. 

Acute muscular rheumatism is an affection of one or 
of a group of muscles. The disease may repeatedly 
occur in the same patient; therefore one attack does 
not mean immunity from another; there is always a 
tendency to the disease. Its treatment is similar to that 
of acute articular rheumatism. Cold and dampness must 
carefully be avoided, and the patient should wear woollen 
garments next the skin. 

Diseases of the Skin. — A few words on skin diseases 
will close these medical discussions. 

Acne, or black-heads, is due to the blocking up of 
the skin-glands, and is marked by the formation of small 
pimples. This condition is treated by regulating the diet 
with the intent of having it wholesome and easily digested, 
regulation of the bowels, and cleanliness. 

Eczema is an inflammatory disease of the skin, and of 
it there are many varieties. It is often due to irritation 
through using hard soaps and to putting the hands in 
certain fluids. 



NURSING IN SPECIAL MEDICAL DISEASES. 297 

Scabies, or the itch, which is contagious, may be ac- 
quired by shaking hands with a person thus affected or 
by touching anything that she has used. There is an 
intense itching of the hands between the fingers, of the 
axilla, and of the inner part of the thighs, that grad- 
ually spreads over the body. It is worse when the 
patient is warm, and especially when she is in bed. 

Nursing. — A sulphur bath (p. 97) will probably be or- 
dered by the physician. In this the patient should be 
immersed for twenty minutes. Vaselin will relieve the 
soreness caused by scratching. All clothing should be 
disinfected or burnt. 

Ringworm is also contagious ; a child thus infected 
should be isolated from other children. 

Herpes zoster, or shingles, is often due ^o debility, to 
damp clothing, and exposure to cold. 

Psoriasis appears in the form of whitened scales, es- 
pecially upon the elbows and knees. 

Erythema is a simple reddening of the skin in patches, 
due to irritation either local or general. 

Urticaria, or hives, is a wheel-like eruption, due to 
indigestion, constipation, or the eating of certain foods. 

Pavus is a disease of the scalp and hair-roots caused 
by a vegetable parasite. 

Alopecia areata is caused by a vegetable parasite 
which destroys the hair-roots in circular masses, causing 
circular areas of baldness. 

Lupus is tuberculosis of the skin. It takes the form 
of raised, reddened, and hardened patches of thickened 
skin, usually about the face and neck. 

Treatment of Skin Diseases. — The treatments of all 
skin diseases differ very much, each case being treated 
according to the method of the physician in charge. 



298 PRACTICAL POINTS IN NURSING. 

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 feehngs when dressing the parts ; 
the patient, too, is often very irritable. All this calls for 
a great amount of patience, kindness, and sympathy on 
the part of the nurse, who must try to hide her emo- 
tions when doing the dressings, for the patients are very 
sensitive and narrowly watch her face. We have here a 
noble example in the Sisters of Charity, who, as was 
said by Dr. Myles Standish, " with kindness in their 
manner, gentle care in their hands, and the love of 
God in their hearts and souls, could care for and dress 
without expression of loathing and disgust the gangrene 
then so often seen in the surgical wards, and the most 
loathsome disease. All honor to them ! They taught 
the world, both physician and the layman, the value 
of nursing." 

Caring for the dead is one of the duties the nurse will 
have to perform. The wTiter 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. 

1 The nurse should see that all her patients, Catholic or Protestant, 
receive the last sacraments before death. 



NURSING IN SPECIAL MEDICAL DISEASES. 299 

When the end has come the following instructions 
should be followed : Straighten the limbs, close the eyes 
by pressing the lids down with the fingers, and then 
leave the room to the family for a while. After the 
family have left the room the bed-clothes must be re- 
moved and a fresh under-sheet put on the bed; take 
away all pillow^s but one. Wash the body with soap and 
water and some disinfectant, and guard it against expo- 
sure the same as if the body were conscious. The rec- 
tum and vagina must be packed with cotton of any kind 
to prevent discharges. Sometimes it is necessary to 
pack the mouth and nostrils for the same reason. Put 
a napkin, drawers, under-vest, night-gown, and stockings 
on the body. Comb and dress the hair in the way that 
it was usually worn by the patient. Arrange the lips 
and prop up the jaw with a roll ; do not bandage, as this 
will wrinkle the skin, it being desirable to have the face 
look as life-like as possible. Clean the nails. 

If there are wounds on the body, they must have a 
fresh dressing put on ; wounds about the head can be 
covered with a small cap made of black silk. Tie the 
limbs with a bandage and cover the body with a sheet. 
Put the room in perfect order and remove all signs of 
the illness. If the case has been contagious, the body 
must be washed with disinfectants and be WTapped in a 
sheet wrung out of the same ; the funeral must be pri- 
vate and the room afterward fumigated (see p. 263). 



300 • PRACTICAL POINTS IN NURSING. 



VI. THE NURSING OF SICK CHILDREN. 

Care of the New-born. — The newly born infant finds 
adjustment to his new surroundings to be quite a task, 
for, until the moment of his birth,, his mother has per- 
formed his functions for him ; now, all of these duties are 
suddenly thrust upon him, if he expects to maintain life. 
He therefore needs to have the most favorable surround- 
ings and the best opportunity. Hence, one important 
thing to be impressed upon the nurse, is the need of 
keeping the baby quiet. Do not handle it for the first 
few hours any more than is absolutely necessary. The 
temperature of the room at birth should be 76° F. at 
least, that the sudden contact with the outer air may not 
be too great a shock, and as soon as the cord is tied and 
dressed, the eyes, nose and mouth are wiped, and breath- 
ing has been well established, the child should be wrapped 
in a sterile towel, then in a cotton blanket, with a hot- 
water bag in the folds of the blanket. Do not cover the 
baby's face entirely; leave the nose and mouth so he can 
have the air which he needs, but protect him from drafts. 
After the mother is attended to, the baby may be thor- 
oughly oiled to help remove the cheesy substance called 
** vernix caseosa," which protects the skin of the child 
while in the womb. The doctor will put the silver ni- 
trate solution in the eyes, which is now required by law 
in most States, and then the baby should be let alone for 
about six hours, watched only to see that he breathes 
well, is warm, aud that the cord does not bleed. 

At the end of six hours a warm soap-and-water bath 
should be given, care being used to remove all the " ver- 
nix caseosa," especially on the scalp, or it may cause in- 



THE NURSING OF SICK CHILDREN. 30I 

flammation. The skin should be thoroughly dried, but 
not with friction, and talcum powder used in the folds 
and creases of the flesh. During the bath the nurse 
should carefully examine the body of the infant to see 
that it is perfectly normal ; any abnormalities must be 
reported to the physician. 

Dressing the Cord. — The navel cord is dressed by 
wrapping it in sterilized gauze or antiseptic cotton, the 
binder put on, and the cord placed on the left side of the 
body, because if placed on the right side it would press 
upon the liver, which at birth is larger than the other 
organs, and which reaches down to the navel. The 
binder must not be pinned too tight or the gas cannot 
pass through the intestines. 

Dressing the Infant. — The clothing of the new-born 
consists of a shirt, a diaper, a skirt, and a muslin slip. 
The climate, season of the year, and home surroundings 
should regulate the weight and quality of the material 
used. While he is small and spends most of his time 
in the crib, it is better not to burden the child with cloth- 
ing, but to have small blankets to wrap about and cover 
over him suitable to the season and the temperature. 
The shirt should be of light wool in the winter, and 
cotton in the summer, and it is best to make the little 
skirt with the waist and lower part all in one, and open 
full length in the back. The outside slip may be of any 
style desired, but it is a good plan to have it open in the 
back like the skirt for the first few weeks ; the advantage 
of this is that the garments are more easily put on, and 
that the clothes may be drawn aside when the baby is 
laid in its crib, and much soiling and changing may be 
avoided. Take care that the child is not too warm so 
that perspiration is induced, for there is then danger from 



302 PRACTICAL POINTS IN NURSING. 

cold when clothing is removed. Besides, the strength of 
the child is used in the effort to maintain an equilibrium in 
the body temperature, his powers of resistance are low- 
ered, and he is less able to resist disease. The foreign 
woman, coming to this country from Europe, insists 
upon following the custom of her people, and binds 
her baby from head to foot with a long binder that is 
wrapped about it and tied. Then the child either has 
a pillow wrapped around and tied, or is placed between 
feather beds, and with a hood on its head, it is put in the 
crib and covered with more clothing and left in a close, 
hot room. Under such conditions the moisture and 
poisons from the skin, bladder, and bowels are reabsorbed 
and the child suffers from the toxic effect ; the tender 
skin is irritated and breaks out with rash, causing great 
discomfort. 

Baby's clothing must allow freedom of motion of arms 
and legs, it must be warm enough to preserve the proper 
bodily temperature, and made in such a way that the 
skin will be protected from undue moisture and heat. 
No tight clothing that will constrict in any way, or 
restrict motion, or prevent escape through the pores of 
the skin of poisonous gases and fluids, should be used 
on the new-born infant. 

After the dressing the baby is laid in the crib or a 
clothes-basket, covered Hghtly, and the eyes shaded 
from the light. A baby should sleep during the first 
few days twenty hours out of the twenty-four, and will 
do so if it is left alone and not taken up for exhibition 
or to be rocked, or carried about, all of which tends to 
keep the child in a perpetual state of excitement, thus 
making it nervous. 

Bathing the Baby. — Until the cord separates, which 
should be on the fourth or fifth day, the infant should be 



THE NURSING OF SICK CHILDREN 303 

giv^en a sponge-bath every morning, and after the separa- 
tion a tub-batJi. The temperature of the water must be 
100° 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 irri- 
tants. If there is chafing, the chafed parts should be 
covered with soft linen. It is best to lay the baby on a 
table for bathing and dressing, as it is easier for the nurse 
to manage, and requires less turning and handling of the 
infant. For the sponge bath a small blanket should be 
used, and only the part being bathed should be un- 
covered. 

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 
also if the baby passes urine. Owing to the absence 
of coloring matter in the infant's urine, whereby it 
will not stain the diaper, and the small amount voided 
at the frequent urinations, it is often supposed that 
there is some obstruction. Close and frequent exami- 
nation will clear up the condition. The diapers must 
be changed as soon as wet, and the parts bathed and 
powdered. 

Nursing of the hifant. — The baby should be put to 
the breast regularly every two hours during the day, 
and only when it awakens during the night. It should 
nurse for ten minutes, and the mother must see that it 



304 PRACTICAL POINTS IN NURSING. 

keeps awake and busy for that length of time ; it is then 
possible to know more accurately the quantity of food 
the baby takes at one feeding. Regular time and a 
definite quantity are all-important factors in the feeding 
of infants. They are thus kept in better condition at all 
times, and the regular habits thus formed are a life-long 
benefit. Immediately before each feeding the mother's 
nipple and the baby's mouth should be washed with boric 
acid solution. 

Babies need water, and should be given warm, sterile 
water in small quantities between feedings. This will 
often stop their crying by allaying thirst and curing colic 
with the warmth in the stomach. 

The infant must not be put to the breast unless it is 
time. Babies get tired of lying in the one position ; they 
cannot turn themselves, and they waken and cry ; there- 
fore their position should be changed by taking hold of 
the clothing at the shoulders and limbs, and gently turn- 
ing them; they will not awaken, and besides making them 
more comfortable, the change will lengthen their sleep. 

Artificial Feeding. — If the baby must be brought up by 
hand (bottle feeding), the physician will direct the cha- 
racter of the food to be given and the nurse must faith- 
fully carry out his orders. At times the food consists of 
equal parts of milk and water until after the third month, 
when the water is gradually diminished, until at the eighth 
or tenth month, when the milk is sometimes given plain. 
If the milk seems to disagree with the infant, a teaspoonful 
of lime-water added may correct the trouble. The bot- 
tles and nipples, and the vessels in which they are 
washed, must all be kept perfectly clean. The rubber 
nipples must be cleansed inside and out, and should be 
boiled for about ten minutes before being used, and be 
kept in cold water during the intervals of feeding. The 



THE NURSING OF SICK CHILDREN 305 

bottles should be washed with soap and water, then put 
in cold water to which has been added a teaspoonful of 
baking-soda, and set over the fire to boil. After being 
thus sterilized they should be kept in cold sterile water 
until filled for feeding. 

Milk Sterilization. — If it is required to sterilize the 
milk, sufficient should be sterilized to last twenty-four 
hours, and enough be put in each bottle for a single 
feeding. The mouths of the bottles should be stoppered 
with absorbent cotton, which will absorb the germs of 
the air and keep them away from 
the milk. The best apparatus for 
steriHzing milk is the Arnold ster- 
ilizer (Fig. 93). In the absence 
of this sterilizer the bottles can 
be placed in an ordinary boiler 
of cold water either on sticks or 
on a folded towel to keep them 
from touching the bottom of the 
vessel, the water reaching to the 
necks of the bottles. The water 
should come to a boil, then the 
boiler cover be put on, and the 
boiler removed from the fire, and 

, - r 1 1 Flf*- 93— Arnold sterilizer. 

left to steam for about one hour, 

after which time the bottles are taken out and put away 

in a cool place. The bottles must not be opened until 

needed. A bottle of the milk should be warmed by 

allowing it to stand a few minutes in a pan of hot water ; 

the cotton is then taken out and the rubber nipple put 

on. If any of the milk is left in the bottle, it must be 

thrown away. Sterilizing the milk renders it free from 

germs. Pasteurization is the preferable method. 
20 




3o6 



PRACTICAL POINTS IN NURSING. 



Infant Food and Rtdes 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 {RotcJt). 



Age. 


Intervals 

of 
feeding. 


Number of 
feedings in 
24 hours. 


Average 

amount at 

each feeding. 


Average 
amount in 
24 hours. 


1st week. 


2 hours. 


10 


I ounce. 


10 ounces. 


1-6 weeks. 


2^ hours. 


8 


1^-2 ounces. 


12-16 ounces. 


6-12 weeks 
and possibly 
to 6th month. 


3 hours. 


6 


3-4 ounces. 


1 8-24 ounces. 


At 6 months. 


3 hours. 


6 


6 ounces. 


36 ounces. 


At lo months. 


3 hours. 


5 


8 ounces. 


40 ounces. 



At the time of feeding the baby must be taken on the 
nurse's lap, and it must not be allowed to doze over its 
meal; the baby, however, must not be hurried; the 
bottle should be taken away when the meal is over, and 
on no account should the child suck from an empty 
bottle. As the baby grows the intervals between the 
feedings are lengthened and the amount of food is in- 
creased. At seven months the baby may have milk 



THE NURSING OF SICK CHILDREN. 307 

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 Development. — At the third week the baby may 
be taken out doors for its first airing, being carried in the 
arms, not in a carriage, and with its head supported. A 
baby will hold up its head at from three to five months, 
will quickly recognize objects at from six to eight months, 
will sit alone at from the seventh to the eighth month, 
will walk at from the ninth to the twelfth month, will ut- 
ter single words about the first year, and will begin to talk 
by the second year. A baby does not shed tears until 
the second or the third month of age, and if very sick at 
eight months the tears do not flow until convalescence 
sets in. The teeth begin to grow between the fourth and 
the seventh month. The ajiterior fontanelle — that is, the 
middle opening in the top of the head — rather increases 
in size during the ninth and twelfth months, and then de- 
creases, and should be closed at eighteen months. The 
baby must not be allowed to stand alone before twelve 
months ; the leg bones are not very strong and they 
may bend ; when sitting up its head and neck should be 
supported. A baby should gradually increase in weight, 
after the second day, from 3 to 5 ounces each week. It 
loses weight during the first two days. 

The temperature at birth is 99° Y., pulse from 130 to 
140 beats, respirations from 40 to 46 per minute. The 
temperature is usually normal after the first week. 



3o8 



PRACTICAL POINTS IN NURSING. 



Care of Premature Infants.— A premaUire baby is 
one born before full term; it is usually put in an incu- 
bator (Fig. 94), 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 
is also arranged to allow a piece of glass to be inserted and 
to slide in and out. Across the middle of this box are 




Fig. 04 —Modified Auvard incubator or couvcuse : a, glass plate of the movable lid 
(3); c, ventilating tube containing small rotarj- fan ; k, ventilating slide ; m, hot-water 
cans ; o, slide closing hot-air chamber. 

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 
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 



THE NURSING OF SICK CIIIIDREN. 3O9 

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 100° F. ; the tempera- 
ture of the room should be from 80 to 86° F., and the air 
be kept fresh and pure. 

If brought up by hand, the baby is wrapped in cotton 
and flannel so arranged that the napkin can be changed 
without disturbing the baby, which must only be taken 
out of the incubator to nurse. Should the attending 
physician not allow the mother to nurse the infant, it 
should be fed every hour during the day with about two 
teaspoonsful of the mother's milk, given by means of a 
medicine-dropper. 

Diseases of Infancy. — Thrush is a disease caused by 
a specific microorganism, 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 
tea every ten minutes until three doses have been taken ; 
or plain water may be used should the tea not be at 
hand. Colic is due to cold or to the accumulation of 
gas in the bowels, and it generally yields to heat. The 
child lies with the knees drawn up, its cries are sharp, 
long, and loud, and they die away as the pain is re- 
lieved. 

If the food does not digest well, the movements will 
be green, and in them there will be curds of milk. This 
condition must promptly be reported to the physician. 



310 PRACTICAL POINTS IN NURSING. 

Lime-water or baking-soda (about half a teaspoonful 
added to the milk) will often correct the indigestion ; the 
white of an ^^'g 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. 

Bowel Obstruction. — Blood in the movements and con- 
stipation may be due to obstruction of the bowel. The 
child screams with pain ; the abdomen is distended and 
tender ; there is vomiting ; the respiration is difficult, and 
there may possibly be convulsions. Until the arrival of 
the physician hot fomentations may be apphed over the 
abdomen and a soapsuds enema given. To give the enema^ 
everything must first be prepared and laid on a chair or a 
table near by ; the nurse takes the baby on her lap, and 
lays it on its left side, with the knees drawn up. The 
tube, which for a very small baby should be the smallest 
tube that comes with the syringe, should be oiled, the 
air expelled, and the tube inserted in the rectum and the 
bulb gently squeezed. Pressure is applied over the 
rectum to retain the enema for a short time. In very 
young children a movement of the bowels may some- 
times be provoked by merely introducing into the rectum 
the nozzle of the syringe or a lubricated finger. 

Diarrhea. — In diarrhea the bowel- movements will be 
found acid, and sour-smelling, and will contain particles 
of undigested food ; their color will be green. The baby 
has, besides the frequent movements, griping pains in the 
abdomen, vomiting, and restlessness. Diarrhea is often 
caused by improper feeding and changes in the temper- 
ature during the hot summer months. The extreme heat 



THE NURSING OF SICK CHILDREN 3 I I 

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 ^'g'g well beaten and added to an equal 
amount of cold water and a little sugar. When the 
vomiting is persistent the stomach is to be washed out. 
A small rubber catheter, with a funnel attached to one 
end, is used, and the washing is done in the same man- 
ner as that for an adult (see p. 75). 

Vomiting may be caused by over-feeding, when the 
milk will be returned clear because the stomach cannot 
hold the amount ingested. This condition is not serious ; 
but when the milk is returned curdled and sour, it is due 
to indigestion or it may be a symptom of some disease. 

Cholera infantum begins with vomiting and diarrhea, 
weak, rapid pulse, and symptoms of lowered vitality and 
collapse. 

Treatment consists of high starch-and-laudanum ene- 
mata to check the movements. Heat must be applied to 
the body or the child may be put in a hot bath (temp, of 
105° F.). The food for a while is generally white of ^^^ 
with 4 drops of brandy, alternated with 10 drops of Val- 
entine's or expressed beef until the appearance of undi- 
gested food is removed from the bowel movements. The 
air of the room must be kept pure and fresh. When the 
child is strong enough to be taken out, it should be kept 
outdoors the greater part of the day. Cholera infantum 
is caused by impure air and improper food and exposure 
to heat. 



312 PRACTICAL POINTS IN NURSING. 

Rickets, which is also due to improper food and impure 
air, is a disease of the bones owing to an insufficient amount 
of inorganic matter in the bones, that makes them soft, so 
that they easily bend. The child is restless when asleep, 
throwing off the bed-clothes ; when awake it is fretful and 
irritable, and cannot bear to be touched ; the abdomen is 
distended ; the head is large ; the anterior fontanelle (the 
middle opening in the top of the head) is found open at 
the time when it should be closed — that is, at about 
eighteen months ; the teeth are late in appearing ; there 
may be hydrocephalus (dropsy of the brain) ; and the 
long bones of the legs are so bent that the child is 
knock-kneed. There are other symptoms, all caused 
by the want of proper nutrition, and the child presents a 
sickly, puny appearance. 

The treatment of rickets lies in nourishing food, perfect 
cleanliness, pure, fresh air, and massage, and in not allow- 
ing the child to walk, to stand, or to sit until its bones 
are strong enough to bear the weight of the body. 
Many cases of knock-knee are caused by the child be- 
ing allowed to walk or to stand before the bones of 
the legs are strong. 

Convulsions may be due to indigestion, pin-worms, 
etc., or to brain-excitement in rickets, or to irritation of 
the nerve-centres in teething. A great number of the 
diseases of children are ushered in with convulsions, 
which take the place of the initial chill in the adult 
They may come on suddenly or gradually. 

Treatment. — The first thing for the nurse to do is to 
put the child into a hot bath (the temperature about from 
lOO to 104° F.), without waiting to undress it, which can 
be done in the water. The head should be kept raised 
and cold applied to it. The hot-water bath will dilate 



THE NURSING OF SICK CHILDREN. 313 

the blood-vessels of the body, thus diverting the blood 
from the brain to the body. If the attack is the begin- 
ning of any of the eruptive diseases, the heat will also 
bring out the rash, besides relieving any pain in the 
abdomen or elsewhere. The baby is to be kept in the 
bath about five minutes, and is then taken out and 
wrapped in a warm blanket ; an enema is given to clear 
the bowels. A physician should be summoned. 

Teething, which usually begins about the seventh 
month, may be accompanied by many disturbances, such 
as diarrhea, indigestion, convulsions, all of which should 
receive attention. 

Worms. — Delicate children are often troubled with 
worms, which are of three kinds — thread-worms, round- 
worms, and tape-worms. The first two are the most 
common. The symptoms are numerous : itching and 
rubbing of the nose and external parts, vomiting, rest- 
lessness, grating the teeth during sleep, convulsions, 
etc. ; but we must wait until the worms are seen in the 
movements before attributing to them any of these 
symptoms. The worms are generally found in the 
lower bowel, and are passed in the movements, though 
sometimes they are vomited. The bowels should be 
thoroughly cleared by giving the child a dose of castor 
oil, followed by an enema of salt and water, and these 
measures continued daily until the worms have all been 
passed, no more being seen in the movements. The 
expulsion of a tape-worm belongs to the physician. 

Protrusion of the bowel may be remedied by placing 
the child on its back and elevating its buttocks. The 
parts should be washed with tepid water and the bowel 
replaced, then a pad or compress wrung out of ice-water 
be applied, and kept in place with a napkin. If this 



314 PRACTICAL POINTS IN NURSING. 

treatment does not succeed, a physician should be sum- 
moned. Protrusion is often caused by constipation and 
the straining efforts of the baby. A baby should be 
taught regular habits, which, with a little patience, can 
be established. 

Ophthalmia neo7iatoriiin is a purulent inflammation of 
the conjunctiva, which is one of the coats of the eye- 
ball. It is a very serious variety of ophthalmia, gen- 
erally caused by infection during birth from the ma- 
ternal discharges. In this case the fault usually lies 
entirely with the nurse in not cleansing the eyes 
immediately after the head is born, and also in not 
washing the baby's hands, because in this way any 
mucus on its hands is rubbed into the eyes ; it is also 
caused by using the same cloth and water for washing 
the eyes that have been used for the body. Any red- 
ness of the eyes or the eyelids must promptly be re- 
ported. If cold compresses are ordered, they must be 
changed every two minutes. 

Syringing the eyes is best done with a medicine-drop- 
per. The dropper is filled with the ordered solution, which 
may be of boric acid : in applying the solution it should 
flow from the outer to the inner corner of the eye, thence 
to a piece of cotton or of compress. The eye must be 
kept perfectly clean, and all pieces of cotton or compress 
used about it must be burned. Ophthalmia is a germ 
disease and is highly contagious. If the nurse has to 
touch the eyes with any solution, she should twist a 
piece of absorbent cotton around the end of a tooth- 
pick or a match-stick, a fresh piece being used for each 
eye, these eye-swabs being burned immediately after- 
ward. These cases are very fatiguing, but the baby's 
sight depends upon the faithfulness with which the phy- 



THE NURSING OF SICK CHILDREN. 315 

sician's orders are carried out. Many cases of blindness 
are due to neglect. The nurse must protect herself by 
not touching her face, eyes, or hair unless her hands 
have been thoroughly washed and disinfected. Every- 
thing employed about the eye or eyes must be burned, 
and on no account be used about other parts of the body. 

Snuffles, or cold in the head, may be relieved by keep- 
ing the baby warm, oiling the outside of the nose, and 
keeping the nostrils clear by cleaning them with a small 
piece of cotton twisted around a match-stick. 

Infant paralysis is recognized by the baby having no 
power over its limbs. Sometimes the affection is ushered 
in with convulsions and a high fever, and vomiting, then 
follows a wasting of one or more muscles. The limb is 
at first tender, and the baby may cry when it is touched. 
The baby must be kept warm, good nourishing food be 
given, and massage and electricity applied. 

Tongue-tie. — Sometimes the band beneath the baby's 
tongue is too short and the baby cannot nurse. It is 
then tongue-tied, and the band will have to be snipped. 
This is a simple and almost painless operation, taking only 
a very few minutes, and no anesthetic is required, neither 
is there any loss of blood, except in some cases in which 
the scissors are kept close to the tongue rather than 
toward the jaw bone. The nurse can see the baby's 
tongue by placing a little sugar on the lower lip of the 
baby; this will cause it to put out the tongue to get the 
sugar. The little operation should be done by the 
doctor. 

The temperature of babies and that of some of the 
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 



3t6 practical points in nursing. 

break the thermometer, the mercury and fine glass 
entering the rectum. The baby should be placed on 
its left side on the nurse's lap. 

Pulse and Respiration. — The pulse can only be taken 
correctly when the baby is asleep. The pulse is very 
easily affected, the least thing sending it up, together 
with the temperature, and increasing the respirations. 
The pulse at birth is about 140 beats per minute, and 
gradually it decreases with increase in age, as follows : 

First month the pulse is about 120 

First to second year it is about no 

Second to fifth " " " loo 

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. 

Diseases of Childhood. — Any of the diseases which 
attack grown persons may also attack children. 

Typhoid fever is apt to run a milder course in children 



THE NURSING OF SICK CHILDREN. 317 

than in adults ; the nursing, however, is just the same. A 
strict watch must be kept of the temperature for hemor- 
rhage, which is indicated by a sudden drop of tempera- 
ture and a weak, rapid pulse. The bowel-movements 
after the hemorrhage are dark red, but if the feces are 
not passed for some time after, they resemble tar. The 
child must be kept perfectly quiet (not allowed to move), 
so that the blood will coagulate in the blood-vessels and 
prevent further hemorrhage. Cold water or crushed ice 
may be given in small quantities ; only the amount of 
water or ice it is intended the child to have should be 
put into the tumbler; if there is more and the tumbler is 
taken away, the child will cry for it. Baths and packs 
are given in the usual manner. Ice can be applied to 
the head by crushing the ice and making an ice poul- 
tice which can be stitched upon a night-cap. This will 
prevent the poultice falling from side to side. In the 
absence of rubber there may be used flannel or towels, 
which are fastened to the pillow, so that the weight of 
the poultice will not be on the child's head. 

With children ulceration of the bowels is less likely 
than with adults, consequently the dangers of hemor- 
rhage and perforation are less. The rash may be absent, 
but the brain-symptoms are marked and generally the 
temperature rises suddenly. 

Meningitis is inflammation of the membranes of the 
brain. 

Symptoms. — The child is restless, listless, drowsy, and 
fretful ; loses flesh ; grinds the teeth when asleep, and 
the pain in the head causes him to wake up with a 
scream ; he cannot tolerate the light or the slightest noise; 
the pulse is increased and the temperature is raised. These 
symptoms deepen ; the drowsiness increases, followed by 



3l8 PRACTICAL POINTS IN NURSING. 

delirium. The pupils of the eyes may be dilated or evenly 
contracted, or the child may squint ; there may be convul- 
sions. Finally there is complete coma. 

The treatment of meningitis lies in keeping the child 
perfectly quiet in a darkened room and in applying cold 
constantly to the head. The bowels must be kept open 
and the child be fed by the rectum if necessary. The 
child must be kept perfectly clean. As the stupor sets 
in the urine and the excreta will involuntarily be passed. 

Mumps is an inflammation of one or both of the par- 
otid glands, situated beneath the ears. There are fever- 
ishness, headache, restlessness, chill, and vomiting, and 
then the swelling begins. The disease is both conta- 
gious and infectious, and for this reason an affected child 
must be isolated from other children. 

Treatment. — The child must be kept warm and hot 
fomentations applied to relieve the pain, or the neck and 
face may be covered with absorbent cotton or flannel. 
Oil rubbed into the skin will relieve the tight feeling. 
After four or five days the swelling begins to subside 
and the pain is relieved. Soft food should be given. 

hicontinence of urine needs the care of a physician, as 
it may be due to some trouble with the bladder, or the 
urine may contain too much acid. Children who have 
this trouble are very often whipped and scolded by both 
parents and nurses : this is a great mistake, and is wrong 
to a child, unless the nurse is sure that the incontinence 
is due to carelessness. 

Chorea, or St. Vitus' dance, is a nervous disease of 
childhood, and is characterized by the involuntary 
twitching of one or more or of all the muscles of the 
body, that ceases when the child is asleep. In mild 
cases recovery takes place in from four to six weeks; 



THE NURSING OF SICK CHILDREN 3I9 

but in severe cases, when the whole body is involved, the 
child may die, either through inability to take nourishment 
or to sleep, or from heart complications. The affected 
child must be isolated from other children or they will 
imitate its affliction. Good nourishing food must be 
given, and the child be kept free from all excitement. 
Rheumatism being one of the complications of chorea, 
any stiffness of the joints must be reported. The child 
must be treated very kindly and gently spoken to; a 
sharp word has been known to throw a child into con- 
vulsions. Should convulsions set in without any appa- 
rent cause, such as fear, worry, or excitement, they may 
be the beginning of some complication. In severe cases 
of chorea the patients are kept in bed. There is always 
the liability to recurrent attacks, and women who have 
had an attack in childhood may have a recurrence of 
the disease during pregnancy. 

Surgical Diseases of Children. — The surgical dis- 
eases of children are similar to those of adults, and 
demand the same treatment. After any trouble with 
the bowels, such as peritonitis or appendicitis, the child 
should wear a flannel abdominal binder, because sud- 
den changes in the temperature are liable to affect the 
bowels ; the binder will keep the bowels warm and 
guard against recurrent attacks ; the bowels must also 
be kept open. Pain in the knees or the hips must be 
reported ; it may denote hip disease. 

Hip-joint disease (Coxalgia) is caused by a blow or a 
fall, or it may originate from tubercular inflammation of 
the structure of the hip-joint or scrofula, the patient in- 
heriting either of these diseases. The germ lodges in the 
end of the femur or thigh-bone. If the disease is of 
tubercular origin, tubercular meningitis may set in. The 



320 PRACTICAL POINTS IN NURSING. 

child must be confined to bed; he must not sit up. 
Every httle while he will scream in his sleep on ac- 
count of pain caused by a muscular spasm which brings 
the inflamed surfaces of the joint together. Any knock- 
ing against or jarring of the bed causes great pain. 

Children must have plenty of fresh air and sunlight; 
they cannot live healthfully without; also good nourish- 
ing food, of which milk should be the chief 

Nurse's Management of Children. — A child who has 
been used to home-training and to having every whim 
satisfied does not take kindly to the nurse, and often 
will not allow her to do anything for him. Therefore, 
it is generally well for the child to see the nurse in 
the room for a little while, the mother acting under her 
directions, and after he has become accustomed to the 
nurse's presence the way will be much easier. If the 
first thing the nurse has to do is to dress a painful 
part, she should not go up to the child and begin the 
dressing, but she should talk to him about his play- 
things ; then, after a while, with a little tact, she can look 
at the part, touching it very gently ; if this causes no 
pain and the child thinks the nurse is not going to hurt 
him, he will let her do the dressing, the nurse all the time 
keeping up the conversation to attract his attention to 
other things. With children the nurse should be firm 
and at the same time be gentle ; she should let yes mean 
yes, and no mean no. If the nurse has difficulty with a 
child at first, he will see that she is firm and that her 
orders are to be carried out. On no account must the 
child be deceived. A child will often take the most dis- 
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 



THE NURSING OF SICK CHILDREN 32 1 

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 
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 
21 



322 PRACTICAL POINTS IN NURSING. 

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." 



CARE OF NERVOUS AND MENTAL PATIENTS. 323 



VII. NURSING CARE OF NERVOUS AND 
MENTAL PATIENTS. 

The Nurse's Qualifications. — The care of patients 
suffering from nervous and mental disorders is almost a 
distinct field of nursing; first, because a nurse in general 
training seldom meets with this class of cases, and second, 
because it requires special qualifications and experience 
in order to understand how to handle them. A nurse 
must possess infinite tact, patience, wisdom, discernment ; 
she must observe carefully and study thoughtfully mental 
characteristics, and learn to interpret the thoughts that 
are expressed in actions. A sick mind is to be nursed 
back to health, or made as happy and contented as pos- 
sible, and it calls for the higher mental qualifications that 
all nurses do not possess without special training. Then 
again, it is only by actual contact with these patients that 
one may learn their characteristics and how to treat them, 
and we can only hope to make some suggestions that 
will help nurses who find themselves in charge of a 
nervous or mental case. 

Physical Symptoms. — Physical symptoms must be 
viewed in a different light from those observed in patients 
that are physically ill. There are objective symptoms, 
or those that are revealed by the stethoscope, blood- 
pressure apparatus, physical examination, thermometer, 
etc., and subjective symptoms, or those that are related 
by the patient as felt by herself Objective symptoms 
are reliable, but subjective symptoms are not reliable in 
their bearing upon the physical condition. Both affect 
the nervous and mental state of the patient. 



324 PRACTICAL POINTS IN NURSING. 

Temperature, pulse, and respiration vary less in these 
cases than in surgical or acute medical diseases. We are 
accustomed, in a general hospital, to judge of the condi- 
tion of a patient by the way the clinical chart shows ap- 
proach to the normal line or deviation from it. This may 
not be taken as a guide in nervous and mental cases, for 
variations are slight in some, and in others the sudden 
change is unaccountable and not necessarily alarming. 
In cases of depression, melanchoHa, organic brain disease, 
or senile dementia the temperature and pulse may run 
much below normal, and this indicates a sluggishness 
which accompanies the lowered mental activity. With 
those suffering from hysteria, the temperature and pulse 
will take a sudden rise into the realms of seeming danger 
and return again to the normal in the same manner. 
This is indicative of the unstable nervous equilibrium, and 
should not be considered alarming. In some nervous 
conditions there will be a tachycardia, with a pulse rang- 
ing from loo to 140, without a corresponding rise of 
temperature. No serious results may be looked for if 
rest and quiet are observed; the condition is due to a 
general nerve exhaustion. In acute mental disease, where 
there has been a period of great excitement, the tempera- 
ture, pulse, and respiration will rise and remain alarm- 
ingly high, due to mental and physical exhaustion. The 
patient may go on to death unless something can be done 
to relieve the excitement and support the wasting vitality. 
A rapid pulse without corresponding rise of temperature 
is characteristic of exophthalmos, and the accompanying 
nervous and mental manifestations are sometimes most 
trying. Such patients are fault-finding and querulous 
and very difficult to get along with. 

Constipation, a dry, tissue-paper skin, sordes on the 



CARE OF NERVOUS AND MENTAL PATIENTS. 325 

teeth, brittle nails, and dry hair, are indications of a lack 
of nutrition in the tissues, and of insufficient secretion and 
excretion, and the mental condition is a part of the whole. 
Improvement in the mind will follow improved nutrition. 
Auto-intoxication brings its share of physical symptoms 
and is often responsible for the mental breakdown. Sal- 
low, dry skin, sordes on the teeth, foul breath, obstinate 
constipation, scant urine, indicate re-absorption of the 
toxins, and the mind is clouded and disturbed. The 
character of vomiting, if it is present, should be carefully 
observed and noted, because it may be diagnostic to the 
physician. Projectile vomiting indicates organic brain 
disease. Vomiting immediately after eating in cases of 
hysteria, usually denotes that the patient has used some 
means of producing emesis because she wishes to make 
the nurse's task of feeding greater. 

The weight charts are interesting because the gain or 
loss indicates improvement or retrogression in the ner- 
vous and mental state. Gain in weight is like a substan- 
tial bank account. In the fat-cells there is stored nervous 
energy for future use, and it is an important part of a 
nurse's responsibility to care for, and feed her patients so 
they will gain in weight. 

Among subjective symptoms may be mentioned head- 
ache, backache, nausea, sensations of all kinds, crawling, 
prickhng, tight bands, constriction about the head or 
neck, ball in the stomach. Pains of all kinds and in all 
parts of the body are found, and they are due in part to 
poor circulation, but are often creations of an introspec- 
tive mind. These all have their bearing upon the nervous 
and mental condition, and must not be looked upon too 
seriously nor be wholly disregarded. 

Mental Symptoms and Characteristics. — It is essen- 



326 PRACTICAL POINTS IN NURSING. 

tial that a nurse should understand mental symptoms and 
characteristics, and know how to recognize them. This 
is much more difficult than to recognize physical symp- 
toms, as we are dealing with an intangible thing and are 
dependent upon our uncertain minds to interpret. Unless 
very much distorted, our eyes and ears will see and hear 
definitely, but different minds are capable of different in- 
terpretations, and herein lies the nurse's difficult task and 
the need of special qualifications and experience. Let us 
go briefly into the definition and illustration of some of 
the mental symptoms. 

A dehisioii is a false belief A man believes that he is 
God, or a divinely appointed agent. It is easy to realize 
that this is a false beHef, but to the patient it is just as 
true and sure as our own belief that there is a. God. 
Paranoiacs will carry out a whole reasoning process to 
prove some delusion of this kind ; their reasoning is won- 
derfully accurate, but they start from the wrong premise. 
No amount of argument will change their belief That is 
fixed, so it is useless to argue with them. When the 
delusion is in the form of a belief that a member of the 
family has been untrue to the patient, it is a little more 
difficult to prove that it is a delusion, and here experience 
teaches as no book can. 

An hallucination is a false sense-perception. Patients 
see sights and hear sounds that do not exist. This is due 
to an irritation of the brain-cells that produce them, and 
the sensation is real to the patient. A girl sees her 
brother in the room and holds conversations with him. 
With eyes fixed upon a certain point she talks to him, 
waits for his reply, and thus carries on a conversation 
that is altogether made up of false sense-perceptions. 
Patients even feel the heat of the fire that they believe is 



CARE OF NERVOUS AND MENTAL PATIENTS. 327 

burning the house, and they smell the smoke as well. 
Such conditions are exceedingly distressing to witness, 
for they represent untold suffering, and while patients' 
actions are often weird, one should show no fear or alarm, 
and assurance of safety from harm should be given in- 
stead of argument against the existence of these things. 
Always bear in mind the reality of these sensations to 
the patient, and you will be better able to know how to 
help him. 

An illusion is a false sense-perception of a real object^ 
A man may think that the cord of his bath-robe is a 
snake, and its movements are interpreted as those of a 
snake. The swaying limb of a tree seen through a win- 
dow is an arm that continually beckons him, and a noise 
of some kind is the voice that calls. If your attention is 
called to these objects, do not deny their existence except 
to your own eyes and ears, but assure the patient that 
no harm will come to him from these things. 

Aboidia is indecision, inhibited action. A man who 
sits down to a hotel table, hesitates, and waits and thinks, 
unable to decide whether he will have beef or chicken, 
this or that which is on the menu. The waiter exhausts 
his patience and tries to hurry the man, but to no avail ; 
he cannot bring his mind to a decision. Even when the 
dinner is placed before him, his actions are inhibited and 
he does not know what article of food to eat first. He 
hesitates when dressing, unable to decide whether the 
right arm should go in the coat first or the left one. 

Phobias are morbid fears. A woman with the morbid 
fear of dirt makes herself miserable and every one she 
comes in contact with. She must carry a cloth around 
with her to wipe the door-knobs before she can touch 
them, and if anything falls on the ground or the floor, it 



328 PRACTICAL POINTS IN NURSING. 

must be thrown away without touching. It is almost 
impossible to live with such persons ; husbands are made 
most miserable and unhappy, and the home is entirely 
upset. There are many kinds of phobias — fear of high 
places, closed rooms, open space, crowds, fear of light, 
of darkness, of bridges, of falling, and many others — all 
manifestations of an abnormal mind. These patients 
come under the group called psychasthenics, in distinc- 
tion from the purely mental disorders ; they cannot be 
cared for successfully in the home, and their management 
is very difficult anywhere. The outlook is not very 
hopeful ; by re-education we may be able to help them 
in some degree. 

Negativism is opposition manifested toward all that is 
suggested. The taking of food is resisted, baths, daily 
care, treatments, everything that is essential to the pa- 
tient's improvement. We find this symptom in the acute 
disturbance of mania, melancholia, the beginning of ado- 
lescent insanity ; and with some types of cases negativism 
continues for months at a time. Resistance is very 
marked, and force must usually be used to accomplish 
anything that is needed to be done. Sometimes nega- 
tivism is caused by delusions or hallucinations : the pa- 
tient believes some one has poisoned the food, or a voice 
tells her not to eat. 

An obsession is an imperative idea. A patient is im- 
pelled to do a certain thing, and it is impossible to per- 
suade him that it need not be done. In Bible times men 
were " possessed of the devil." Some murderous deeds 
are the result of an insane obsession. Patients that are 
confined in a hospital will insist that they must be at a 
certain place at a specified time ; they seem to have no 
reason for it, yet they become quite disturbed if they are 
not allowed to carry out this imperative idea. 



CARE OF NERVOUS AND MENTAL PATIENTS. 329 

An impulse is a morbid desire that prompts an act 
before the will can intervene. At a moment when the 
nurse's eye is not on the patient he will rush to the stair- 
way and throw himself over the banister to the floor 
below. An opportunity comes and the sudden impulse 
prompts the act before the mind can reason and the will 
prevent it. Suicides are frequently impulsive acts that 
would not have taken place if time had been allowed for 
even a moment's thought. 

States of depression and of exaltation are frequent 
symptoms of mental disease and sometimes alternate in 
the same case. Patients remain in these states for weeks 
or months, or even years at a time ; those that are de- 
pressed should be constantly watched, for there is always 
danger of suicide. States of exaltation and ideas of 
grandeur are characteristic of paretic dementia. Men 
believe themselves possessed with boundless wealth, and 
if not restrained they will negotiate for property and 
goods, and give checks for the purchase price which can 
never be cashed. They have most extravagant ideas of 
some business proposition, and talk incessantly to every 
one they meet about the wonderful possibilities. 

Other symptoms and characteristics of mental disease 
are untidiness, vulgarity, masturbation, profanity, inordi- 
nate desires, worry, besides many others. Untidiness 
must be mentioned particularly, because it is an almost 
diagnostic symptom, and one that is very common in 
mental diseases. The nurse must deal with it as a symp- 
tom and accept her task in a professional way. Scolding 
or punishment accomplishes nothing ; they are not re- 
sponsible for it ; it comes because the will control is with- 
drawn by the disease which affects the mind. Untidiness 
always accompanies the very much disturbed, excited 



330 PRACTICAL POINTS IN NURSING. 

periods, the long-continued depressed states, and organic 
brain disease. Senile dementia in its advanced stage 
shows untidiness and a tendency to vulgarity and pro- 
fanity. A nurse may not be surprised to hear profane 
language from the best saint the world has known if the 
mind is changed by disease, and she must not judge 
moral character by the language or actions under such 
circumstances. 

Suggestions for the Nursing Care. — The ** Golden 
Rule " that must guide nurses in the management of 
nervous and mental patients is : *' Be kind, but firm." 
Keep this rule ever before you and it will aid in your 
success. Even where force is necessary, it is kindness, 
and the patient will realize this when improvement comes 
and he looks back upon his own weakness. He must be 
made to feel that whatever is done for him is for his 
good, and the nurse must be sure it is for his good when 
she insists upon certain things. A mind weakened by 
disease is not capable of deciding what is best, and the 
will is perverted so that it may not be depended upon ; 
it is therefore necessary for the nurse to think and decide 
for her patient, also to supplant his morbid will by her 
own which is normal. Whatever is undertaken should 
be accomplished, unless conditions arise which would- 
make it unwise to proceed, and when force is necessary, 
there should be help enough to insure success. Be steady 
and firm in your management, not vacillating and change- 
able, and your patient will not try to take advantage of 
you ; she will know that what has been denied to-day 
will not be allowed to-morrow, and she will soon realize 
that you have a reason which is based upon her needs 
for all that you require. Follow out a regular routine in 
your work and it will be easier to establish in your pa- 



CARE OF NERVOUS AND MENTAL PATIENTS. 33 1 

tient a co-operation that will become a habit. The matter 
of management is so much a part of the re-education 
which is necessary that it forms an important part of the 
treatment. The mind is distorted, like a crippled limb, 
and will not functionate any better ; it is unstable, unre- 
liable, and must be re-educated to normal functions. This 
is so much a part of the nurse's responsibility that she 
should realize the importance of it. She is with the pa- 
tient through the twenty-four hours, while the doctor 
sees him only at intervals during the week, and then 
perhaps under an assumed mental attitude for his own 
benefit, in the doctor's estimation. The diseased mind 
has gotten out of its regular habits of work, it has lost 
its equilibrium, therefore daily routine is one of the best 
agents to re-establish normal habits in the mind. 

Study your patient's mental condition by watching his 
actions, hstening to his story, and to his dreams as he 
relates them. Dreams are often projected into the day 
as delusions, and the relation of dreams should be en- 
couraged. Always keep a hopeful, cheerful atmosphere 
about your patient, tell him not to worry, that he is 
going to get well, that his " queer thoughts " will vanish 
as his physical condition improves. Do not allow such 
epithets as " bug-house," " crazy," etc., to be applied to 
patients, it only lessens their confidence in you ; they 
resent such reference because they do not realize their 
mental incapacity. 

Non-indulgence is a kindness to your patient and 
should be a part of the treatment faithfully carried out. 
Indulgence is one of the factors that has contributed to 
the nervous and mental breakdown ; parents place no 
restraint upon their children nor teach them self-control. 
For this reason isolation from friends is necessary in 



332 PRACTICAL POINTS IN NURSING. 

order to accomplish much with patients. If people could 
realize what it means to a child's future to teach him self- 
control, they would pave the way for the development of 
a strong mentality by restraint instead of indulgence, and 
this training would begin the day of the child's birth. A 
child that gets all he cries for, grows up with a will power 
undeveloped, and, yielding to the temptations that come, 
in time he suffers the mental breakdown that results from 
indulgence. If he has been taught to yield to others, to 
restrain himself from foolish and harmful desires, the re- 
sult will be a stable, well-balanced mind that will not be 
easily thrown out of equilibrium. Nurses in general 
practice have an excellent opportunity to bring these 
facts home to parents, and should be impressed with the 
importance of them. The same principles govern the 
nurse's management of mental cases in the re-educational 
process. 

In cases of melancholia or those with suicidal tenden- 
cies, the nurse must be continually on her guard to pre- 
vent patients doing harm to themselves. ** Eternal vigi- 
lance " must be the motto, and all possible temptation 
must be removed, as well as everything with which vio- 
lence could be done — sharp instruments, glass, pictures, 
nails, pins, bottles, ropes, bathrobe cords, knives, forks, 
anything that could be used to inflict a wound or by 
which hanging or choking could be accompHshed. Poi- 
sons that could be taken, including vvashing powders and 
disinfectants, must be kept under lock and key. Do not 
allow such a patient in the bath-room alone, and watch 
stairways, gas jets, and bath-tubs, for all these offer 
opportunities for inflicting bodily harm. A patient should 
not be left alone while eating, and all knives, forks, and 
dishes should be accounted for before he leaves the table. 



CARE OF NERVOUS AND MENTAL PATIENTS. 333 

lest he secrete some weapon. Suicidal patients are often 
very quiet and say but little about destroying themselves, 
but their minds may be the more actively engaged in 
planning out their schemes. Do not relax your vigilance 
for a moment ; your patient is watching for the oppor- 
turilty you will give him when you are off your guard. 

Feeding-. — The nurse's duty in feeding patients is a 
most important one. Gain in weight is one of the essen- 
tials in the physical improvement that lays the foundation 
for gain in nervous and mental equilibrium. Patients can 
and must be fed, and this is a part in the treatment which 
the nurse is almost entirely responsible for. The three 
** p's " — patience, persuasion, and persistence — will help 
you to win in the fight ; and it is a fight, because patients 
almost universally oppose taking food. If they will not 
voluntarily feed themselves, the nurse may perform the 
act for them, as she does for helpless patients. Some- 
times it may be accomplished by persuasion, and by 
making the patient understand that it is a part of the 
routine of his daily care in which he is expected to co- 
operate. By putting before him a quantity of food that 
he can and should eat, he is given a definite task, and it 
may be most easily disposed of in this way. When there 
are delusions about the food or about eating, it is almost 
always necessary to force feed ; then, of course, fluids 
must be given. Milk and eggs, wnth the addition of salt 
and sugar to supply these elements not found in sufficient 
quantities, is the best diet for force feeding, as they con- 
tain the food principles that are needed to build up tissue 
and to supply energy in a form easily taken and easily 
digested with very little waste. The nourishing qualities 
of the food must be the first consideration and not the 
palatable quahty, for the patient's taste is nil under these 



334 PRACTICAL POINTS IN NURSING. 

circumstances ; he had just as soon take nails as milk \{ 
food must be forced. Liquids can sometimes be literally- 
poured down the patient's throat by holding the glass to 
his mouth and persistently pouring it while the head is 
held ; if he can be induced to swallow before he realizes 
what he is doing, he will keep it up if he has something 
to swallow. 

If this is not successful, assistance enough to accom- 
plish the task must be procured, milk and eggnog, water, 
and a feeding-cup (Fig. 102) provided, with plenty of 
towels to protect the patient's clothing, and then you are 
ready for your task. The method of procedure need not 
be described, for conditions and circumstances must be 
taken into consideration and best judgment used. A few 
suggestions may be given. The long-nosed feeding-cup 
will be found best, and the spout should be placed in the 
cheek, instead of between the teeth, so as to make it 
more difficult for the patient to use her tongue to close 
the opening of the cup and stop the flow of fluid. Pour 
a small quantity at a time, but keep up the act of swal- 
lowing by a steady flow of fluid, holding the nose, if 
necessary, to produce deglutition. Guard against the 
patient's bubbling and spitting out, and against injury to 
the gums or mouth with the nose of the cup. Every 
possible way of resisting will be attempted by the patient, 
and the ingenuity of the nurse must be ready to meet 
each new eflbrt of the patient to keep from taking food. 
Do not lose courage, but persevere, with the thought that 
life and reason are at stake, and you will seldom fail. It 
will not be possible to use the same methods with all 
patients ; each case is a proposition peculiar to itself; 
rules cannot be laid down to be strictly carried out as 
for catheterizing or aspirating; experience alone will 



CARE OF NERVOUS AND MENTAL PATIENTS. 335 

teach how to meet the situation as it arises. If feeding 
by stomach or nasal tube is necessary, it is the doctor's 
responsibility, and preparations should be made as for 
lavage, described on page 75. The quantity of food to be 
given at one time, and the frequency should be directed 
by the doctor. 

The Care of Old People. — One of the first requisites 
in a nurse to whom is intrusted the care of old people is 
a love for the aged, a respect for the gray hairs and tot- 
tering steps. If you ''hate" old people, you have no 
business to attempt t'o take care of them. All aged per- 
sons, whether suffering from some mental disease or not, 
show senile characteristics, for decline is going on in all 
of them. The heart has lost its vigor and tone, the cir- 
culation is, therefore, not so good, the brain as well as 
other organs and tissues suffer in consequence. Vitality 
is lowered, there is sclerosis of the arteries, with a tend- 
ency at all times to emboHsm more or less extensive. 
Their powers of resistance are lessened and they recover 
slowly from any indisposition. Mentally, they are slow 
of comprehension, easy to take offence, easy to please, 
penurious, they hoard up things of small value, they are 
jealous, very determined in their own way, not progres- 
sive, the old ways of doing things are far better than any 
new methods. One of the most pathetic things about 
old people is their sorrow at being " laid on the shelf" 
The time comes when they must yield their place and 
their duties to younger ones, and it is a most difficult 
task for them ; they cannot realize that they are in any 
way becoming unfit, and hold tenaciously to their duties. 
All of these characteristics are found in old people. In 
those who have some brain disease or a senile dementia 
the symptoms -are exaggerated, and these patients are 



336 PRACTICAL POINTS IN NURSING. 

very trying to deal with. Get their confidence, show 
your sympathy for them, control by making them think 
they are having their own way, yield a point here and 
there if no harm will come, and do 7wt try to manage 
them by displaying any authoritative spirit, for their years 
of experience will not accept such treatment from a 
younger person. The most we can expect to do for old 
people is to make them as comfortable and contented as 
possible ; re-education is out of the question ; you cannot 
change their way of thinking or working, and they are 
entitled to sympathetic consideration. After the years 
of burden bearing that they have had we will all be as 
determined and childish as they are. Let this thought 
make you most sympathetic and helpful. 

Management of Adolescent Mental Cases. — The 
contrast between this group and the last is very marked 
and the treatment is entirely different. There is every- 
thing to hope for, much that can be accomplished, and 
re-education is the method to be used. The usual course 
of adolescent mental disease is a period of intense excite- 
ment, which has been preceded by some rather obscure, 
abnormal mental manifestations, which were not noticed 
until after the rather sudden outbreak. The excitement 
is followed by the catatonic period, which lasts for a 
longer or shorter time, and from this the patient emerges, 
either going on to recovery or, after a time, when little 
change takes place, he lapses into a state of hopeless 
dementia. During excitement he is noisy, destructive, 
untidy, resistive, and in every way hard to manage. He 
cannot be cared for at home because a certain amount 
of restraint, moral and physical, is necessary to hold him, 
and neither are available at home. This excitement is 
characterized by most comical antics — climbing on the 



CARE OF NERVOUS AND MENTAL PATIENTS. 337 

tables and chairs, crawling through transoms, using the 
chandeliers for trapeze performances, etc. Unless baths, 
food, elimination, sleep, and daily care are attended to 
promptly and regularly the patient is in danger of going 
on to exhaustion, so it is necessary for the nurse to co- 
operate with the physician in best efforts to conserve the 
strength and tide the patient over this critical period. 
What has been said about feeding and management ap- 
plies here, and the feeding proposition is a most important 
and difficult one. 

In catatonia the patient is Hke a piece of inert matter, 
except for the involuntary activities that cannot be in- 
hibited. He lies in one place and in one position without 
moving ; if an arm is raised it remains in the same posi- 
tion until some one puts it down or exhaustion and force 
of gravity bring it down. He will not walk unless taken 
hold of and pulled ; he will not chew when food is put 
into his mouth ; all voluntary actions are inhibited ; it is 
necessary to handle him like a doll and care for him like 
a baby. The feeding is a difficult problem, but can be 
accomplished as suggested in the paragraph on '* Feeding." 

The beginning of convalescence, when the mind awak- 
ens from its dreams, is a critical time, and affords the 
greatest opportunity for the nurse to be of lasting benefit 
to her patient. The awakening is like the opening up 
of a child's mind, and the thoughts must be directed as 
a child's mind is developed and led into the light of 
reason and understanding. When the patient questions 
why this is, or what that means, explain to him as you 
would to a child ; help him to understand the things that 
seem strange to him. This dawn of the reason is a most 
interesting and wonderful time, and the nurse leaves her 
impress upon her patient for good or ill, just as a teacher 
22 



338 PRACTICAL POINTS IN NURSING. 

does upon her pupil. The return of the mind to the 
normal is thus largely directed by those who come in 
contact with the patient, and it can be molded well if 
care and thought is given to the task. 

Neurasthenia and Hysteria. — Neurasthenia and hys- 
teria are allied because they are both functional nervous 
disorders, and they may be treated together here, for the 
care is similar. Although mental symptoms are manifest, 
it is a great mistake to intimate to the patient or her 
friends that the mind shows the least marks of instability ; 
but how could it be otherwise, since the brain is a part 
of the nervous system. Most of the nervous and mental 
symptoms are the result of impaired digestion, poor nu- 
trition, lack of assimilation. The nerves and brain have 
lost their equilibrium, their functions are unstable, they 
are not to be depended upon. 

The " rest treatment," which was worked out and so 
successfully used by Dr. S. Weir Mitchell, is usually ap- 
plied to these nervous cases, and the nurse should under- 
stand the principles of it so as to be able to carry it out. 
The treatment rests upon the tripod — rest in bed with 
isolation from friends, full feeding, and massage. Rest in 
bed conserves the nervous energy which is exhausted. 
It must be absolute rest and coupled with isolation, or 
it will not accompHsh its purpose. There is a bond of 
sympathy between patient and family, and a freedom that 
is harmful at this time, because the routine of treatment 
must be strictly adhered to, and the patient rebels against 
it. Only a nurse who is firm and tactful can win in this 
rebellion, and she can do it because she knows the mean- 
ing and benefit of the treatment. Full feeding builds up 
the tissues, produces better blood, and stores up nervous 
energy in the fat that is put on. Food makes nervous 



CARE OF NERVOUS AND MENTAL PATIENTS. 339 

energy and rest conserves it. Massage supplies passive 
exercise, so that the food is assimilated, but uses no ner- 
vous energy. It is a mistaken idea that when there is 
nervous exhaustion vigorous exercise will tire the mus- 
cles and rest the nerves, so it is beneficial. The fact is 
entirely lost sight of that every muscular effort requires 
nerve force, and, therefore, exercise only taxes still more 
the nerves, already exhausted. It will be readily seen 
that the " rest treatment " is based on philosophical, 
physiological facts. 

Another factor in the treatment is the importance of 
establishing and maintaining a daily routine. Certain 
things should be done at certain specified times. Baths, 
massage, nourishment, rest should be scheduled as reci- 
tations in a school. This regular routine is one of the 
best ways of helping to re-establish the mental equilib- 
rium in these nervous cases, for the mind has worked in 
anything but a regular, systematic way ; actions and de- 
sires and worries and expressed opinions have demon- 
strated this. The doctor usually maps out the routine, 
and both patient and nurse will be kept busy at something 
all day if they carry it out faithfully. When convales- 
cence begins, there will be added to the routine some 
form of diversion, like reading, games, or fancy work, 
carefully planned to help and not to tire or overstimulate. 
Later, walks and drives and occasional calls will form a 
part of the curriculum. As to the mental treatment, one 
of the principal points to remember is that sympathy is 
the thing they crave above everything else, and they will 
assume attitudes and imagine ills in order to solicit sym- 
pathy. This is freely given by family and friends, and 
patients know they can get it ; they live upon it ; it is 
their food, drink, and sleep, but a most demoralizing sub- 



340 PRACTICAL POINTS IN NURSING. 

stitute. It is plain, then, that isolation is most essential 
before a nurse can overcome the vitiating influence of 
giving and taking sympathy. 

The pains and sensations, dizziness, headache, nausea, 
constipation, exist because of highly sensitive nerves that 
are made so by being undernourished and overstimu- 
lated. The society lady is the frequent nervous wreck 
because her luncheons and dinners at all hours are made 
up of a most pernicious combination of indigestible stuff 
that cannot be construed in any way to be food. The 
overstimulation of nerves to meet the demands for socia- 
bility and entertainment, brings about the combination of 
forces to wreck the nervous equilibrium. The physical 
symptoms, although subjective, are not all imaginary; 
there is a cause for them, and the treatment is directed 
toward the cause. The nurse should pay little outward 
attention to these symptoms, but go steadily on, carrying 
out the routine, overlooking the peevish, unhappy, fault- 
finding spirit that goes with the disease. Be a constant 
booster, instilling courage and hope for recovery in your 
patient, allaying her worries by your own cheerfulness, 
and literally lifting her up from the slough of despondency 
by your own healthful mental attitude. Difficulties may 
arise with the family because of the strict isolation you 
maintain, but the responsibility may be thrown back upon 
the doctor for settlement. 

With cases of hysteria a more rigid disciphne and 
isolation should be carried out, for sympathy and indul- 
gence is more harmful to them. These patients " play 
to the gallery," so to speak, in order to attract attention 
and sympathy; so, if they faint in a most conspicuous 
place, or jump from a window and wander into the hands 
of the police, or show you a bottle marked " poison " 



CARE OF NERVOUS AND MENTAL PATIENTS. 34.I 

and tell you they took the contents, just realize that they 
are trying to work up a sensation and show no anxiety 
or surprise to them. Granting a possibility of truth, take 
up the situation with the doctor and let him direct your 
actions. You may be sure they will always protect them- 
selves from injury by selecting a soft spot to fall if they 
faint, or the right person near if a seeming attempt at 
suicide is made. They do not care to eat, for they know 
they will get better if they do, so they hide the food that 
is brought them in some cunning way, or, if they have 
no chance to do this, they produce emesis by some arti- 
ficial means. They are most trying patients to deal with, 
for it seems as though it were impossible to outwit them. 
Go steadily on with the routine of the treatment and let 
your mental attitude be that of indifference to their acting. 



342 



PRACTICAL POINTS IN NURSING. 



PHYSIOLOGY AND DESCRIPTIVE 
ANATOMY. 

I. Physiology. 

Blood-circulation. — The circulation of the blood 
through all the parts of the body, taking with it the mate- 
rial for nutrition and gathering up the waste material, is 
caused by the action of the heart, the arteries, the capil- 




FiG. 95.— The heart. 

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 capillaries. These vessels are 



PHYSIOLOGY AND DESCRIPTIVE ANATOMY. 343 



very tiny, yet they allow a constant stream of blood to 

pass through them ; they are very numerous and near 

the surface of the body, so that in pricking the finger we 

get an oozing of blood which comes from the capillaries. 

The capillaries connect with 

the veins, which at first are 

very small, but they grow 

larger and larger until they 

merge into two large veins, 

the vena cava superior and 

the vena cava inferior, which 

bring the blood back to the 

heart, and which are on the 

right side of the heart. 





Fig. 96.— Orifices of the heart, seen from 
above, both the auricles and the great vessels 
being removed (Huxley) : /'yl, pulmonary ar- 
tery and its semilunar valves ; A O, aorta and 
its valves ; RA V, tricuspid, and LA V, bicus- 
pid valves ; MV, segments of mitral valve ; 
LV, segment of tricuspid valve. 



Fig. 97. — Left auricle and ventricle, 
opened and part of their walls removed 
to show their cavities (Allen Thomson) : 
I. right pulmonary vein cut short; i, 
cavity of left auricle; 3, 3', thick wall 
of left ventricle ; 4, portion of the same 
with papillary muscle attached; 5, the 
other papillary muscles; 6, 6', the seg- 
ments of the mitral valve; 7 in aorta is 
placed over the semilunar valves ; 8, 
pulmonary artery ; 10, aorta and its 
branches. 



The Heart : its Structure and Valves. — The heart is a 
pear-shaped organ (Fig. 95), situated in the front of the 



344 PRACTICAL POINTS IN NURSING. 

chest, with its apex, or the small end, pointing down and 
to the left. This important muscular organ has two dis- 
tinct parts, each of which is again divided into two parts 
connected with each other. Each of these four parts, or 
chambers, holds about 2 ounces ; the two upper cham- 
bers are called " auricles," the two lower " ventricles " 
(Fig. 97). 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 
7nitral valve (Fig. 96). 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. 
96), and the object of these valves is to prevent the blood 
flowing back when the heart dilates. 

Mechanism and Course of the Circulation. — To return 
to the two great veins. The venous blood, which is 
loaded with impurities and is dark colored, reaches the 
two great veins, the vena cava superior and the vena 
cava inferior, which join together and empty into the 
right auricle; this chamber contracts and forces the 
blood down through the tricuspid valve into the right 
ventricle, which contracts and sends the blood through 
the right semilunar valve and pulmonary artery into the 
lungs. In the lungs the blood throws off its impurities, 
takes up a new supply of oxygen, and becomes pure, 
bright-red arterial blood. This change is due to the 
respiration. This pure blood returns to the heart by the 
pulmonary veins, which empty into the left auricle ; this 
contracts and forces the blood down through the mitral 
valve into the left ventricle, which also contracts, and 
sends the blood through the left semilunar valve into the 



PHYSIOLOGY AND DESCRIPTIVE ANATOMY. 345 

aorta, which is the largest artery in the body. The first 
branch of the aorta is the coronary artery, which sup- 
plies the heart itself. The branches of the aorta are 
many, and they grow smaller and smaller as the distance 
from the heart increases, carrying the pure blood to all 
parts of the body ; the last of these branches are the 
capillaries, which are so small that they are invisible to 
the naked eye. The blood, when passing through the 
capillaries, loses its bright-red color and becomes dark, 
because the different tissues take from the blood what is 
necessary for their support, and give in return the waste, 
worn-out material; the oxygen disappears from the 
blood to a great extent, and the blood on reaching the 
veins becomes dark blue, being full of impurities. The 
blood then returns to the heart and thence to the lungs, 
where its impurities are thrown off with the breath. 
The blood takes up a new supply of oxygen in the 
lungs, and repeats its journey through the body. 

There is one instance where the arteries carry venous 
blood, and the veins carry arterial blood ; it occurs in the 
pulmonary circulation, generally called the " lesser " cir- 
culation. In this circulation the venous blood enters 
the right auricle and ventricle, and passes through the 
semilunar valves into the pulmonary artery, thence to the 
lungs, where, as we have seen, it is purified and made 
into bright-red arterial blood, and returns to the heart 
by the pulmonary vein. 

There is another circulation, called the " portal " cir- 
culation, in which four large veins — the inferior and su- 
perior mesenteric, splenic, and gastric — form one large 
trunk called the " vena portae." This portal vein collects 
the blood from the stomach, the pancreas, the spleen, 
and the intestines, and carries it to the liver, where it 



346 PRACTICAL POINTS IN NURSING. 

mixes with the blood that is suppHed to the Hver. The 
blood then passes from the capillaries of the liver into 
small veins, the hepatic veins, which carry it to the vena 
cava inferior. 

The greater or systematic circulation begins at the left 
ventricle, thence through the aorta, and is distributed to 
all parts of the body, going through capillaries and veins, 
and then returning to the right auricle. 

Respiration. — The air we breathe is mainly composed 
of two gases, oxygen and nitrogen, there being more 
nitrogen than oxygen. The oxygen is absolutely neces- 
sary to support life ; still, alone it would not support life, 
because it is too stimulating ; hence there can be danger 
from too much as from too little oxygen. The nitrogen 
serves to dilute the oxygen. There is also a small quan- 
tity of carbonic-acid gas, which is very poisonous, and a 
certain amount of watery vapor, which, when exhaled, is 
invisible, except in cold weather, when it is seen to issue 
from the mouth or the nostrils in the form of a white 
cloud. 

Mechanism of Respiration. — Each time we breathe the 
air passes into the lungs through the nose, mouth, 
larynx, and trachea, thence to the bronchial tubes and 
air-cells of the lungs. The muscles of the chest ex- 
pand, the diaphragm contracts, allowing the lungs plenty 
of room to expand, the ribs are hfted, the lungs expand, 
the air-cells open, and a fresh supply of oxygen is in- 
haled. This action is called " inspiration." The second 
movement is called " expiration," in which the diaphragm 
relaxes and rises in the form of a dome, the ribs descend, 
the chest contracts, the lungs, which are elastic, shrink, 
and the impure air is driven out. We breathe in oxy- 
gen and give out carbonic-acid gas^ which must not be 



Rrn- '^at^ ''"' 'jr^X^y 




zli^ry] 9, left kidney (Machse). 



n 



PHYSIOLOGY AND DESCRIPTIVE ANATOMY. 347 

inhaled again, and to which there is a faint odor, but un- 
noticeable except when present in large quantity. 

Upon entering a poorly-ventilated hall or a room in 
which there are many people, one will at once notice 
the bad air. It is due to the carbonic-acid gas expired 
by each inmate, there being not enough oxygen to purify 
the air. Lighted gas-jets also consume the oxygen. 

If there is too little oxygen to purify the blood, the 
venous blood is distributed to the heart and thence to the 
body, and there is a feeling of faintness and suffocation. 

Our bodies must be supplied with fresh air, food, and 
drink ; we cannot live without them. One knows the 
need of food by the cravings of the stomach, the need of 
water by the dryness of the mouth and throat, the need 
of pure air by the feeling of suffocation. 

Animals, like human beings, take in oxygen and give 
out carbonic acid. Plants take in carbonic-acid gas and 
give off oxygen in the day-time ; in the night they take 
in oxygen and give off carbonic-acid gas. It is for this 
reason that plants should be removed from a room at 
night. 

Besides the lungs, the skin and the kidneys assist in 
removing impurities from the body. 

The Digestion. — The organs of digestion are the sali- 
vary glands, the stomach, the liver, the pancreas, and the 
intestines. These so change the food we eat that it can 
be taken into the blood and nourish the body. 

The alimentary canal (Fig. 98) 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 



348 



PRACTICAL POINTS IN NURSING. 



expanded part of the canal ; its left end is enlarged, 
and because it is on the heart side of the body is called 
the " cardiac dilatation." The right end of the stomach 
narrows and connects with the 
small intestine. The small in- 
testine is a continuation of the 
canal, is about 20 feet long, and 
lies in convolutions in the abdo- 
men ; it ends in the large intes- 
tine, which is about 5 feet long, 
and which runs up the right side 
of the body (ascending colon), 
crosses over under the liver and 
stomach (transverse colon), de- 
scending the left side (descending 
colon), and ends in the sigmoid 
flexure and rectum (Fig. 98). 

Mastication and Deglutition. — 
The food when taken into the 
mouth is cut and ground by the 
teeth, reduced to a fine pulp, and 
mixed with the saliva, which 
changes the starch that the food 
contains into sugar by its active 
principle, ptyalin. When suffi- 
ciently masticated the food is carried backward to the 
opening which leads into the pharynx, and is thrust 
into the latter, the soft palate being lifted and its pillars 
brought together, while the backward movement of the 
tongue causes the epiglottis to incline backward and 
downward over the glottis, thus forming a lid over 
which the food can travel without dropping into the 
air-passages. The epiglottis prevents the food from 




— The alimentary canal. 



PHYSIOLOGY AND DESCRIPTIVE ANATOMY. 349 

passing into the trachea, and the soft palate keeps it 
from passing into the nasal cavities. 

Stomach and Intestinal Digestion. — When the food 
passes into the stomach it is rolled about and thor- 
oughly mixed with the gastric juice until it is reduced 
to the consistency of pea-soup, called " chyme." It then 
passes through the pylorus (a narrow opening at the 
right end of the stomach), and the duodenum, the first 
part of the small intestine adjoining the stomach. A 
large quantity of the fluid (chyme) is absorbed through 
the walls of the stomach and joins the blood-circulation. 
When the food or chyme passes into the duodenum it is 
mixed with the pancreatic juice and the bile, and is con- 
verted into chyle, a milky fluid formed by the digestion 
in the intestines of fatty particles of food. After passing 
through the small intestines the food gradually loses its 
nourishing properties, and finally enters the large intes- 
tine, where it acquires its characteristic fecal odor and 
color. 

Secretions. — Some of the secretions of the body are : 
saliva, perspiration, sebaceous matter, tears, gastric juice, 
pancreatic juice, intestinal juice, milk, bile, and mucus. 

In the mouth is the saliva < _ .. \ •, which chang^es 

I Ptyalin J / ^ 

starch into grape-sugar. 

In the stomach is the gastric juice — water, pepsin, hy- 
drochloric acid — which digests albuminoids. , 

In the intestines are the juices of the intestines — bile, 
pancreatic juice, water — which digest fats, starch, and 
albuminoids. 

Parotid Glands. — The parotid glands are situated one 
in front of each ear. They are salivary glands. 

Excretions. — The excretions are eliminated from the 
body by the skin, the lungs, the kidneys, and the bowels. 



3 so PRACTICAL POINTS IN NURSING. 

Urinary Organs. — The urinary organs are the kid- 
neys, the ureters, the bladder, and the urethra (see page 
362). The kidneys purify the blood by removing from 
it waste and worn-out material. They also regulate the 
amount of water to be removed from the body, and the 
amount to be retained in the body for resorption. 

2. Descriptive Anatomy. 

The anatomy of the body will not minutely be con- 
sidered, but merely a brief description of the skin, the 
muscles, and the bones, and the situation of the different 
organs of the body will be given. 

1. Skin. — The skin is the covering (integument) of the 
body that protects the parts beneath it, and that regulates 
the heat of, and gives off waste material from, the body. 
There are two layers of skin — an outer layer, the epider- 
mis, and an inner layer, the cutis (derma) or true skin. 
The latter is supplied with capillaries and nerves, and 
bleeds freely if cut or pricked. The epidermis does not 
bleed. Just below the cutis is a layer containing fat and 
the larger arteries of the body. On some parts of the 
body the skin is thicker than on others, as the palms of 
the hands and soles of the feet. At the junction of the 
different cavities of the body — the nose, mouth, rectum, 
etc., the skin gradually merges into the lining membrane 
of these cavities, known as mucous membrane. This 
consists of an outer epithelial layer and an inner layer of 
connective tissue containing blood-vessels, nerves, etc. 
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. Devel- 
oped from the skin are the hair and the nails. 

2. Bones of the Body. — The bones are the frame- 
work of the body ; they afford protection to the important 



PHYSIOLOGY AND DESCRIPTIVE ANATOMY. 35 I 

organs, and are covered with a fibrous membrane called 
the " periosteum." There are in the body about 206 
bones of different shapes and lengths. They are divided 
into three groups — bones of the head, of the trunk, and 
of the extremities (PL 3). The femur or thigh-bone is 
the largest, longest, and strongest bone in the body, and 
the stapes (one of the little bones of the ear) is the small- 
est bone in the body. 

The ends of bones, when jointed movably with others, 
are covered with cartilage, having within the joint free 
surfaces of great smoothness, which surfaces are lubri- 
cated by the synovial fluid secreted from the synovial 
membrane which lines the joints. The bones are further 
held together by fibrous tissue in the form of ligaments. 

Bo7ies 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 should 
a person be 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 



352 PRACTICAL POINTS IN NURSING, 

the spinal column by ligaments, which hold them in 
position. The seven true ribs are connected with the 
sternum (breast-bone) by means of cartilages. The 8th, 
9th, and loth ribs are each attached to the lower border 
of the rib above it. The nth and 12th ribs are called 
" floating ribs," having only one attachment, 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 " vertebrae," 
piled one upon the other, making a strong pillar for the 
support of the head and trunk. Between each of these 
small bones is a layer of cartilage of an elastic character 
which allows the body to bend in many directions. 

The seven cervical (or neck) vertebrae extend from the 
base of the skull to the shoulders, the twelve dorsal 
(or back) vertebrae extend from the shoulders to the 
lower ribs. Between each articulating pair of vertebrae 
is an opening on each side for the passage of nerves 
throughout the entire length of the column — the spinal 
cord. The five lumbar (loin) vertebrae extend from be- 
low the ribs to the pelvis, the bones of the sacrum and 
the coccyx forming the extremity of the spine. 

The pelvis is formed by the sacrum, the coccyx, and 
the two ossa innominata. The female pelvis contains 
the womb, ovaries, Fallopian tubes, bladder, and rectum 
(see pp. 362-364). 



PHYSIOLOGY AND DESCRIPTIVE ANATOMY. 353 

Bones of the Extremities. — The Jinnieriis is 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 
v/e 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 Hne. Below 
the forearm is the wrist, and next the hand. 

The lower extremity consists of the thighs, the legs, 
and the feet 

The femur or the thigh-bone, has a round head, and 
fits into a deep cup-shaped socket in the hip-bone. 

The patella, or knee-cap, is a small flat bone situ- 
ated in front of the knee-joint. The two bones of the 
leg below the knee are the tibia and fibula. The tibia 
is the stronger of the two, and is on the inner side of the 
leg. It is joined to the femur, and the fibula, which is 
long and slender, is joined to the tibia, and both articu- 
late with the ankle-bone (astragalus). 

3. Muscles of the Body. — The muscles are the fleshy 
portions of the body, and by their contraction and relax- 
ation are organs of motion. They are divided into two 
classes — those subject to the will, or voluntary muscles, 
and those not subject to the will, or involuntary muscles, 
of which the muscles of the heart and of the intestines 
are examples. The muscles difler 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 sartorius, which is 
23 



354 PRACTICAL POINTS IN NURSING. 

over 1 8 inches in length, reaching from the hip to below 
the knee. 

Running up from the sternum and clavicle to the 
mastoid process is the sterno-cleido-niastoid 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, neither 
can pus penetrate it. 

4. Heart, Blood-vessels, and Lymphatics. — The 
heart is a large muscular organ situated in the front part 
of the left side of the chest, pointing toward the left, and 
enclosed in a membraneous sac called the "pericardium." 
The movements of the heart are involuntary — that is, 
are not under the control of the will. The walls of the 
heart are constantly expanding (diastole) to take in a 
fresh supply of blood, and contracting (systole) to drii^e 
out the blood. Following each systole and diastole 
there is a short pause, amounting to a fractional part of 
a second, which is all the rest that the heart gets. It is 
for the purpose of increasing this period of rest* that 
patients with heart disease are frequently kept quietly in 
bed (see Blood-circulation, p. 342). 

Arteries. — The aorta, which is the largest artery in the 
body, springs from the heart. When it leaves the left 
ventricle it forms an arch, then gives off branches which 
divide and subdivide until they become very small ves- 



PH YSIOL OGY AND DESCRIP TI VE A NA TOM Y. 355 

sels, called " capillaries." The carotid arteries supply the 
head and the neck. The subclavian arteries are beneath 
the clavicles. The axillary is a continuation of the sub- 
clavian, and passes through the armpit and down the 
inner side of the arm as the brachial artery. This 
artery divides at the elbow into the ulnar and radial 
arteries. The ulnar is on the inner side of the forearm, 
and the radial is on the outer or thumb side, and both 
supply blood to the hand and fingers. The aorta de- 
scends through the thorax into the abdomen, and is 
called respectively the ** thoracic " and the ** abdominal " 
aorta. 

The internal iliac artery supplies the walls and organs 
of the pelvis. The external iliac runs along the brim of 
the pelvis down the inner side of the thigh, where it 
takes the name of the femoral artery, whose pulsations 
can be felt in the groin. The femoral passes into the 
back of the thigh and knee, and is called the " popliteal 
artery." The leg and foot are supplied by the tibial and 
peroneal arteries. 

The lymphatics are the vessels which take up the 
lymph from all parts of the body, with the exception of 
the intestines, and return it into the venous system. 

5. Brain, Cord, Nerves, and Organs of the Senses. 
— The brain is composed of gray matter at the surface 
and white matter in deeper portions. It is divided into 
the big brain, or the cerebrum, and the Httle brain, or the 
cerebellum, and is enveloped from within outward by 
three membranes, the pia mater, the arachnoid, and the 
dura mater. 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 
upper portion of the spinal cord within the skull. It re- 



356 PRACTICAL POINTS IN NURSING. 

sembles the cord in being composed of both white and 
gray matter. It is the headquarters of the important 
nerve hnes which go to the heart, lungs, stomach, and 
other prominent organs. The spinal cord is composed of 
gray and white matter, the gray matter being inside the 
cord. It is covered with membranes similar to those of 
the brain, the pia mater, the arachnoid, and the dura 
mater. It is also divided into two halves, and gives off 
thirty-one pairs of nerves, which supply the trunk, the 
extremities, and portions of the head and neck (see p. 
352). At the beginning of the spinal cord the nerve- 
fibres (see p. 289) cross from right to left, so that the 
nerves at the right side of the brain supply the left side 
of the body and vice vei'sd. Thus, when one side of the 
brain fs injured it is the opposite side of the body which 
is affected. This crossing is called the " decussation " of 
the nerve-fibres. 

The nervous system consists of the brain, the spinal 
cord, and the nerves. Through it all the functions of 
the body, both mental and physical, are performed. 
Thought, sensation, and motion are all under the con- 
trol of the brain, which is the seat of government. 

The brain, which is the chief organ of the nervous 
system, may be regarded as a central telegraph office ; 
the gray matter along the spinal cord is the district 
offices, and the nerves are the telegraph wires. 

The nerves are composed of silvery-white fibres, and 
furnish both sensation and motion. The sensory (sensa - 
tion) fibres begin in the skin and end in the brain, and 
carry messages to the brain. The motor (motion) fibres 
begin in the brain and end in the skin, and carry mes- 
sages from the brain. When we want to lift up anything 
or to move a hand, an arm, or a foot, the brain sends a 



PHYSIOL OG V AND DESCRIPTIVE ANA TOM K SS? 

message over the nervous system to the muscle of what- 
ever part we want to move. The muscles contract and 
the part is moved. These are the nerves of motion, or 
the motor nerves. Again, when we are being burnt with 
a hot iron or injured in any way, however slight, the 
nerves of sensation reflect the message to the brain ; then 
we feel the pain, and the brain instantly sends down the 
message over the motor fibres to move the part away. 

The spinal cord gives off thirty-one pairs of nerves, 
each nerve having two roots — the one, called the motor 
root, carrying motor impulses from the cord ; the other, 
the sensory root, carrying sensory impulses to the cord. 
The spinal cord, in addition to canying impulses to and 
from the brain, presides over reflex action, which is an 
involuntary action produced by irritating or stimulating 
a peripheral sensory nerve. Thus, if the patella tendon, 
the tendon in front of the knee, be tapped quickly, the 
stimulus thus produced travels up a sensory nerve to the 
spinal cord, where it is reflected to a motor nerve, and in 
consequence the leg is moved. The path of transference 
of the stimulus is known as the reflex arc, and the move- 
ment of the leg is a reflex action, known usually as the 
patella-tendon reflex or knee-jerk. Winking, coughing, 
and sneezing to get rid of some irritating substance are 
examples of reflex action. The production of an in- 
creased flow of saliva at the sight of certain articles of 
food is also an example of reflex action. 

The vasomotor nerves are the nerves controlling the 
blood-vessels — producing contraction and dilatation. 

Eyes. — The eye, strictly speaking, consists only of the 
eyeball or eye-globe; but connected with the eyeball 
externally are muscles, nerves, blood-vessels, as well as 
other parts specially designed for its protection (see p. 



358 



PRACTICAL POINTS IM NURSING. 



125). The cavities containing the eyeballs are called 
" orbits," which are about i^ inches deep. At the bot- 
tom are small holes through which enter the optic 
nerves. 

Nose. — The nose is composed of bone and cartilage. 

Ear. — The ear is divided into three parts — the ex- 
ternal ear or auricle, the middle ear, and the internal 
ear (Fig. 99). 

The auricle {pinna) is composed of cartilage covered 




Fig. 99. — Semidiagrammatic section through the right ear (Czermak) : G, external 
auditory meatus ; T, membrana tympani ; P, tympanic cavity ; o, fenestra ovaHs ; 
r, fenestra rotunda ; B, semicircular canal ; S, cochlea ; Vt, scala vestibuli ; Pt, scala 
tympani. 

with skin {A), and has a tube about an inch long called 
the " auditory canal " (G), The cavity of the middle ear, 
or the tympanum, is separated from the external canal by 
the drum-membrane (T). This drum-membrane is about 
one-eighth of an inch in diameter and -^\-^ of an inch in 
thickness, and has three layers — one of skin, one of 



PHYSIOLOGY AND DESCRIPTIVE ANATOMY. 359 

fibrous tissue, and an inner layer of mucous membrane — 
and is also supplied with blood-vessels and nerves. The 
ear should not be picked with pins, as there is great dan- 
ger of perforating the drum and causing deafness. The 
middle ear (P) contains the small bones of the ear, the 
incus, stapes, and malleus, which are the smallest bones 
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 ear 
or labyrinth consists of the vestibule ( Vi), the cochlea (5), 
and three semicircular canals {E), also the ends of the 
auditory nerve, the nerve of hearing. Behind the ear is 
a prominence, the mastoid process, closely connected 
with the ear and the brain. Any disease of the middle 
ear may extend to the mastoid, and diseases of both the 
middle ear and the mastoid are always liable to affect the 
brain. 

6. Respiratory, Digestive, and Urinary Organs. — 
the trachea (Fig. 100, 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. 100, 4-6, 7, 8) are the organs of res- 
piration. They have a Hght, 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- 



36o 



PRACTICAL POINTS IN NURSING. 



phragm and from the pelvic cavity below by the brim of 
the pelvis. It is not, like the chest, protected on all 
sides by bone, and consequently its contained organs 
are easily injured. 

The stomach lies on the left side directly under the 
heart (see p. 348). 




Fig. 100. — Thoracic organs i,rar\nx, 2, cricothyroid muscles 3 trachea; 4-6 
right lung; 7, 8, left lung; 9, pericardium; 10. mediastinum; 11 and 14. subclavian 
arteries; 12, 13, carotid arteries; 15, 16, innominate veins; 17,20, subclavian veins; 
18, 19, internal jugular veins ; 21, root of lung. The lungs naturally cover the pericar- 
dium, but in the figure are represented as held back by hooks. 



The liver, the largest gland of the body (weighing 
from 50 to 60 ounces), is situated on the right side of the 
body under cover of the ribs. Attached to the under 



PHYSIOLOGY AND DESCRIPTIVE ANATOMY. 36 1 

side of the liver is a bag called the " gall-bladder," large 
enough to hold about I ounce of bile, which is a green- 
ish-yellow secretion of the liver. Jaimdice is caused by 
stoppage of the gall-duct, the bile being carried into 
the blood and throughout the circulation, and giving 
the whole body a yellow appearance. 

The pancreas, or sweetbread, lies across the abdomen 
below the liver, nearly touching the spleen on the left. 
The secretion or juice of the pancreas is concerned in 
the digestion. 

The spleen is situated at the heart end of the stomach 
beneath the diaphragm. Its function is obscure. 

The peritoneum is the serous membrane which lines 
the abdomen and covers the various organs. 

The ijitestines are part of the alimentary canal (see p. 
347) continuous with the stomach ; the small intestine is 
about 20 feet long, and lies in convolutions or coils in 
the abdomen, ending in the large intestine, (which is 
about 5 feet long, and runs up the right side of the body, 
crosses over under the liver and stomach and down the 
left side, ending with the rectum. The duodenum is 
the first part of the small intestine near the stomach. 
The ileum is the lower half of the small intestine ; the 
ileo-cecal valve is the valve between the ileum and the 
cecum. 

The cecum is the head of the colon, and lies in the 
lower part of the right side of the abdomen. Opening 
from the cecum is the vermiform appendix (Fig. 98), a 
narrow worm-shaped tube from 2 to 5 inches long. Its 
opening is guarded by a valve, but sometimes food, seeds, 
fruit-stones, or hard fecal matter slips into the appendix, 
and inflammation may result (appendicitis). 

The colon is the first part of the large intestine, and 



362 PRACTICAL POINTS IN NURSING. 

passes up the right side as the ascending colon, across 
the body as the transverse colon, and down the left side 
as the desceftdi?tg colon, where it forms the sigmoid flex- 
ure (Fig". 98), which is curved like an S, and which serves 
to remove the fecal matter from the body, this action 
being done by muscles of its own. The colon ends in 
the rectum, which is from 6 to 8 inches long, and which 
terminates at the anus. 

The omentum is a fold of the peritoneum lying in 
front of the bowels like an apron. 

The kidneys are situated at the back part of the ab- 
dominal cavity, one on each side of the upper lumbar 
region of the spine. They are about 4 inches long, 2 
inches wide, and 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 empty- 
ing into the bladder. The urine passes drop by drop 
from the ureters into the bladder, which holds about a 
pint, and which is emptied by the process of urination. 
If the urine is retained in the bladder a long time, it may 
decompose, or rupture of this organ may take place 
through over-distention. 

The bladder is situated in the front portion of the pel- 
vis, is oval in shape, and holds about a pint. 

The urethra is a small canal that conveys the urine 
from the bladder. The opening of the urethra (the 
meatus urinarius) opens immediately above the entrance 
into the vagina. 

7. Internal Female Organs of Generation (Fig. loi). — 
The womb or ''uterus," as it is more commonly called, is 
a hollow, pear-shaped organ about 3 inches long and 2 



PHYSIOLOGY AND DESCRIPTIVE ANATOMY. 363 



inches broad at the top, or fundus, and about I inch thick. 
It consists of the fundus, which is the rounded upper 
portion, into each side of which enters a Fallopian tube, 



4V- 




_^ ^ ^ _Round , 

- I refer 

- llhrine 
, urtfiry^ 



^ 



Fig. 101. — Blood-vesseis ot the pelvis ^Bourgery and jacob) : tiie anterior part ol the 
pelvis has been removed, and the bladder and the anterior vaginal wall have been 
partially cut away. The uterus is drawn up, and the Fallopian tubes are displaced 
into the iliac fossae {from An American Text-Book of Obstetrics). 

of a body, and of a cervix 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- 
tween the bladder and the rectum, and any distention of 



364 PRACTICAL POINTS IN NURSING. 

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 are more apt to influence 
the condition of the patient than large ones, and, no 
matter how much medical care the patient has received, 
or how successfully a difficult operation has been per- 
formed, or how attentive the nurse has been, the advan- 
tages may all be lost through some trifling mistake in 
the serving of the food. The laboring man is content 
to eat bread and meat with his fingers and to drink 
tea from his dinner-pail, but it would make a refined 
man or woman very unhappy to be compelled to eat 
from broken dishes and to be served by a nurse who 
spilled the liquids, who held a cup or a tumbler at the 
rim in offering drink, instead of holding it at the bottom 
or by the handle, who served the food cold, who tasted 
the food in the patient's presence, who had unclean 
hands, or who wore a soiled apron. 

The serving of food requires a great deal of judgment 
and good taste, and in no branch of her work can a nurse 

3G5 



366 



APPENDIX. 



be of more service to a sick patient than in her ability to 
serve properly the food. The taking of food is the chief 
event of the day for a sick patient, and the patient's 
mind should be diverted from her illness in the anticipa- 
tion of the meal, which should be served daintily and, if 
possible, should be composed of something unexpected. 
The tastes of the patient, however, should be consulted 
as far as possible : while it is unwise to ask the patient 
beforehand concerning the bill of fare, as it is often the 




Fig. 102. — Feeding-cups. 



unexpected which pleases, still, if she expresses a prefer- 
ence for a certain dish, it should be supplied, provided it 
is sanctioned by the physician. 

Punctuality should be observed in serving the meals, 
as frequently the appetite will be lost if the meal is de- 
layed beyond the accustomed hour. When a patient is 
very ill only the simplest foods are given, and these are 
prescribed by the doctor. Fluids can conveniently be 
taken by suction through a bent-glass tube or by a 



FEEDING THE SICK. 367 

pretty feeding-cup with a spout, the cup being carried to 
the bedside on a small tray covered with a spotless nap- 
kin (Fig. 102). The mouth of the patient must afterward 
be wiped dry with a fresh clean napkin (not with the 
corner of a face-towel). When convalescence sets in it 
becomes necessary to vary the food. The dishes selected 
should be savory, sufficiently varied, and suited to the 
digestive power of the patient. 

In preparing the tray the nurse should be sure first 
that it is clean on both sides, then to cover it with a 
spotless tray-cloth, and the dishes, which should be the 
prettiest and best that the house affords, should be sys- 
tematically arranged upon it. The tray must not be 
crowded, and discord in color should always be avoided. 
A few flowers in a small vase or laid loosely on the tray 
will add to its attractiveness. Too little rather than too 
much food should be served, and plenty of time be 
allowed for the meal, so that the food will be thoroughly 
masticated and mixed with the digestive juices. Hot 
food must be served hot, the dishes having previously 
been heated and wiped dry on the outside, and cold food 
must be served cold, lukewarm food being unpalatable. 
Pains must be taken not to spill the liquids. 

When a patient is permitted to sit up out of bed for 
an hour each day, it is generally best to utilize this hour 
for dinner, which, being the principal meal of the day, 
will then be thoroughly enjoyed, and will also, be better 
digested by the patient. If the patient takes the meals 
in bed, care must be taken that a comfortable position is 
secured and that the legs are not cramped by the food- 
tray. 

Every nurse of to-day knows something of the sci- 
ence of bacteriology, and that foodstuffs, especially the 



368 _ APPENDIX. 

animal portions, become spoiled through the presence in 
them of bacteria. Nurses have also heard lectures on, 
and understand the vast importance of, asepsis in sur- 
gical nursing : they would not think of doing a surgical 
dressing without first making their hands and everything 
to be used about the dressing aseptic, as the lack of such 
care might cost the patient her life. The nurse should 
be equally careful about cleansing the hands before hand- 
ling food, because, not knowing what germs are on her 
hands, it is possible thus to infect milk or other food 
with the bacillus of tuberculosis or of other disease. It 
is in the weakened stomach of the baby and of the inva- 
lid that bacteria develop and cause harmful results. That 
one has good health notwithstanding the careless prepa- 
ration of the food he eats, that he eats fruit which has 
passed through an endless series of dirty hands, that he 
cools the liquids he drinks with ice gathered from ponds 
impregnated with every form of bacteria, and that a 
healthy stomach has the power to destroy many germs, 
are no arguments against absolute cleanliness and neat- 
ness when serving food to the sick. 

A surgical dressing must be done before meal-time, and 
all traces of the dressing cleared away. The bed must 
be arranged, the patient's hands and face be bathed, and 
the room set in order before serving the meal. While 
eating the mind of the patient should be diverted by 
cheerful conversation, and the tray be removed as soon 
as the meal is finished. 

In most fevers patients are allowed to have a liberal 
supply of water or beverages, such as orangeade, lemon- 
ade, etc., which flush out the kidneys and aid in elimina- 
ting the worn-out material generated in the body by the 
fever. Eight grains of sodium bicarbonate, soda-water, 



FEEDING THE SICK. 369 

or Vichy water will render sour lemonade effervescing 
and will make a very refreshing beverage. Cold drinks 
should be sipped slowly, the thirst being relieved much 
better by sipping fluids than by quickly drinking them. 
Strong black coffee should be added to milk ; it is a 
heart- and brain-stimulant, and is very useful in typhoid 
fever when the patient seems to be sinking into a stupor. 
The diet-kitchen outfit may consist of the following 
appliances and accessories : 

A spirit- or gas-light chafing-dish ; . 

A single porcelain-lined saucepan ; 

A double porcelain-lined saucepan ; 

An 8-ounce measuring-glass ; 

A minim measuring-glass ; 

A cooking-thermometer ; 

A mince-meat machine ; spoons ; a glass funnel ; 

Borax ; sodium 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 Hght foods can be prepared. 

Diet in Convalescence. — The following sick-room 
dietary has been prepared as a guide for feeding conva- 
lescents. The diet for convalescence from typhoid fever 
may also be selected from it. 

First Day. 
Breakfast: Mutton broth with bread-crumbs. ' 
Lunch : Milk-punch. 
Dinner : Raw oysters ; thin bread and butter with 

crust removed ; sherry wine. 
Lunch : Cup of hot beef-tea. 
Supper : Milk toast ; jelly ; cocoa. 

24 



370 



APPENDIX. 



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. 

Supper : Buttered milk-toast (crust removed) ; jelly ; 
cocoa. 



Lunch : 
Dinner : 



Lunch : 



Third Day. 
Breakfast : Soft-boiled egg ; bread and butter ; coffee. 
Lunch : Milk-punch. 
Dinner : Chicken soup ; tender sweetbreads ; Bavarian 

cream ; light wine. 
Lunch : Egg-nog. 
Supper : Raw oysters ; bread and butter ; tea. 



Fourth Day. 

Breakfast : Oatmeal with sugar and cream ; a tender 
sweetbread ; creamed potatoes ; Graham 
bread and butter ; coffee. 

Lunch : Glass of milk. 

Dinner : Chicken panada ; baked potato ; bread ; tapi- 
oca cream. 

Lunch : Cup of hot chicken broth. 

Supper: Buttered dry toast (crust removed); wine 
jelly ; banquet crackers ; tea. 



FEEDING THE SICK. 



371 



Fifth Day. 

Breakfast : An orange ; a scrambled egg ; oatmeal with 
sugar and cream ; soft buttered toast ; 
coffee. 

Lunch : Milk-punch. 

Dinner : Cream-of-celery soup ; a small piece of ten- 
derloin steak ; a baked potato ; snow pud- 
ding ; bread ; wine. 

Lunch : An egg-nog. 

Supper: Calfs-foot jelly; soft-boiled ^g'g'^ bread and 
butter; cocoa. 

Sixth Day. 

Breakfast : Oatmeal ; poached eggs on toast ; coffee. 

Lunch : Cup of chicken broth. 

Dinner : Chicken soup ; small slice of tender roast 
beef; baked potato ; rice pudding ; bread. 

Lunch ; Glass of milk. 

Supper : Baked apples ; raw oysters ; bread and but- 
ter; orange jelly; tea. 



Seventh Day. 
Breakfast: An orange; mush and milk; scrambled 
eggs; cream toast; coffee. 
Cup of soft custard. 

Mutton soup; small piece of tender beef- 
steak; creamed potatoes; sago pudding; 
bread; wine. 
Cup of beef-tea. 
Supper : Sponge-cake with cream ; buttered dry toast ; 
wine jelly; cocoa. 



Lunch : 
Dinner ; 



Lunch : 



372 • APPENDIX. 

Eighth Day. 
Breakfast: Boiled fresh fish; oatmeal; Graham bread; 

coffee. 
Lunch : Chicken-broth. 
Dinner: Potato soup; breast of roast chicken; mashed 

potatoes ; macaroni ; blanc-mange. 
Lunch : Cup of mulled wine. 
Supper: Cream toast; lemon jelly; chocolate. 

The dietary for succeeding days may be selected from 
that of preceding days. Change of diet may cause a 
temporary rise in the temperature and pulse. 

2. Recipes for Invalid Foods and Beverages. 

Simple Farinaceous Foods. — Arrowroot. — Mix i 
teaspoonful of Bermuda arrowroot with 4 teaspoonsful 
of cold milk. Stir it slowly into half a pint of boiling 
milk, and let it simmer for five minutes. It must be 
stirred all the time, to prevent lumps and to keep it from 
burning. Add half a teaspoonful of sugar and a pinch 
of salt, and if desired one of cinnamon. In place of the 
cinnamon half a teaspoonful of brandy may be used or a 
dozen large raisins may be boiled in the milk. If the 
raisins are preferred, they should be stoned and the 
sugar may be omitted. 

Corn-starch or rice-flour gruel is made in the same 
way. 

Boiled-flour Gruel. — Moisten i pint of flour with 2 
ounces of cold water ; make it into a ball and tie it up 
tightly in a strong cloth. Slightly dampen the cloth, 
sprinkle it with flour, and boil it hard for ten hours ; 
then take off the cloth, and let the ball dry in a slow 
oven for ten hours more. Grate 2 teaspoonsful of flour 



RECIPES. 373 

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 i part of oatmeal (H. O.) ; boil rapidly 
from twenty to thirty minutes ; serve either hot or cold 
with cream or milk and sugar. 

Oatmeal Gruel No. 1. — Take 2 tablespoonsful of oat- 
meal, I saltspoonful of salt, and i quart of boiling water. 
Boil one hour. Strain and serve with milk or cream 
(Mrs. Lincoln). 

Oatmeal Gruel No. 2. — Pound \ cup of coarse oat- 
meal until it is mealy. Put it in a tumbler, and fill the 
tumbler with cold watei Stir well ; let it settle ; then 
pour off the mealy water into a saucepan. Fill again 
and pour off the water, and again repeat this, being care- 
ful each time not to disturb l:he sediment in the bottom 
of the tumbler. Boil the water twenty minutes. Season 
with salt. Thin with a little cream or milk. Strain and 
serve hot (Mrs. Lincoln). 

Beef-teas and Extracts. — The best pieces for beef- 
tea are the round and rump, as they contain the most 
and best-flavored juices. Wipe the meat with a wet 
cloth and remove all fat and skin. Beef-tea should not 
be allowed to boil, but should be kept at the temperature 
at which albumin coagulates, which is from 134° to 160°. 
Boiling water coagulates it, and beef-tea made in this 
way is without value as food. It is a stimulant. Beef- 
extract is the pure juice of the meat. Beef-tea is the 
juice diluted with water. The meat should be cut into 
small pieces, as, more surfaces being exposed to the 
water, the juices will be drawn out more quickly. Beef- 



374 APPENDIX. 

tea should not be strained, as the sediment contains the 
nutritious part. 

Beef-essence. — Mince finely i pound of lean, juicy 
beef, from which all the fat has been removed ; put into 
a wide-mouthed bottle or fruit-jar and cork tightly. Set 
the jar in a kettle of cold water over a slow fire, and 
let it boil for three hours. Strain and season with salt 
and red pepper. 

Bottled Beef-extract. — Cut i pound of lean beel 
into small pieces. Put it into a large-mouthed jar or 
bottle. Place the jar, covered, in a kettle of cold water, 
and heat slowly until near the boiling-point. Keep it at 
this temperature for two hours. Strain and press the 
meat to obtain all the juice. Season with salt. The 
water in the kettle should come nearly as high as the 
meat in the jar. In administering beef-extract, be care- 
ful to stir up the sediment. 

Beef-juice. — Place a \ pound of lean, juicy beef on a 
broiler over a clear hot fire and heat it through. Press 
out the juice with a lemon-squeezer into a hot cup, add 
salt, and serve hot with toast or with crackers. 

Beef-tea. — Free i pound of lean beef from fat, ten- 
don, cartilage, bone, and vessels ; chop up fine, put into 
I pint of cold water to digest two hours. Simmer on 
range or stove three hours, but do not boil. Make up 
for water lost in the evaporation by adding cold water, 
so that a pint of beef-tea represents i pound of beef 
Press the beef carefully and strain and flavor to taste. 

Beef-tea may rapidly be prepared by placing the jar 
containing the meat, finely divided, without any water, 
in an oven for twenty minutes, then add boiling water 
according to the quantity required. 

Beef-tea Peptonized. — To a \ pound of raw beef, free 



RECIPES. 375 

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 i 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 taste and serve with toast 
or with crackers. Rice may be used instead of the 
oatmeal. 

Raw-meat Diet. — Scrape pulp from a good steak, 
season to taste, spread on thin slices of bread ; sear 
bread slightly and serve as a sandwich. 

Meat Cure. — Procure a slice of steak from top of the 
round — fresh meat without fat ; cut the meat into strips, 
removing all fat, gristle, etc. with a knife. Put the meat 
through a mincer at least twice. The pulp must then 
be well beaten up in roomy saucepan with cold water or 
skimmed beef-tea to the consistency of cream. The 
right proportion is i teaspoonful of liquid to 8 tea- 
spoonsful of pulp ; add black pepper and salt to taste ; 
stir the mince briskly with a wooden spoon the whole 
time it is cooking, over slow fire or on cool part of cov- 
ered range, until hot through and through and the red 
color disappears. This requires about half an hour. 
When done it should be a soft, smooth, stiff puree of the 
consistency of a thick paste. Serve hot. Add for first 
few meals the softly-poached white of an egg. 

Sweetbreads. — Keep the sweetbreads in cold water 
until ready to use ; then remove the fat, pipes, and mem- 



3/6 APPENDIX. 

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 Broth. — Skin and chop up a small 
chicken or half a large fowl : put, bones and all, with a 
blade of mace, a sprig of parsley, 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 i 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. 

Eg-g" Broth. — Beat together i ^g^ and \ teaspoonful 
of sugar until very light ; add i pint of boiling water, 
stirring all the time ; add \ teaspoonful of salt. Serve at 
once. 

Mutton Broth. — The lean part of the neck or loin 
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. 



RECIPES. yjj 

Oysters. — Fricasseed Oysters. — To i cupful of milk 
add a \ cupful of oyster liquor. When the liquids boil 
add I teaspoonful of flour and \ teaspoonful of butter, 
rubbed together ; boil until it thickens ; then add i 
dozen oysters : cook until the oysters are plump and 
their edges curl; serve immediately, plain or on toast. 

Peptonized Oysters. — Mince 6 large or 12 small 
oysters ; add to them, in their own liquor, 5 grains of 
extract of pancreas with 15 grains of sodium bicarbonate 
(or one Fairchild peptonizing tube). This mixture is 
then brought to blood-heat (98° P.), and maintained, 
with occasional stirring, at that temperature thirty min- 
utes, 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. 

Oyster Stew. — Take i pint of oysters, i pint of milk, 
I teaspoonful of salt, \ cupful of water, i tablespoonful 
of butter, i saltspoonful of pepper. Scald the milk. 
Wash the oysters by adding the water, and remove all 
shells. Drain, saving the liquor. Put the liquor into 
a stewpan and heat slowly. Skim carefully. When 
clear, add the oysters and cook slowly until the edges 
curl and they are plump. Add the hot milk, butter, 
salt, and pepper, and serve. Do not let the oysters boil, 
as that toughens them and renders them indigestible. 

Oyster Broth. — Cut into small pieces i pint of oys- 
ters ; put them into a \ pint of cold water, and let them 
simmer gently for ten minutes over a slow fire. Skim, 
strain, and add salt and pepper. 



37^ APPENDIX. 

Puddings. — Arrowroot Pudding*. — Add the yolks of 
2 eggs to the plain arrowroot recipe (see p. 372), with 
I teaspoonful of powdered white sugar, mix well and 
bake in a lightly buttered dish for ten or fifteen minutes. 

Custard Pudding". — Break i ^^'g into a teacup, and 
mix thoroughly with sugar to taste; then add milk to 
nearly fill the cup, mix again, and tie over the cup a 
small piece of linen ; place the cup in a shallow sauce- 
pan half full of water and boil for ten minutes. 

If it is desired to make a Light Batter Pudding, a 
teaspoonful of flour should be mixed in with the milk 
before tying up the cup. 

Corn-flour Pudding. — Take I pint of milk, and mix 
with it 2 tablespoonsful of the flour: flavor to taste, 
then boil the whole eight minutes ; allow it to cool in a 
mould, and serve with or without jam. 

Rice 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 ^gg. 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. 

Snow Pudding. — Dissolve half a box of gelatin in I 
pint of cold water; when soft, add I pint of boiling 
water, the grated rind and juice of 2 lemons, and 2\ 
cupsful of sugar. Let the gelatinized water stand until 
cold and begins to stiffen. Then beat in the well-beaten 
whites of 5 eggs. Pour into a mould and set on ice. 
Serve with Custard Sauce — i quart of rich milk, the 
yolks of 5 eggs, with 2 extra eggs added, and a \ cup- 
ful of sugar. Flavor with vanilla. 



RECIPES. 379 

Soups. — Chicken Soup. — An old fowl will make a 
more nutritious soup than a young chicken. Skin, cut 
it up, and break the bones with a mallet. Cover well 
with cold water, and boil slowly for three or four hours. 
Salt to taste. A little rice may be boiled with it if 
desired. 

Mutton Soup. — Cut up fine 2 pounds of lean mutton, 
without fat or skin. Add 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. 

Oyster Soup. — A cupful of oysters with their liquor 
are placed in a saucepan and brought to a boil. Skim 
them and add i cupful of hot milk, i tablespoonful of 
butter, \ teaspoonful of salt, \ teaspoonful of pepper; 
bring to a boil and serve at once. 

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 gradu- 
ally pour in the milk. Stir well and strain through a 
sieve, and heat once more. Beat up an ^%^ and put it in 
the soup-tureen, and pour over it the soup when ready to 
serve. 

Cream of Tomato Soup. — Heat separately 2 table- 
spoonfuls of tomato juice and \ cupful of milk. To the 
tomato juice add \ teaspoonful of soda. Melt i table- 
spoonful of butter in small saucepan and add i table- 
spoonful of flour, stirring until it thickens, and then add 
it to the milk, stirring carefully ; add \ teaspoonful of 
salt and a dash of pepper; add the heated tomato juice 
to the soup. Serve at once with crisp crackers. 

White Celery Soup. — To \ pint of strong beef-tea add 



380 APPENDIX. 

an equal quantity of boiled milk, slightly and evenly thick- 
ened 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 little cheese may 
be grated over). Bake until brown. 

Creamed Potatoes. — Put i tablespoonful of butter 
into a frying-pan, and when it bubbles add I tablespoon- 
ful of flour ; add i 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 tablespoonfuls of milk, J 
teaspoonful of salt, I saltspoonful of pepper. Beat the 
eggs slightly with a spoon until you can take up a 
spoonful. Add the salt, pepper, and milk. Mix well. 
Put I tablespoonful of butter into a hot omelet-pan. 
When melted and hot pour in the ^gg, letting it spread 
over the pan. When the ^%'g begins to harden, draw 
the cooked part back toward you, letting the uncooked 
^g'g take its place. So continue until the ^gg is of a 
creamy consistency. Place the pan over the hottest 
part of the fire for a few seconds to brown the omelet 
slightly. Fold over and turn out upon a hot plate (Mrs^ 
Lincoln). 



RECIPES. 381 

Poached Eggs. — Have a frying-pan nearly full of hot 
water, not boiling but simmering. Add i teaspoonful 
of salt. Place in the pan as many muffin rings as there 
are ^%gs to be cooked. Break the eggs carefully into 
the rings. Dip the water over them with a spoon until 
a film has formed on the top of the yolk and the white 
is firm. Remove the rings and take up the eggs with a 
skimmer. Serve on buttered toast. Place a bit of but- 
ter and a little salt and pepper on each ^g^. A very 
nourishing and palatable dish is prepared by poaching 
the eggs in milk instead of water, and after taking up the 
eggs on toast, pour the milk over all. 

Scrambled Eggs. — Take 4 eggs, \ 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 ^<g<g to be properly cooked should 
never be boiled in boiling water, as the white hardens 
unevenly before the yolk is cooked. The yolk and 
white should be of a jelly-like consistency. 

Chicken panada is made by rubbing together in a 
mortar the meat from the breast and wings of a roast or 
a boiled chicken, with an equal quantity of stale bread ; 
then add gradually the water in which the chicken was 
boiled or other broth ; boil for a few moments and rub 
through a fine sieve. 

Salisbury Meat-cake. — Take a piece of tender rump- 
steak about half an inch thick ; place it on a clean board, 



382 APPENDIX. 

and with a sharp knife scrape off all the soft part until 
there is nothing left but the tough, stringy fibre. Take 
the soft part thus obtained and season with salt and 
pepper ; make it into small flat cakes about half an inch 
thick, and broil them over a brisk fire for two or three 
minutes. Serve on thin shoes of buttered toast. 

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 cow's milk and i teaspoonful 
of arrowroot (made into a paste with cold water) are to 
be stirred into the solution, and from i to 2 tablespoons- 
ful of cream added just at the termination of the cook- 
ing. It is then to be moderately sweetened with white 
sugar, when it is ready for use. The whole preparation 
should occupy about fifteen minutes. 

Prepared Milk. — Peptonized Milk — Cold Process. 
— 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. Process. — Mix the peptonizing powder with 
water and milk as described above ; place bottle in water 
so hot that the whole hand can be held in it for a minute 
without discomfort ; keep the bottle there ten minutes ; 
then put on ice to check further digestion. Do not heat 
long enough to render the milk bitter. Peptonized milk 
may be sweetened, flavored with grated nutmeg, or 
taken with carbonated mineral water. Put the mineral 



RECIPES. 383 

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 i quart of milk and 
boil until the sago is nearly dissolved. Sweeten to taste 
and serve either hot or cold. 

Koumyse. — Take an ordinary beer-bottle with patent 
shiftable stopper ; put in it I pint of milk, the sixth part 
of a cake of Fleischmann's yeast, or i tablespoonful of 
fresh lager-beer (brewer's) yeast, \ tablespoonful of white 
sugar reduced to syrup ; shake well and allow to stand 
in refrigerator two or three days, when it may be used. 
It will keep there indefinitely if laid on its side. Much 
waste can be saved by preparing the bottles with ordi- 
nary corks wired in position and drawing off the koumyss 
with a champagne tap. 

Toasted Bread. — Toast (dry). — Cut thin slices of 
bread into strips ; toast carefully and evenly without 
breaking, slightly butter, and serve immediately on a hot 
plate. 

Cream Toast. — Take I cupful of cream, i saltspoon- 
ful of salt, 2 slices of dry toast. Scald the cream. Add 
the salt, and pour it over the toast, or make the same as 
milk toast, using cream in place of the milk. If pre- 
ferred, the slices of toast may be first dipped in hot salted 
water. 

Eggr Toast. — Take l ^g%, l saltspoonful of salt, I 
cupful of milk, 6 slices of bread. Beat the ^gg slightly, 
add the salt and milk. Soak slices of bread in this until 
soft. Butter a hot griddle, put on the bread ; when one 
side is brown, put a bit of butter on each slice, then turn 



384 APPENDIX. 

and brown the other side. Serve with sugar and cinna- 
mon (Mrs. Lincoln). 

Milk Toast. — Take I cupful of milk, \ tablespoonful 
of corn-starch, \ tablespoonful of butter, 2 slices of dry- 
toast, I saltspoonful of salt. Scald the milk. Melt the 
butter in a saucepan ; when hot and bubbling add the 
corn-starch. Pour in the hot milk slowly, beating all 
the time until smooth. Let it boil up once. Then add 
the salt. Toast two slices of bread. Pour the thickened 
milk over the slices. Let it stand five minutes. Serve. 

Peptonized Milk Toast. — Over 2 slices of toast pour 
I gill of peptonized milk (cold process) ; let stand on 
the back part of the range for thirty minutes. Serve 
warm or strain and serve fluid portion alone. Plain 
light sponge-cake may be similarly digested. 

Invalid's Lunch. — A nice way to prepare a very light 
lunch for an invalid (to be taken with a cup of tea) is to 
toast 3 milk crackers ; then pour boiling water over 
them, drawing it off immediately ; spread jam or mar- 
malade over the toasted crackers and pile them up on a 
dish. Set the dish of crackers in the oven while making 
the tea, and take both to the sick-room. This lunch 
will prove appetizing and refreshing if unexpected. 

Desserts. — Baked Apples. — Core and pair 2 tart 
apples ; fill the core-holes with sugar ; grate over the 
apples a little nutmeg ; add a little water to baking-pan 
and put in oven and bake until the apples are soft. Serve 
with rich milk or cream. Sprinkle with icing sugar if 
not sweet enough. 

Bavarian Cream. — Whites of 6 eggs beaten very 
light ; 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 



RECIPES. 385 

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. — Mix I tablespoonful of cornstarch 
with I tablespoonful of fine sugar; make into a smooth 
paste with cold water. Heat 2 cupfuls of milk in a 
double boiler ; add the paste and stir until smooth. Cook 
for ten minutes; then remove from fire and add \ teaspoon- 
ful of vanilla flavoring; pour into a moistened mold and 
set in a cool place. Serve cold with sugar and cream. 

Blanc-mange of Rice. — Simmer \ pint of milk with i 
tablespoonful of pounded white sugar until near boiling ; 
then stir in 2 ounces or i large tablespoonful of ground 
rice previously mixed with \ pint of milk until smooth ; 
boil for ten minutes, stirring all the while, and pour into 
a moistened mold and serve cold. 

Baked Custard. — Beat 2 eggs slightly ; add I table- 
spoonful of sugar, \ teaspoonful of salt, 2 cupfuls of 
milk, and \ teaspoonful of vanilla flavoring ; mix thor- 
oughly ; pour in custard cups buttered on the inside; 
grate nutmeg over the top ; set in a pan of water and 
bake in moderate oven until firm. 

Soft Custard. — Take of cornstarch 2 tablespoonfuls 
to I quart of milk ; mix the corn with a small quantity 
of the milk and flavor ; beat up 2 eggs ; heat the re- 
mainder of the milk to near boiling ; then add the 
mixed corn, the eggs, 4 tablespoonfuls of sugar, a 
little butter, and salt. Boil the custard two minutes, 
stirring briskly. 

Calf 's-foot Jelly. — Thoroughly clean 2 feet of a calf, 
cut into pieces, and stew in 2 quarts of water until re- 
duced to I quart ; when cold take off the fat and sepa- 
25 



386 APPENDIX. 

rate the jelly from the sediment. Then put the jelly 
into a saucepan, with white wine and brandy and flavor- 
ing to taste, with the shells and whites of 4 eggs well 
mixed together ; boil for a quarter of an hour, cover it, 
and let it stand for a short time, and strain while hot 
through a flannel bag into a mould. 

Lemon Jelly. — Take half a box of gelatin, i cupful 
of cold water, i pint of boiling water, i cupful of sugar, 
\ cupful of lemon-juice. Soak the gelatin in the cold 
water twenty minutes or until soft. Add boiling water, 
sugar, and lemon-juice; strain (Mrs. Lincoln). 

Orange Jelly. — Dissolve half a box of gelatin in a ^ 
cupful of cold water. Take the juice of 6 oranges and 
of 2 lemons, i cupful of sugar, and i cupful of boiling 
water. Stir all together and strain. Put in a cold place 
and serve with " kisses " or a white cake. This jelly 
can be attractively served by placing it in the skins of 
the oranges cut in half and the edges notched. The 
pulp of the oranges must carefully be removed, and the 
skins thrown into cold water until required, then dried 
inside and filled with the jelly. 

Peach Foam. — Take 3 or 4 ripe peaches ; peel and 
cut into small pieces ; place them in a bowl with half a 
cupful of powdered sugar and the white of I ^g^ ; beat 
with a fork until it forms a thick smooth mass. Serve in 
a saucer, with or without cream. 

Tapioca Cream. — Take i pint of milk, 2 tablespoons- 
ful of tapioca, 2 tablespoonsful of sugar, i saltspoonful 
of salt, 2 eggs. Wash the tapioca. Add enough water 
to cover it, and let it stand in a warm place until the 
tapioca has absorbed the water. Then add the milk and 
cook in a double boiler, stirring often until the tapioca is 
clear and transparent. Beat the yolks of the eggs. Add 



RECIPES. 387 

the sugar and salt and the hot milk. Cook until it 
thickens. Remove from the fire. Add the whites of 
the eggs, beaten stiff. When cold add I teaspoonful of 
vanilla. 

Peptonized-milk Jelly. — First take about half a box 
of Nelson's gelatin, and set it aside to soak in i teacup- 
ful 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, \ cupful 
of cold water, i pint of boiling water, i cupful of wine, 
I cupful of sugar, i lemon. Soak the gelatin in the 
cold water until soft. Add the boiling water, wine, sugar, 
and lemon-juice. Strain. Keep on ice until ready to 
serve (Mrs. Lincoln). 

Junket. — Sweeten to taste i quart of fresh milk in a 
shallow dish, and stir in liquid rennet i 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 invaHds ; it 
may be flavored by grating nutmeg on the surface or by 
adding a few drops of brandy. 

Irish Moss. — Wash thoroughly a handful of Carrageen 
moss, pour over it 2 cups of boiling water, and let it 
stand where it will keep hot, but not boil, for two hours. 
Strain, add the juice of i lemon, and sugar to taste. 



388 APPENDIX. 

Irish-moss Blanc-rQang-e. — Take i quart of milk, \ 
cupful of Irish moss, i saltspoonful of salt, i teaspoon- 
ful of vanilla. Pick over and wash the Irish moss, and 
let it soak in cold water fifteen minutes. Drain off the 
water. Add the milk and cook in a double boiler until 
it thickens when cold. Strain. Add the salt and vanilla 
and turn into a mould. When cold serve with sugar 
and cream, also with sliced bananas (Mrs. Lincoln). 

Snow-eggs. — Take a small teacupful of new milk and 
boil it in a small, shallow saucepan with a little sugar ; 
while it is boiling break i ^%'g, putting the yolk and 
white in separate cups ; whip up the white to a fine light 
froth, and when the milk is quite boiling take a large 
spoonful at a time of the white, place it on the top of 
the milk for a moment or two, then turn it, and when 
sufficiently solid lift it out on a slice ; then mix up the 
yolk with some sugar, add the boiling milk, mix and 
boil again for a few minutes, then pour around the white 
and serve. 

Whipped Cream. — Mix 2 gills of rich cream, J cup 
of pulverized sugar, and 2 tablespoonsful of sherry 
wine ; put on ice for an hour, as cream whips much 
better if chilled ; whip with an egg-beater, and as the 
froth rises skim off the latter, and lay it on a sieve to 
drain, returning the cream which drips away, to be 
whipped over again. Place on the ice a short time 
before serving. Frozen whipped cream makes a very 
delicious and nourishing invalid dish. 

Wine Whey. — Put 2 pints of milk into a saucepan 
and stir over a clear fire until nearly boiling ; then add 
1 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 



RECIPES. 389 

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 it with cold milk and stir into the 
milk when it boils. Whip a tablespoonful of cream, and 
beat it into the chocolate just as it is taken from the 
stove. This makes i cup of rich, delicious chocolate. 
Do not let it boil, as it becomes oily and loses its fine 
fresh flavor. 

Cocoa. — Allow I teaspoonful of cocoa for each cup ; 
add sufficient hot water to form a paste ; pour on boiling 
milk (or milk and water) and sweeten to taste ; five min- 
utes' boiling will improve the cocoa (Wilbur). 

Coffee. — Stir together 2 tablespoonsful of freshly- 
ground coffee, 4 of cold water, and half an ^'g<g. Pour 
upon them i pint of boiling water, and let them boil for 
five minutes. Stir down the grounds, and let the coffee 
stand where it will keep hot, but not boil, for five minutes 
longer. Sugar and cream should be put into the cup 
first in serving, and the coffee poured upon them. 

Coffee (French). — Some persons prefer filtered to boiled 
coffee. Filtered coffee is best made in a French biggin, 
consisting of two tin vessels, one fitting into the other, 
the upper one being supplied with strainers. The coffee, 
very finely ground, is placed in this utensil, and the boil- 
ing water allowed slowly to percolate through it. The 
pot should be set where it will keep hot, but not boil, 
until the water has gone through. Pouring it through 
the coffee a second time will make it stronger, but it 
loses in flavor. Cafe noir is always made in this way. 

Crust Coffee. — Take i pint of crusts — those of Indian 



390 APPENDIX. 

bread are the best — brown well in a quick oven, but 
do not let them burn ; pour over them 3 pints of boiling- 
water and steep for ten minutes. Serve with cream. 

Nutritious Coffee. — Dissolve a little isinglass or gela- 
tin (Knox) in water ; put \ an ounce of freshly-ground 
coffee into a saucepan with i pint of new milk, which 
should be nearly boiling before the coffee is added ; boil 
both together for three minutes ; clear it by pouring 
some of it into a cup and dashing it back again ; add the 
isinglass, and leave the coffee on the back part of the 
range for a few minutes to settle. Beat up i ^<g<g in a 
breakfast-cup, and upon it pour the coffee ; if preferred, 
drink without the ^g'g. 

Rice Coffee. — Parch and grind like coffee a \ cupful 
of rice. Pour over it I quart of boiling water, and let it 
stand where it will keep hot for a quarter of an hour ; 
then strain, and add boiled milk and sugar. This is nice 
for children. 

Egg-nog". — Thoroughly beat a fresh &^g with an egg- 
beater, adding about a teaspoonful of sugar just before 
it is finished. Pour this in a glass and fill with milk ; 
flavor with vanilla or brandy ; stir well with a spoon ; 
add chipped ice and serve. Some patients prefer orange- 
juice in the place of milk and flavoring. 

Egg" Flip. — Beat the yolk of i ^g^ with \ teaspoonful 
of sugar until light and creamy; add i wineglass of 
sherry or i dessertspoonful of brandy; add to this the 
white of I ^g^ beaten stiff. Should be served at once. 

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 



RECIPES. 391 

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 
is most generally used. If you have no freezer, a very 
good sherbet may be made by freezing it in a tin pail 
packed in a pailful of salt and ice. Let it stand fifteen 
minutes. Remove the cover, scrape the frozen mixture 
from the side of the pail, mix thoroughly, cover, and let 
it stand fifteen minutes more ; then scrape down again. 
Repeat this process until the mixture is frozen sufficiently 
(Mrs. Lincoln). 

Egg" Lemonade. — Beat i ^^<g with i tablespoonful of 
sugar until very light ; stir in 3 tablespoonsful of cold 
water and the juice of a small lemon; fill glass with 
pounded ice and drink through a straw or a glass tube. 

Sterilized Milk. — Put the required amount of milk in 
clean bottles (if for infants, each bottle holding enough 
for one feeding). Plug the mouths of the bottles lightly 
with rubber stoppers ; immerse to their shoulders in a 
kettle of cold water; boil twenty minutes; or, better, 
steam thirty minutes in ordinary steamer ; firmly push 
the stoppers in the bottles, cool them rapidly, and keep 
in refrigerator. Warm each bottle just before using. 

Milk and Albumen. — Put into a clean quart bottle I 
pint of milk, the whites of 2 eggs, and a small pinch of 
salt. Cork and shake hard for five minutes. 

Milk-punch. — Take \ pint of fresh cold milk and add 
2 teaspoonfuls of sugar, and stir well until dissolved; 
then add i ounce either of brandy or sherry wine. 



392 APPENDIX. 

Milk-shake. — To 6 ounces of milk add 2 teaspoonfuls 
of sugar and a teaspoonful of vanilla ; place in a wide- 
mouthed bottle with some cracked ice ; cork securely 
and shake well. Sherry wine may be used instead of 
the vanilla, or an egg may be added previous to shaking. 

Mulled Wine. — Take \ cup of boiling water, into 
which put 2 teaspoonfuls of broken stick-cinnamon and 
6 whole cloves, and let all steep for ten minutes ; then 
strain. Now take 2 eggs and 2 tablespoonfuls of sugar; 
beat them together until very light, and stir into the 
spiced water. Pour from height into this mixture a 
cupful of sweet wine boiling hot (the wine should not be 
boiled in a tin vessel). By pouring this preparation from 
one pitcher to another several times it will become light 
and foamy. Serve hot. 

Orangeade. — Substitute orange-juice for that of lemon 
in the recipe for Lemonade. 

Orange Sherbet. — Take i^ cupsful of orange-juice, i 
tablespoonful of gelatin, \ cupful of cold water, \ cup- 
ful of boiling water, i cupful of sugar, i pint of cold 
water. Soak the gelatin in the cold water. Then add 
the boiHng water, the orange-juice^ the sugar, and the 
cold water. Strain and freeze. Any kind of fruit-juice, 
sweetened and diluted, may be used in place of the 
orange-juice. 

Tea. — Scald out the teapot and put in the tea, using i 
teaspoonful for each cupful. Pour on boiling water, and 
let teapot stand four or five minutes. If allowed to 
stand too long, the tannin in the tea is developed, which 
not only darkens the tea, but also renders it hurtful. 

Flaxseed Tea. — Flaxseed (whole), i ounce ; white 
sugar, I ounce (heaping tablespoonful) ; licorice-root, \ 
ounce (two small sticks); lemon-juice, 4 tablespoonsful. 



RECIPES. 393 

Pour on these materials 2 pints of boiling water; let it 
stand in a hot place four hours ; strain off the liquor. 

Albumen-water. — Stir the whites of 2 eggs into a \ 
pint of ice-water, without beating ; add enough salt or 
sugar to make it palatable. 

Apple-water. — Slice into a pitcher \ a dozen juicy 
sour apples ; add I tablespoonful of sugar, and pour 
over them i quart of boiling water. Cover closely until 
cold, then strain. 

Barley-water. — Wash 2 ounces (wineglassful) pearl 
barley with cold water. Boil it five minutes in fresh 
water; throw both waters away. Pour on 2 quarts 
boiling water ; boil down to i quart. Flavor with thinly- 
cut lemon-rind ; add sugar to taste. Do not strain unless 
at the patient's request. 

Gum-arabic Water. — Dissolve I ounce of gum- 
arabic in I pint of boiling water, add 2 tablespoonsful 
of sugar, a wineglassful of sherry, and the juice of I 
large lemon. Cool, and add ice. 

Lime-water. — Put a portion of unslaked lime in a 
covered earthen or glass jar and add as much cold water 
as desired. Stir well and let settle, then pour off the 
clear portion for use. More water can be added to the 
lime until all has been taken up, and if kept covered it 
will remain clear. Lime-water is often ordered with milk 
to neutralize acidity of the stomach. 

Rice-water. — Pick over and wash 2 tablespoonfuls 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 sherr}^ or port wine, 2 
tablespoonsful. 

Tamarind-water. — A ver>^ refreshing drink may be 



394 APPENDIX. 

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 burn. Put them into a pitcher ; pour 
over them i quart of boiling water ; cover closely and 
let stand on ice until cold ; strain. May add wine and 
sugar. 

Whey. — Heat i pint of milk to 100° F. ; add 2 tea- 
spoonfuls of essence of pepsin : beat with a fork in order 
to separate the curd ; strain through a fine strainer. 
Should be served cold. 

MINERAL WATERS. 

Alkaline waters contain sodium carbonate and bicar- 
bonate in comparatively large amounts. The conditions 
in which these waters produce their best effects are — 
Chronic gastric catarrh, especially with hyperacidity 
and catarrhal inflammation of the mucous membrane of 
the biliary passages. Good results have been obtained 
in acute catarrhal nephritis ; also in lithemia, gout, and 
chronic rheumatism. 

Carbonic-acid waters owe their potency to the pres- 
ence of carbonic-acid gas. Any variety of water may be 
found impregnated with this gas, whose presence possi 
bly increases the diuretic effects of the water. Fever- 
patients find these waters very agreeable. The addition 
of this gas acts as a sedative to the gastro-mucous mem- 
brane, and when taken cold and in sips relieves nausea 
and tends to check vomiting. Carbonic-acid water 
added to milk is admirably received by some patients 
with irritable stomach, and occasionally milk will be 
accepted in this form when it is absolutely refused in the 
pure state. Another very popular use to which these 
waters are put is in diluting wines. 



MINERAL WATERS. 395 

Chalybeate waters are those holding in solution one 
or more of the iron compounds, most frequently ferrous 
bicarbonate and ferrous oxide. Iron waters owe their 
virtues to the presence of iron, which usually exists in 
the form of the bicarbonate of the protoxid, held in 
solution by an excess of carbonic-acid gas. The ordi- 
nary indications for the use of iron are met by employ- 
ing waters of this class. They are useful in anemia, but 
usually have other constituents, whose administration 
may or may not be indicated in certain cases. 

Purgative waters usually owe their properties to 
sodium sulphate and magnesium sulphate. When a 
gentle saline laxative is indicated, these waters often give 
better results than either Epsom or Glauber's salt, and 
are therefore of greater service. In congestion of the 
liver, chronic gastric catarrh with atony, jaundice, lithe- 
mia, gout, and in the obese, the regular use of water of 
this class properly selected and administered yields excel- 
lent results. 

Saline waters contain common salt in solution, also 
small quantities of the chlorides, of the alkalies, and of 
alkaline earths. This saline when taken into the stomach 
dissolves albumin and starches ; promotes digestion and 
absorption of food ; supplies the intestines with chyme 
rich in albumin and starches ; enters the blood, which 
carries the salt to all the tissues of the body after sup- 
plying its own needs. The usefulness of the3e 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 



396 APPENDIX. 

hot. Preference should be given to those springs charged 
with carbonic-acid gas, which greatly increases the pala- 
tableness of this class of waters. The therapeutic dose 
is from i to 5 fs daily. 

Sulphuretted waters are due to the presence in the 
water of sulphuretted hydrogen gas, and they usually 
contain the sulphates of sodium and potassium. When 
taken internally, they augment peristalsis and perspira- 
tion. Frequently sulphur springs are used as baths, and 
with good results, especially in chronic skin-affections — 
such as eczema — in rheumatism, and in gout. The 
waters are useful in constipation, and are asserted to 
have produced good results in cases of chronic bronchitis 
and phthisis. In all these diseases they are administered 
internally and used externally as baths. 



WEIGHTS AND MEASURES. 

11. WEIGHTS AND MEASURES. 



397 



APOTHECARIES WEIGHT. 

Metric 
Pound — ft. Ounces — S. Drachms — 5. Scruples — 3. Grains — gr. grammes 

I 



12 


= 


96 


= 


288 


= 


5760 


= 372.96 


I 


= 


8 


= 


24 


= 


480 


= 31.08 






I 


» 


3 


= 


60 


= 3-885 










I 


= 


20 


= 1.295 



apothecaries' (wine) measure. 

Gallon— C. Pints— O. Fluidounces— ft. Fluidrachms— f5. Minims— TTl. 

1=8= 128 = 1024 = 61,440 

I = 16 = 128 = 7680 

I = 8 = 480 

1 = 60 



:OMPARi 


\TIVE V. 


/ILUES OF 


APOTHECARIES AND 


METRIC 






FLUID MEASURES. 










Cubic 




Cubic 






Cubic 


Minims. < 


:entimetres. 


Minims. 


centimetres. 


Minims 


centimetres. 


I = 


0.061 


II = 


0.678 


40 


= 


2.36 


2 = 


0.123 


12 = 


0.739 


50 


= 


3.08 


3 = 


0.185 


13 = 


0.801 


Fluidrachms 




4 =- 


0.246 


14 = 


0.862 


I 


= 


3.7 


5 = 


0.308 


15 = 


0.924 


2 


= 


7-39 


6 = 


0.370 


16 = 


1. 00 


3 


= 


11.09 


7 - 


0.431 


17 = 


1.06 


4 


= 


15.00 


8 = 


0-493 


18 = 


1. 12 


5 


= 


18.50 


9 - 


0.544 


20 = 


1.23 


6 


= 


22.50 


10 = 


0.616 


30 = 


1.84 


7 


= 


26.00 


Fluid- 


Cubic 


Fluid- 


Cubic 


Fluid- 




Cubic 


ounces. 


centimetres. 


ounces. 


centimetres. 


ounces. 




centimetres. 


1 = 


30.00^ 


8 = 


236.59 


20 


='-- 


591-50 


2 = 


59-14 


9 = 


266.16 


22 


= 


650.62 


3 = 


89.00 


10 = 


295-73 


24 


= 


710.00 


4 = 


118.29 


12 = 


355-00 


28 


= 


828.26 


5 = 


148.00 


14 = 


414.00 


32 


= 


946.35 


6 = 


177.42 


16 = 


473.17 


izm 


= 


1000.00 


7 = 


207.00 


18 = 
* More accura 


532.32 
Ltely, 29.57 c.c. 


128 


= 1 


5785.43 



398 



APPENDIX. 



APPROXIMATE MEASURES. 

One minim varies from one to two drops.* 
I fluidrachm = (about) I teaspoonful. 



2 fluidrachms = 
\ fluidounce = 
2 fluidounces = 
4 fluidounces = 
8 fluidounces = 



I dessertspoonful 
I tablespoonful. 
I wineglassful. 
I teacupful. 
I tumblerful. 



HOUSEHOLD MEASURES. 

4 teaspoonsful of liquid = I tablespoonful, 

1 pint of liquid = i 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 = l pound. 
2\ cups of powdered sugar = i pound. 



ANTISEPTIC SOLUTIONS^ (e. Q. THORNTON, M. D.). 



Drug. 


Com- 
mercial 
form. 


Solution. 


Strength. 


Per 
cent. 


Boric Acid 

Carbolic Acid 

Corrosive Chloride of ) 
Mercury (corrosive >- 
sublimate) J 


Powder. 
Liquid, j 

Crystals. 

Liquid. | 

Liquid. | 

Crystals. 

Liquid. 
Crystals. 


One ounce to a pint. 
Six drachms and fifteen minims'* 
to a pmt. J 

Seven and a half grains to a pint. 

Two drachms and thirty minims "1 
to a pint. J 

Two drachms and thirty minims ) 
to a pint. J 

Thirty grains to a pint. 

Four ounces to a pint. 
Five grains to a pint. 


I --i^ 
I : 2o 

I : looo 

I : so 
■ :SO 
I : 250 

I : 4 
I : 1500 


3 

5 

0.1 
2 


Lysol 

Potassium Perman-l 
ganate j 

Solution of Hydrogen \ 
Dioxide j" 

Thymol 


2 
0.4 

25 

.07 



1 A drop is popularly, although erroneously, supposed to be a ininiin. True, there 
are 60 drops in a fluidrachm of water, but this is the case with only a few liquid med- 
icines. The size of a drop depends on the shape of the vessel from which it is being 
dropped and on the adhesiveness of the fluid dropped ; consequently, a drop is a very 
indefinite quantity. Tinctures, spirits, and other alcoholic fluids drop from 120 to 130 
drops to the fluidrachm, whereas thick syrups and a few other liquids drop less than bo 
drops to the fluidrachm (Thornton). 

2 These antiseptic solutions are of ordinary strengths, and are intended only for local 
application. They may be prepared with either hot or cold (preferably distilled) water. 
To decrease the strength of either solution the quantity of water must be increased; 
for example, if a i : 2000 corrosive-sublimate solution is required, the proportion would 
be ^'% gr. to the quart. 



CONFINEMENT TABLE. 



399 



1 






i 


t4 

Ctf 


< 


CO 






< 




o 
O 

CO 


P)*^ 








P)*- 




?J.^ 


CO 




^•^ 




^^ 




^^ 


CO 


^^ 


^^ 


VO 

CO 


O VO 

CO 


CO 


O vO 
CO 


^^ 


O vO 
CO 


a^ 




Osro 


as CO 


s^^ 


CM 


OSIT) 
CM 


^^ 


OsvO 
CM 


CM 


Oslo 
CM 


C?S LO 

CM 


^^ 


00^ 


^^ 


00 N 


^^ 


00 't 

CM 


00 Tj- 
CM 


00 ^ 
CM 


00 "^ 
CM 


^^ 


00 -* 
CM 


«^ 


J. CO 


?r^ 






t^ ro 
CM 


t^ en 

CM 


r^ CO 

CM 


t^ CO 
CM 




r^ CO 

CM 


t^ CO 
CM 


r>. CO 

CM 


voc. 




N CO 


VO M 

N CO 


vO CM 
CM 


vO CM 
CM 


vO CM 
CM 


vO CM 


VO CO 
CM 


vO CM 
CM 


VO CM 
CM 


VO CM 
CM 


^- 


vnn 


n CO 


^^ 


CM 


CM 


CM 


vn 1-4 
CM 


UT) CM 

C4 


lO w 


J?" 


CM 


^^ 






^^ 


rl-00 
CM C>» 


S-^ 


t% 


CM CO 


^■^ 


^?:?. 


^P) 


CM CO 


;?^ 


ro O 


fOOO 
C< CS| 


CO 00 
CM M 


CO t>. 
CM CM 


!?a 


^^ 


coO 
CM CO 


^^ 


CO O 
CM CO 


^^ 


CO Os 
CM CM 


8g^ 




CM N 


CM CM 


CM vO 
CM C^ 


CM 0^ 
CM CM 


CM 00 
CM CM 


CM Os 
CM CM 


S^ 


CM Os 
CM CM 


S^ 


CM 00 


?;^ 


«00 




^^ 


CM CM 


mOO 
CM CS 


1-4 I^ 
CM CM 


^ 00 
CM C< 


^"^ 


11 00 
CM CM 


M 00 
CM CM 


►1 t^ 

CM CM 




gj:r 


g^ 


SJ? 


S^ 


a^ 


S^ 


S^ 


S^ 


O t^ 
N CM 


S cT 


S^ 


2^^ 


2^^ 




2^^ 


as CO 

M CM 


2^^ 


2^^ 


2^^ 


2^^ 


OssO 
I-I CM 


2^^ 


Os LO 
•1 CM 


00 u-1 


^^ 


00 m 


^?? 


00 CM 
M CM 


^^ 


"^t 


^^ 


^^ 


00 ITi 
w CM 


^^ 


00 T^ 

w CM 


t^ 


11 M 




I- CM 
M CM 


►* CM 


i:-^ 


t^ -o 


^^ 


^^ 


j:-^ 


j:-^ 


t^ CO 
n CM 


-SET 


^^ 


M C^ 


K< CM 


^S 


VO CO 
i-i CM 


vO M 
i-H CM 


^^ 


^^ 


^^ 


^^ 


VO CM 
n CM 






il?g 


ll?g 


m as 


-at 


1-4 CM 


-a"^ 


u^ CM 
NH CM 


li^ CM 
•I CM 


M CM 


n CM 




2-^ 


ri- as 


Tj- OS 


Tj-00 


^N 


t% 


t"^ 


^^ 


►-■ CM 


;?;; 


-^ O 
w CM 


:r8 


:?S 


CO 00 


COOO 


cot^ 


::S 


CO On 


::a 


:?S 


:rs 


:?8 


CO OS 


w as 


N 0\ 


N t^ 


CM t^ 


CM vO 


CM Os 


CM 00 


CM Os 


CM Os 


CM Os 


CM Os 

11 1 


rj 00 


woo 


«00 


HHVO 


W SO 


•-t to 

h4 IH 


M 00 


1-4 >H 


K4 00 


M 00 


« 00 


n 00 

M 1 


n t^ 


t^ 


O ^- 


O vn 


O LO 


o ^ 


o t-< 


o o 


o t-- 


O r- 


O r^ 


o *;• 


O VO 


Own 


ON^ 


as^ 


ON^ 


OS CO 


Os"^ 




ONVO 


OsvO 


Osvo 


osvo 


(Jsxo 


00 u^ 


00 "^ 


00 CO 


00 CO 


00 CM 


00 ^ 


00 Th 


00 "^ 


00 "^ 


00 lO 

11 


00 "^ 


00 ^ 


»s."* 


*^M 


tN. N 


t^ CM 




t^ ^ 


t^ CO 


!>. Th 


*^« 


t^Tl- 


*^« 


t>.CO 


vO fO 




VO i-r 


VO « 


VO O 


VO CO 


vo ^^ 


VO CO 


VO CO 


vo <r) 


VO CO 


VO CM 


w^ N 


vr>N 


mO 


u^O 


lO Os 


U-> CM 


U-) w 


tr> CM 


U^CM 


mcM 


u^CM 


VO 1 


•*« 


■*« 


'^OS 


Ti-as 


^00 


"t « 


Tj-O 


-* w 


Tf « 


^ « 


rh« 


^O 


roO 


fOO 


CO 00 


COOO 


COt^ 


COO 


CO OS 


COO 


COO 


CO O 


CO o 


CO o> 


N OS 


N OS 


c^ t^ 


CM t^ 


N vO 


CM Os 


CM 00 


M C?s 


CM OS 


CM Os 


N OS 


CM 00 


«00 


«00 

£z 


N- vO 


H4 VO 


•I vr» 


« 00 


M r^ 


«00 


«00 


MOO 


« 00 


n t^ 


ia 


so 




it 


C CO 




<2 


H 

to 5, 




> bi) 


am' 



400 



APPENDIX. 



IV. ABBREVIATIONS. 



J 



V 



v/ 



aa., ana, equal parts of each. 

A. c, ante cibum, before meals. 
Add., aide, add to it. 

Ad. lib., ad libitum, as you please. 

Alt. dieb., alternis diebus, every other 
day. 

Alt. hor., alternis horis, every other 
hour. 

Alt. noc, alternis node, every other 
night. 

Ante cib., ante cibum, before meals. 

Applic, applicatur, apply. 

Aq., aqua, water. 

Aq. bull., aqua bulliens, boiling 
water. 

Aq. dest., aqua destillata, distilled 
water. 

Aq. font., aqua fontana, spring water. 

Aq. mar., aqua marina, sea-water. 

Aq. pluvial., aqua pluvialis, rain- 
water. 

Aq. pur., aqua pura, pure water. . 

B. i. d., bis in die, twice a day. 

Bis hor, oi bis horis, every two hours. 
Bis ind., bis iti die, twice a day. 
Bull, bulliat, let it boil, 
c, cum, with. 

C. or Cong., congius, a gallon. 
c. c, cubic centimetre. 
Cap., capiat, let him take. 
Cent., centigrade. 

Cochl., cochleare, spoonful. 
Cochleat., cochleatim, by spoonfuls. 
Coch. mag., cochlear magnum, a 

tablespoon. 
Coch. med., cochlear medium, a 

dessertspoon. 
Coch. parv., cochlear parvum, a 

teaspoon. 
Comp., compositus, compound. 
Conf., confectio, a confection. 
Cort., cortex, bark. 
Cuj., cujus, of which. 



^^Decoct. hord., decoctum hordei, bar- 

ley-water. 
yDecub., decubitus (a bed), lying 
down. 

Destil., destilla, distil. 

Det., detur, let it be given. 

Dil., dilutus, dilute. 

Dim., dimidius, one-half. 

Div., divide. 

Div. in p. aeq., dividatur in partes 
cequales, divide into equal parts. 

Drachm., drachma, a drachm. 

Duo., duo, two. 

'Emp., emplastrum, a plaster. 

Eafem., enema. 

Eyktr., extractum, extract. 
y F., Fahrenheit. 
^. mist., fiat mistura, make a mixture. 

F. pil. fiat, pilula, make a pill. 
y'jPar., faradic. 
/ Fe., ferrum, iron. 

Filt., filtra, filter. 

Fl. or f ., fluidus, fluid. 

Fl. ex., fluidextr actum, fluidextract. 

Fot., fotus, a fomentation. 

Ereq., frequenter, frequently. 
^/Ft., fiat., let there be made. 

YZ, fluidrachma, fluidrachm. 

F ^ , fluiduncia, fluidounce. 

Garg., gargarisma, a gargle. 

Gm., gramme. 

Gossyp., gossypium, cotton- wool. 

Gr., granum, a grain, or grana, grains. 

Gtt., giitta, a drop, or guttce, drops. 

Guttat., guttatim, by drops. 

H. or hor., hora, an hour. 

Hg., hydrargyrum, mercury. 

Hirud., hirudines, leeches. 

Hor. decub., hora decubitus, at bed- 
time. 

Ind., in die, daily. 

Inf., injusum, an infusion. 

Inject., injectio, an injection. 



/ 



ABB RE VIA TIONS, 



v/i 



Lat. dol., lateri dolenti, to the affected 
side. 

L., litre. 

Lb., libra, a pound. 

Lib. or lbs., librcB, pounds. 
\_JAm., limones, lemons. 

Lin., linimentum, liniment. 

Liq., liquor. 

Lot., lotio, a lotion. 

M., misce, mix. 

TIjJ, minimum, a minim. 

Mac, macera, macerate. 
\^^-Man., maniptilus, a handful. 

Mass. pil., massa pilularum, pill- 
. mass. 
v^Me\., mellita, honey. 

Mist., mistura, a mixture. 

N- b., nota bene, note well. 

No., numero, in number. 

Noct., node, at night. 

O., odarius, a pint. 

01.-, oleum, oil. 
x/^l. oliv., oleum olives, olive oil. 
. / 0. m., omni mane, every morning. 

Ov., ovum, an egg. 

Oz., uncia, ounce. 

P. or pug., pugillus, a pinch. 

Part, vie, partibus vicibus, in divided 
^ doses. 

P. c, post cibum, after meals. 

Pil., pilula, a pill. 

Pond., pondere, by weight. 

Pt., pint. 

P. R. N., pro re natd, as occasion 
arises. 

Pulv., pulvis, a powder. 

Q., quaque, each or every. 

Q. d., quarter in die, four times a 
day. 

Q. h., quaque hora, every hour. 
26 



401 

every two, three, or 



V 



Q. 2, 3, or 4 h. 

four hours. 
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. 
I^., recipe, take. 
Rad., radix, root. 
Rect., redificatus, rectified. 
S. F., spiritus Jrumenti, whiskey. 
S. or Sig., signa, write. 
Scr,, scrupulum, scruple. 
Sem., semen, seed. 
Sol., solution. 
Spr., spiritus, spirit. 
Sp. gr., specific gravity. 
SS. or s., semissis, a half. 
St., stet, let it stand. 
Stat., statim, immediately. 
Sum., sumendus, to be taken. 
S. V. G., spiritus vini gallici, brandy. 
S. V. R., spiritus vini rectificatus, 

alcohol. 
Syr., syrupus, syrup. 
T., temperature. 
T., ter, three times. 
T. i. d., ter in die, three times a day. 
Tr., tinctura, tincture. 
Troch., trochisci, lozenges. 
Ung., unguentum, ointment. 
Ut. diet., ut dictum, as directed. 
Vin., vinum, wine. 
W., weight. 

5 , drachma, a drachm. . 
5, uncia, an ounce. 
9, scrupulum, a scruple. 



402 



APPENDIX. 



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GLOSSARY. 



Abdomen. The belly; the cavity 
between the chest and the groins. In 
abdominal injuries a nurse has usu- 
ally to keep her patient at rest and 
watch for signs of peritonitis. Lapar- 
otomy is the operation Ukely to be 
performed. 

Ab dominal . Pertaining to the ab- 
domen. 

Abductor. A muscle which draws 
a hmb from the median line of the 
body. 

AbnpnnaL Irregular, a deviation 
from the usual course. 

Abortion. Miscarriage before the 
fourth month. 

Aboulia. Inhibition of the will. 
Indecision. 

Abscess. A collection of pus in a 
cavity, the result of inflammation. 
If it disappears without being opened 
it is said to be dispersed. An abscess 
wound should pucker and the edges 
sink; the pus should be whitish 
green, inodorous, and moderately 
liquid. 

Absorbents. Wool and other 
dressings which suck up moisture. 

Absorption. The sucking up of 
substances by the lymphatic vessels. 

Accident. A casualty or unfore- 
seen event not characteristic of dis- 
ease. An unexpected symptom. 

Accoucheur. An obstetrician, a 
midwife. 

A . C . E . Mixture . An anesthetic : 
I part alcohol, 2 parts chloroform, 
and 3 parts ether 

Aceta. Solutions of medicines in 
vinegar. 

Acetabulum. The cup-like socket 
into which the head of the femur 
fits. 

Acetic. Pertaining to vinegar. 

Achilles' Tendon. The large 
tendon attached to the heel-bone. 

Acid. A compound which is 
capable of uniting with alkalies, but 
which when liquid has a sour taste 



and turns blue litmus paper red. 
Vinegar and lemon-juice are acids. 

Acidity. The quality of being 
sour; sharpness to the taste. 

Acme. The crisis of the disease. 

Acne. An eruption caused by the 
retention of secretion in the sebaceous 
glands. 

Aconite. A poisonous anodyne, 
sometimes used as a cardiac sedative. 
It increases perspiration. 

Acoustic. Pertaining to sound and 
hearing. 

Acrid. Sharp, burning. 

Action. The mode in which one 
object influences another. Actions 
may be divided into several classes, 
as chemical, organic, and physical. 
Vital actions are those necessary to 
life; physiological actions are those 
which are normal; pathological ac- 
tions are those presented in a diseased 
condition. 

Acupressure. Arrest of bleeding 
by means of long pins, with glass 
heads, passed across the course of 
the artery. 

Acupuncture. Insertion of nee- 
dles to treat certain diseases. 

Acute. A severe but short attack 
of disease. 

Adduct. To draw toward the 
centre or the median line. 

Adductor. A muscle which draws 
toward the median line of the body. 

Adenitis. Inflammation of a gland. 

Adenoid. A glandular tumor, es- 
pecially an overgrowth of the glandu- 
lar tissue at the back of the nose, seen 
especially in young children, and par- 
tially closing the passages for respira- 
tion, and frequently producing mouth- 
breathing and mental dulness. 

Adhesion. The process by which 
severed tissues unite. 

Adipose. Fatty. 

Adiposis. Fatty degeneration. 

Adjuvant. A secondary ingredi- 
ent in a prescription, aiding the chief 
drug. 

Adnexa. Appendages. 

421 



422 



~ APPENDIX. 



Adnexa uteri. The Fallopian 
tubes and ovaries. 

Adolescence . The period between 
puberty and maturity. From 14 to 
25 in a man; 12 to 21 in a woman. 

Adult. A person who has passed 
the age of maturity. 

Adynamic. Defect of power, weak- 
ness. 

Aerobia. Bacteria which require 
oxygen or air for their existence. 

Affection. Any condition in which 
mind or body is modified or affected; 
disease, febrile affection, cardiac af- 
fection, etc. 

Afferent. Conveying from surface 
to centre; apphed to the lymphatic 
vessels and nerves. 

Affusion. Pouring water upon the 
body as a remedy. 

After-birth. A vascular organ 
which nourishes the fetus and is ex- 
pelled after labor; placenta. 

After-care. The care or nursing 
of convalescents. 

After-pains. Pains from uterine 
contraction following labor. 

After-treatment. (See Ajier- 
care.) 

Agalactia. Lack of milk in a 
mother. 

Agglutination. A jouiing or ad- 
hering together. 

Aggregate. Gathered in clusters. 

Ague. (See Malaria) 

Air-bed. A mattress made of 
India-rubber and filled with air. 
Water-beds are filled with water. 

Air-cell. An air-sac; an air-vesi- 
cle of the pneumonic tissue. 

Air-cushions. Cushions of vari- 
ous shapes made of India-rubber and 
filled with air, which the nurse blows 
in through a valve. 

Air-passages. The 'respiratory 
organs — larynx, bronchia, etc. 

Air-pump. An apparatus by 

which the air may be exhausted from 
a communicating vessel. 

Alalia. Defect of speech caused 
by paralysis. 

Albino. A person with white hair, 
fair skin, and pink eyes; caused by 
pigmentary deficiency. 

Albumin. A proteid substance, 
the chief constituent of the body. 

Albuminuria. The presence of 
albumin, a substance resembling white 
of egg, in the urine; a condition cha- 
racteristic of kidney disease. A syn- 



onym of Bright's disease. Test for 
albumin: The application of heat gives 
an opacity that does not clear on the 
addition of nitric acid. 

Alcoholism. A morbid state pro- 
duced by excessive drinking of wines 
or spirits. Watch for delirium tre- 
mens and morning vomiting. 

Alienist. A physician who makes 
a specialty of treating mental diseases. 

Aleukemia. Deficiency in the 
number of white blood-corpuscles in 
the blood. 

Alimentary Canal. The tube 
through which the food passes from 
me mouth to the anus. 
u Alkali. The opposite to an acid; 
a soapy substance. Turns red Utmus 
paper to blue. Soda and potash are 
alkaUes. 

Aloes. The juice of several varie- 
ties of aloe; astringent and cathartic. 

Alopecia. Absence of hair, bald- 
ness. 

Alterative. A remedy which al- 
ters nutrition and excretion and re- 
stores normal function to an organ or 
the body. 

Alum. Crystals of aluminum and 
potassium. Very astringent, shghtly 
emetic. Salts of aluminum are used 
as a non-volatile antiseptic. Alum 
dusted on wounds acts as a styptic 
and arrests bleeding. 

Alveoli. The sockets of the teeth. 

Ambidexter . Equally skilful with 
both hands. 

Amblyopia. Indistinct vision; ap- 
proaching blindness. 

Amenorrhea. Abnormal absence 
of the menses. 

Amentia. Defect of intellect, 
idiocy. 

Ammonia. A volatile alkali with 
a pungent odor. Stimulant; also 
used as an expectorant. Chloride of 
ammonium is often given as an in- 
halation, when it generally falls to 
the nurse to charge the inhaler. 

Amnesia. Loss of memory. 

Amnion. The sac directly encir- 
cUng the fetus in utero. 
, Amniotic Fluid. (See Liquor 
(Annii.) 

^ Amputation. The removal of a 
limb or an organ. It is termed pri- 
mary if performed immediately after 
the injury; secondary if performed 
later. A nurse should note the num- 
ber of ligatures and sutures used. 



GLOSSARY. 



423 



The strapping to keep the flaps to- 
gether should be \ inch broad for 
forearm to \\ inch for thigh. The 
stump should be kept raised and with 
no clothes weighing on it. Watch 
constantly for bleeding or collapse. 

Amyl. A radical composed of 
carbon and hydrogen. Amyl nitrite 
is sometimes inhaled (5 drops on 
lint) in angina pectoris, epilepsy, etc.; 
it should be given when the patient is 
lying down. 

Anacrotic. Vibrations in the 
pulse-beat; marked on the upward 
line by the sphygmograph. 

Analgesia. Diminished sensibil- 
ity to pain. 

Anasarca. Serum in the tissues; 
widespread dropsy. 

Anatomy. The science which 
treats of the structure of the body. 

Anemia. A deficiency of red cor- 
puscles in the blood, generally ac- 
companied by pallor of the face and 
palpitation of the heart. Pills con- 
taining iron, "Blaud's pills," are 
often given. Fresh air and diet are 
the most important factors in the 
nursing. Foods rich in salts, as 
rare beef, vegetables, and fruits, are 
given. 

Anesthesia. Insensibility to pain. 
Local anesthesia is loss of feeling of a 
limited part of the body produced by 
a spray of the anesthetic or occurring 
spontaneously. 

Anesthetic. The agent which 
produces insensibility. Before a pa- 
tient is put under an anesthetic the 
nurse must see that there is nothing 
in the mouth (false teeth must be re- 
moved) and that all clothing is loose. 
No solid food must be taken by the 
patient for 6 or 8 hours before the 
anesthetic is given. Watch if the 
patient becomes livid, or if the breath- 
ing becomes shallow and irregular; 
these are dangerous symptoms. 

Aneurysm. A dilatation of an ar- 
tery. The treatment aims at produc- 
ing coagulation of the blood in the 
aneurysm, as a rule. The nurse may 
be called upon to apply digital com- 
pression — compression by the fin- 
gers. Sudden death is frequent in 
these cases, and the nurse has to keep 
the patient absolutely at rest. 

Angina Pectoris. A neurosis of 
the heart usually associated with dis- 
ease of the base of the aorta and of 



' the coronary arteries, and manifested 
I clinically by paroxysms of intense 
pain and oppression in the region of 
1 the heart, a sensation of impending 
! death, etc., and frequently terminating 
I fatally. 

1 Angioma. A tumor composed of 
blood-vessels. 

Ankylosis. An immovable state 
of a joint resulting from union of the 
bones. 

Anodyne. A remedy to procure 
relief from pain, such as opium. 

Anorexia. Lack of appetite, ab- 
horrence of food. 

Anteflexion. A bending forward, 
as of the uterus. 

Anthelmintic. Applied to reme- 
dies for expulsion of intestinal worms. 

Anthrax. A carbuncle or malig- 
nant boil. Charbon anthrax is con- 
tracted from animals, and is fatal in 
30 per cent, of cases. The pustule 
is generally excised. 

Anthypnotic. An agent to pre- 
vent sleep. 

Antidote. The corrective to a 
poison; thus alkalies are given in cases 
of poisoning by acids. 

Antifebrin. Against fever. Ace- 
tanilide. 

Antiperiodic. An agent to prevent 
the regular return of certain symp- 
toms. Thus quinine is used in ague as 
an antiperiodic. 

Antiphlogistic. Relieving in- 
flammation. 

Antip3rretic. A remedy for high 
temperature. 

Antipyrine. A drug, used in the 
form of a white powder, to reduce 
high temperature. It begins to act 
in 15 minutes. Causes perspiration 
and, in rare cases, cardiac weakness 
Caution: May cause alarming symp- 
toms. 

Antisepsis. Exclusion of the 

germs that cause putrefaction; the 
totality of measures taken to prevent 
septic poisoning. 

Antiseptic. Against putrefaction. 
A nurse has much to do with the 
proper use of antiseptics, especially 
in surgical cases, where, if putre- 
faction starts in a wound, there is 
great danger. Iodoform, carbolic acid, 
corrosive sublimate, salicylic acid, 
chlorine, terebene, eucab'ptus, thy- 
mol, and Condy's fluid are the com- 
monest antiseptics. Strict atten- 



424 



APPENDIX. 



tion must be paid to all orders given 
in connection with the use of these 
agents, and in every case a nurse 
must rinse her hands in some disin- 
fectant both before and after dress- 
ing a wound. The antiseptic spray 
is an apparatus consisting of a lamp, 
boiler, and jar containing the car- 
bolic acid, used to throw a spray 
during operations, or the dressing 
of wounds. 

Antitoxin. A substance or serum 
used to counteract a disease by sub- 
cutaneous injection. 

Antrum. A cave; applied to the 
maxillary sinus, etc. 

Anuria. Suppression of urine. 

Anus. The lower termination of 
the rectum, the opening through 
which fecal matter is discharged. An 
artificial anus is an opening made 
into some higher portion of the in- 
testinal canal, when for some reason 
the proper anus is absent or diseased. 
The operation to make an artificial 
anus is colostomy. 

Aorta. The large artery rising 
from the left side of the heart, and 
supplying blood to the whole body. 

Aortic Valve. The valve at the 
jimction of the left ventricle and the 
aorta. 

Aperient. A mild purgative medi- 
cine, such as cascara, usually given 
at bed-time. 

Aphasia. Loss of speech, often 
caused by cerebral lesion. 

Aphonia. Loss of voice, due to 
fault in the vocal cords, or to dis- 
turbance of the central nervous system. 

Aphthae. Small white ulcers in 
the mouth; a disease of infants. The 
nurse must watch for intestinal de- 
rangement. The mouth of the infant 
must be cleansed with boracic acid, or 
with some similar preparation, after 
each nursing. 

Apnea. Suspended respiration. 
Sometimes seen in chloroform an- 
esthesia and in the newborn. 

Apoplexy. Sudden loss of con- 
sciousness, motion, and sensation due 
to hemorrhage into the brain or to the 
plugging of one of the blood-vessels 
of the brain. Paralysis of one side 
of the body, stertorous breathing. 
The patient is kept recumbent, with 
ice to the head, and a purgative is 
usually given. Note if the pulse 
grows weak and the surface cold. 



Great variations of temperature, with 
giddiness, may point to another at- 
tack coming on. 

Appendectomy. Removal of the 
appendix vermiformis. 

Appendicitis. Inflammation of 
the vermiform appendix. 

Appendix Vermiformis . A rudi- 
ment of the lengthened cecum; or, 
according to Darwin, a relic of the 
lower form of life from which we 
have sprung. Inflammation of the 
vermiform appendix occurs in "typh- 
Utis," and may lead to peritonitis. 
Relapse must be watched for. Sur- 
gical interference often has to be re- 
sorted to, and, in some cases, lapar- 
otomy is performed and the appendix 
removed. 

Application. The act of applying 
anything, as a plaster, bandage, etc. 

Apyrexia. An intermission or ab- 
sence of fever. 

Aqua. Water: the abbreviation is 
aq., while aq. bull, stands for boihng 
water; aq. dest., distilled water; and 
aq. mar., for sea water. 

Aqua Fortis. Nitric acid. A 
powerful corrosive used in testing. 
Must be used with care, for if it 
comes in contact with the fingers it 
causes a bum. Antidotes: Magne- 
sia, milk. 

Areola. The brown circle about 
the nipple of the breast. 

Areometer. An instrument for 
measuring the specific gravity of 
fluids; a hydrometer. 

Armpit. (See Axilla) 

Arnica. The tincture of arnica 
is used for bruises as a local stimulant. 

Arsenic. A poison. Given fre- 
quently, in the shape of a white pow- 
der, in small doses, in skin diseases 
and other affections. Should be 
given after food. Report at once if 
the tongue gets a white fur, or diar- 
rhea or gastric pains commence. 
Antidotes for overdose: Magnesia, 
with tincture of iron, chalk and 
water, milk. 

Arteries. The tube-like vessels 
through which the blood is propelled 
by the heart to the peripheral organs. 
(See Axillary, Brachial, Femoral, and 
Tibial) 

Arteritis. Inflammation of the 
arteries. 

Artery. A tube which conveys 
the purified blood from the heart to 



GL OSSAR Y. 



425 



the capillaries. Bleeding from an 
artery is bright red, and flows in 
jets. A nurse should know the points 
at which it is possible to arrest bleed- 
ing by pressure on the artery; in 
every case this point is nearer the 
heart than the site of injury. In am- 
putation, etc., the severed arteries are 
tied with ligatures of silk, or of catgut. 

Arthritis. Inflammation of the 
joints, as occurs in gout, rheumatism, 
etc. 

Articular. Relating to the joints. 

Articulation. A joint or juncture 
of bones; the mechanism of jointing. 
The articulation of a skeleton is the 
manner in which the bones are joined 
together. The movable articulations 
of the bones are of various forms: 

1. Those in which the bones glide 
upon plane surfaces, as in the articu- 
lation of the fibula with the tibia; 

2. Those articulations known as "ball- 
and-socket joints," such as the hip- 
joint; 3. Those having a hinge-hke 
articulation, with a forward and back- 
ward motion only, as the knee-joint. 
Applied also to the distinct enuncia- 
tion of articulate speech. 

Arytenoid. The name of two 
funnel-shaped cartilages and two 
glands of the larynx. 

Asafetida. An antispasmodic, 
chiefly given in hysteria. Strong un- 
pleasant smell. 

Ascaris. A genus of worm found 
in the human body. Ascaris lumbri- 
coides, long roimd worm; Ascaris 
vertnicularis, thread- worm. 

Ascites. Dropsy of the abdomen. 

Aseptic. Free from putrefaction. 
In aseptic surgery all instruments, 
dressings, etc., are sterilized by heat 
before use. 

Asphyxia. Suspended animation, 
when the lungs are deprived of air, 
as in the newborn. 

Aspiration. The operation of 
drawing ofl fluids from the body 
by means of an aspirator: this in- 
strument consists of a hollow ex- 
ploring needle fixed to a tube, which 
connects it with a bottle; the bottle, 
in its turn, is connected with an ex- 
hausting pump. There are two stop- 
cocks at the head of the bottle, one 
to each connection. The air in the 
bottle is exhausted, and the needle is 
plunged into that part of the body 
where the fluid is congregated. The 



duty of the nurse is to have a second 
bottle at hand in case the first is not 
large enough to contain all the fluid, 
and to measure and note the amount 
of fluid withdrawn. She should also 
have ready a flannel bandage, 12 
inches broad, lint, sticking-plaster, 
hot water, sponges, pins, and brandy. 
After-treatment: rest, light stimulat- 
ing diet. 

Assimilation. The process of 
transforming food into such a nutri- 
ent condition that it is taken up by 
the circulatory system. 

Asthenia. Failure of strength, 
debiUty. 

Asthma. A disease marked by 
paroxysms of difficult breathing, 
with sense of suffocation. Asthma is 
generally chronic, and not dangerous 
till other compHcations ensue. The 
duty of the nurse is to have any in- 
halations or medicines ordered always 
at hand, in case an attack comes on: 
also to note the sputum. The patient 
must be kept strictly to the diet 
ordered, as this has great effect in 
mitigating the spasms. 

Astigmatism. Inequality in the 
refractive power of the eye. 

Astragalus. The ankle-bone. 

Astringent. A medicine causing 
contraction and arresting the flow 
of secretions. 

Ataxy. Irregularity; applied to 
locomotion, to the pulse, and to cer- 
tain fevers. 

Atony. Wanting in tone or vigor; 
weakness. 

Atresia. Absence of a natural 
passage. 

Atrium. The portion of the auricle 
of the heart that receives the venous 
blood. 

Atrophy. Wasting; one limb or 
organ of the body is often afllicted 
with atrophy without the other parts 
suffering. 

Atropine . The active principle of 
belladonna. Used as a sedative in 
asthma, neuralgia, spasms, etc., and 
hypodermatically to check sweating, 
etc. Applied to the eye, it soothes and 
causes enlargement of the pupil. 
It is a poison. Antidotes: Sulphate 
of zinc as an emetic, ammonia, and 
stimulants. 

Audiphone . A fan-shaped instru- 
ment held against the teeth to in- 
crease hearing wa the cranial bones. 



426 



APPENDIX. 



Auditory Canal . The passage ex- 
tending from the external ear to the 
tympanic membrane. 

Aura Epileptica. A peculiar sen- 
sation, like a current of air rising 
from the limbs or body to the head, 
ushering in an epileptic attack. 

Auricle. The external ear; the 
two uppermost chambers of the heart 
are called, respectively, the "left" 
and "right" auricles. A small gold 
instrument worn in the ear to aid 
hearing is also termed an auricle. 

Auricular. Pertaining to the ear. 

Auriscope. An instrument fitted 
with a speculum for examining the 
internal ear. 

Auscultation. Listening to sounds 
of the body for the purpose of diag- 
nosis. For immediate auscultation the 
ear is placed directly against the body, 
for mediate auscultation a stethoscope 
is used. 

Autopsy. A post-mortem exam- 
ination or examination after death. 

Axilla. The cavity beneath the 
upper part of the arm at its junction 
with the shoulder. 

Axillary Artery. The artery of 
the armpit, connecting the subcla- 
vian and brachial arteries. 

B. 

Bacillus. A rod-shaped bacte- 
rium; the comma bacillus is the 
germ of cholera. 

Backbone . The vertebral column ; 
spine. 

Bacteria. Germs; microorgan- 
isms. Of interest because many dis- 
eases are due to them. 

Bag of Waters. The membranes 
enclosing the liquor amnii as they 
project through the os uteri in the 
first stage of labor. 

Baking Soda. Sodium bicarbon- 
ate; saleratus. 

Ballottement. The falling back 
of the fetus when pushed upward 
by the finger; a sign of mid-preg- 
nancy. 

Balneum. A bath, abbreviated to 
bain. Tepidimi, warm, or 85° to 95° 
Fahr., immersion for fourteen min- 
utes. Calidum, hot, or 98° to 105° 
Fahr., immersion for ten minutes. 
Frigidum, cold, or 60° to 70° Fahr., 
immersion for five minutes. A nurse 
must always prepare the bath before 
the patient is put into it, and always 



use the bath-thermometer. The tem- 
perature of a vapor bath may rise as 
high as 110° Fahr. 

Balsam of Peru. Used to heal 
slight scratches, etc., especially 
cracked nipples. 

Bandages. The usual form of 
bandage is the roller, or long strip 
of linen rolled tightly into a cyUn- 
drical form. The arm bandage should 
be 2 inches wide and 6 yards long; 
the leg bandage, 3 inches wide and 
8 yards long; the rib bandage, 6 
inches wide and 6 yards long. The 
triangular bandage is the shape of a 
large handkerchief folded with two 
opposite points together. The T- 
bandage is formed of two pieces of 
roller bandage, the one being tacked 
to the centre of the other, so that 
they look like a capital T. Bandages 
are made of mushn, flannel, or gauze. 
India-rubber bandages are used for 
ulcers and other surgical cases. The 
nurse must learn by practice to apply 
all bandages neatly and so as to give 
equal pressure (see p. 196). 

Bath. See page 88 for the different 
varieties of baths. 

Bath-thermometer. A Fahren- 
heit tube mounted in a wooden or a 
metal frame for immersion in water 
to ascertain its temperature. 

Battery. A collection of jars for 
generating electricity. 

Bearing-down. The feeling of 
weight or pressure in the pelvis in 
certain diseases. Bearing-down pains 
are uterine pains during labor. 

Bed. The couch or support on 
which the body may rest in sleep and 
in sickness. (For the different forms 
and varieties of beds, see p. ^t,) 

Bed-cradle. A semicircular ap- 
paratus to prevent the contact of the 
bed-clothes wdth a diseased or an in- 
jured part. 

Bed-pan. A large shallow vessel 
for receiving the fecal and urinary 
discharges from bedridden patients. 

Bed-rest. An apparatus for prop- 
ping up patients in bed. 

Bed-sore. A sore caused on the 
buttocks, heels, or shoulders by con- 
stant pressure on the bed. Bed-sores 
arise in long illnesses if the nurse is 
not very careful. 

Belladonna. A drug used to 
soothe pain; to check sweating and 
the secretion of milk. (See A tropin.) 



GLOSSARY. 



427 



Benzoic Acid. An antiseptic and 
expectorant, useful in chronic bron- 
chitis and urinary disorders. 

Beri-beri. An acute Indian dis- 
ease, causing great weakness, an- 
emia, and dropsy. The disease is 
sometimes seen in the Southern 
United States, and among the Chi- 
nese and Japanese of California. The 
patients should be well fed with ni- 
trogenous foods and kept quiet and 
warm. A daily bath or rub should be 
given. Special attention must be paid 
to the ventilation of the sick-room. 

Bile. The secretion of the liver; 
greenish, bitter, and viscid. To test 
for biliary coloring matter, pour a 
few drops of the urine on a white 
plate, and add a few drops of nitric 
acid, when, if the coloring matter be 
present, a play of colors — violet, 
green, and red — will occur. 

Bilious. A term applied to diges- 
tive disturbance arising from irregu- 
lar biUary secretion. 

Binder. A broad band passed 
tightly round the abdomen after 
childbirth. An ordinary round towel, 
or a piece of flannel ij yds. in length 
and 18 in. in breadth, will do for the 
mother. The infant needs a fine flan- 
nel or twilled binder, 4 inches broad 
and long enough to go well round the 
body and overlap. 

Biparous. Bearing twins. 

Birth. The delivery of a child; 
parturition. Plural birth, the birth 
of more than a single child; posthu- 
mous birth, the birth of a child after 
the death of its father; premature 
birth, expulsion of a viable fetus be- 
fore full term; still-birth, a child born 
lifeless. 

Birth-mark. A patch of congen- 
ital discoloration of the skin due to a 
dilated condition of the capillaries. 
"Mother's mark." 

Bismuth. Stomachic sedative and 
tonic. Causes black stools. Over- 
dose poisons. 

Bistoury. A small surgical knife, 
usually curved, for making incisions. 

Bladder. The sac which holds the 
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 for special attention 
from the nurse. The Latin term for 
the bladder is vesica. 



Bland. A term applied to mild and 
soothing medicines and applications. 

Bleeding. (See Hemorrhage.) 

Blepharitis . Inflammation of the 
edges of the eyelids. 

Blind-spot. Point where the op- 
tic nerve enters the retina: it is abso- 
lutely blind. 

Blister. An agent producing a 
vesicle containing serum; usually a 
blistering fluid or a plaster (can- 
tharides). The nurse generally is 
entrusted to apply the blister; the 
part must first be washed with soap 
and warm water, and the plaster fas- 
tened lightly with a bandage, or, if 
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 takes from six to 
twelve hours to rise. To dress, snip 
the most pendant part of the bleb, 
and let the serum run out into a re- 
ceiver, or a bunch of absorbent cotton. 
Apply the ointment ordered. A per- 
petual blister is a blister kept open for a 
longer or shorter time by means of ap- 
propriate dressings. 

Blood. The fluid that circulates 
through the heart, arteries, and 
veins. Arterial blood, ''red blood," 
so called because contained in the 
arteries; venous blood, that contained 
in the veins. 

Blood-casts. Microscopic fila- 
ments of coagulated blood found in 
the urine, or tube-casts to which blood 
corpuscles are attached. 

Blood-clot. The coagulum, or 
jelly-like mass formed in blood when 
it clots. 

Blood-current. The "flow" of 
the blood through the arteries and 
veins. 

Blood-poisoning, A term denot- 
ing any ailment arising from the in- 
troduction of decomposing organic 
matter or putrefactive germs into the 
blood. (See Pyemia and Septicemia.) 

Blood-serum. A yellowish, thin 
fluid constituent of blood, separating 
from the blood-clot or fibrin in coag- 
ulation. 

Blood-vessels. Tube-like struc- 
tures for conveying the blood through- 
out the body. 

Boil. Popular name for a small 
tumor or furuncle. 

Bone -repair. The healing of a 
broken bone. (See p. 189.) 



428 



APPENDIX. 



Borax. Boric acid and soda; used 
as an antiseptic, and as a soothing 
drug in diseases of the throat, nares, 
etc. Also to promote catamenial dis- 
charge. 

Boric Acid. A mild antiseptic in 
the form of white crystals, used to 
impregnate Unt 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.). 

Breast-bone . A flat, oblong bone 
at the anterior part of the thorax. 
. Breast-pump. An instrument for 
drawing the milk out of the breast. 

Breath. _ The air exhaled from the 
lungs; applied also to the act of in- 
spiration. 

Breathing. {See Respiration) Ab- 
dominal breathing is that in which the 
abdominal walls move decidedly and 
in which the diaphragm is actively 
engaged; thoracic breathing is respi- 
ration in which the thoracic walls are 
actively moved. 

Bregma. A space on top of an 
infant's head where the parietal bones 
join the frontal bones. It is diamond 
shaped. The anterior fontanel. 

Bright '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- 
thehum. 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. 

Bromides. In large doses are val- 
uable hypnotics, in small doses they 
lessen cerebral excitement. They con- 
sist of a combination of bromine with 
potassium, sodium, or ammonium. 
In epilepsy, bromide of potassium is 
found very useful. 

Bromidrosis. Offensive sweating 
most common in the feet. Cork soles 
should be worn, and the stockings 
dusted with boric acid. 

Bronchiae. The bronchial tubes 
or air-tubes between the larynx and 
the lungs. 

Bronchitis. Inflammation of the 
bronchial tubes; it may be either 
chronic or acute. (See p. 274.) 

Bronchocele. Enlargement of the 
thyroid gland; goitre. 

Bruit. The French for "sound" 
and used with regard to the sounds 
heard in auscultation. Bruit de 
braqiiement, crackling; de diable, 
humming; de frottcment, friction; de 
pot file, cracked pot; de rape, rasping; 
de soufflet, bellows sound. 

Bryonia. A drug extracted from 
the roots of bryony. Purgative; 

acts also on the kidneys. 

Bubo. Swelling of the groin with 
suppuration; generally syphilitic, and 
therefore to be approached with care 
by the nurse. Old dressings to 
be burnt at once, and forceps only to 
be used in removing them. 

Buchu. Drug used as a diuretic 
and antacid. 

Burnett's Fluid. A solution of 
chloride of zinc used as a disinfectant. 
Poison. 

Burns. Any severe burn or scald 
is usually followed by collapse, and for 
this the nurse must watch. Conges- 
tion of the internal organs may follow 
if the patient rallies from the first 
shock. In changing the dressings 
only a small piece of the injured sur- 
face must be exposed to the air at 
once, hence the dressing is usually in 
[ strips. Whiting and water, olive oil, 
or immersion in water are the usual 
means of excluding the air. Skin- 
grafting may be performed subse- 
I quently to assist in starting granula- 
tion. The smell of a burn is very 
disagreeable, but can to a certain 
extent be overcome by the use of 
some simple cologne. 



GLOSSARY. 



429 



Buttocks. The nates, or fleshy 
part of the body posterior to the hip- 
joints, formed by the masses of the 
glutei muscles. 



Cacao Butter. A pure white fat 
derived from the fixed oil of the 
chocolate tree. It has a pleasant 
odor and taste, and is used largely in 
making suppositories. 

Cachexia. A condition of de- 
praved nutrition and wasting of the 
body occurring in the course of chronic 
disease. 

Cadaver. A dead body. 

Caffeine. The alkaloid of coflfee; 
a cerebral stimulant and powerful 
diuretic. Sometimes given hypodcr- 
matically for headaches and neuralgia. 

Calabar Bean. A spinal sedative 
and depressant. The alkaloid is 
called "physostigmin" and is used 
as an antiseptic in ophthalmic cases. 
It contracts the pupil. 

Calculus. A concretion found in 
the various reservoirs of the body, 
usually called "stone" or "gravel." 
It is most common in the bladder, 
and the operations for the removal or 
crushing of the stone are lithotomy, 
lithotrity, and litholapaxy (which see). 

Calendar Month . The calendar 
or solar month is the twelfth part of 
the year = to 30 days, 10 hours, 29 
minutes. The lunar month is the 
interval from one new moon to an- 
other = to 29 days, 12 hours, 44 min- 
utes. 

Callous. Hard, insensible, thick- 
ened. 

Callus. The new material formed 
when a fractured bone unites. 

Calomel. Subchloride of mercury. 
An alterative and purgative, used 
specially in bilious cases and in in- 
fantile diarrhea. Sometimes used as 
an ointment in skin diseases. Watch 
for mercurialism. 

Caloric. Heat. 

Camisole. A strait-jacket; an ap- 
paratus used for restraint. 

Camphor. A volatile oil, used 
both internally (sometimes causes 
alarming symptoms) and externally as 
a stimulant. 

Canal. A term applied to any pas- 
sage of the body other than ducts of 
glands, blood-vessels, and air-passages. 

Cancer. A malignant growth, a 



tumor. Carcinoma. The only sure 
cure is by operation, and then there is 
the risk of recurrence of the disease in a 
fresh part. In cancer of the uterus 
the operation is hysterectomy. Can- 
cer takes three forms: Scirrhous, or 
hard cancer, most common in the 
breast; encephaloid, or soft cancer, 
usually internal; epithelial cancer, 
most common in the lip. Soft can- 
cer may be fatal in a few months; 
hard cancer patients may live for 
years. The nurse has often to tend 
cancer patients; the treatment con- 
sists of extreme cleanliness, and such 
methods of relieving pain as the physi- 
cian orders. The smell of cancer is 
often very offensive. 

CancrumOris. Ulceration of the 
mouth in ill-fed children. 

Cannabis Indica. Indian hemp, 
hashish; a soporific. 

Cannula. Surgical name for a 
metal tube, such as that employed in 
the operation of tapping. 

Cantharides. Dried Spanish flies, 
used to produce blisters. 

Caoutchouc. India-rubber. 

Capillaries. The minute blood- 
vessels connecting the veins and ar- 
teries. 

Capsicum. Cayenne pepper; a 
useful stimulant. 

Capsule. A small usually ovoid 
case or shell, made in two parts fitting 
together, and composed of gelatin, 
for administering nauseous medicines. 

Carbolic Acid. A powerful anti- 
septic produced from coal-tar. In 
its pure state it is called "phenol." 
Taken internally in large doses it is a 
poison, and the antidotes are pow- 
dered chalk, milk, and alkaloids. 
Carbolic acid may be absorbed into 
the system when it is used as a dress- 
ing; the nurse generally first discovei 
this by the urine, which, on sta 
turns a very dark green. This 
be reported to the doctor. Carbolic 
lotion is used for the hands at the 
strength of i .-40; for the spray, for 
moistening pads, etc., at the strength 
of I : 20. Nine parts of acid to one 
of glycerin is used as a caustic. Cau- 
tion: Several deaths have occurred 
from nurses leaving carbolic acid 
within the patient's reach. If possi- 
ble keep it under lock and key. 

Carbo Ligni. Charcoal. Given 
for chronic diarrhea and dyspepsia. 



48 

coveji^ « ' 
, must 



430 



APPENDIX. 



Carbonate. Compound of car- 
bonic acid and a base. 

Carbuncle. Severe inflammation 
of a piece of the skin and adjacent 
tissue; a large and painful boil. The 
patient's diet wall need particular 
attention, as carbuncles are a sign 
of weakened constitution; it is possible 
that spray treatment may be tried; or 
it may be opened and the wound 
dressed. 

Carcinoma. Cancer. 

Cardiac. Relating to the heart. 

Cardiograph. An instrument 
which records the beating of the heart. 

Caries. Decay of the bone, and 
subsequent suppuration. The nurse 
has to secure rest of the diseased 
part, absolute cleanliness of the 
wound, and to note the discharge — 
particularly if it contains pieces of 
bone. 

Carminative. A remedy for flat- 
ulence. Dolby's contains opium and 
must be used with caution. 

Carotid. The principal (right and 
left) artery of the neck. 

Carpus. The wrist. 

Carron Oil. Linseed or olive oil 
and lime-water in equal parts; a dress- 
ing used for burns. 

Cartilage. Gristle; a semitrans- 
parent substance of the body, very 
elastic, and softer than bone. 

Caruncle . A small fleshy growth ; 
hence caruncida lachrymalis, the small, 
red globe of the inner corner of the ej'e; 
and carunculcB myrtiformes, the granu- 
lations around the vagina, remnants 
of the ruptured hymen. 

Cascara Sagrada. A mild laxa- 
tive. 

Cascarilla. Drug used as an as- 
tringent. 

Case. A single instance or exam- 
ple of a disease. 

Case -taking. The chief points 
are — (i) History of the previous 
health of the patient, his occupation, 
his habits of life; (2) history of the 
present illness from the very first 
symptoms; (3) history of the pa- 
tient's family, particularly with refer- 
ence to hereditary tendencies; (4) the 
patient's condition at the time of tak- 
ing the case. 

Casein. An albuminate component 
of milk. 

Castile Soap. Soap made from 
olive oil. 



Castor Oil. An aperient medicine 
of unpleasant taste. It is best ad- 
ministered to adults in coffee or in 
brandy and water. Povir some cof- 
fee into a cup and shake the cup so 
that the sides are wet with coffee; 
pour the oil into the centre of the 
coffee; make the patient open the 
lips widely and let the oil pass well 
to the back of the throat. Give a 
drink of pure coffee just before and 
just after the oil. For children, 
powder a dessertspoon with pulver- 
ized sugar, pour in the oil, powder 
its surface with sugar. Give a drink 
of milk just before and just after the 
oil. Usual dose: teaspoonful for a 
child; ^ to I ounce for an adult. 

Casts. A cast is a fibrous or plas- 
tic mass that has taken the form of 
some cavity in which it has been 
moulded. Casts are either intesti- 
nal, nasal, renal, tracheal, etc., ac- 
cording to their source; and epithe- 
lial, fatty, fibrinous, granular, mu- 
cous, etc., according to their constitu- 
tion. (See Blood-casts, Epithelial Casts, 
and Renal Casts.) 

Catalepsy. A disease producing 
periods of trance, during which the 
limbs remain in any position in which 
they are placed. A pinch of snuff to 
the nostrils will sometimes break the 
trance. A nurse for these cases must 
have considerable moral strength. 

Cataplasm. A poultice. 

Cataract. Opacity of the lens of 
the eye, causing blindness if not re- 
moved. The operation is usually iri- 
dectomy. The nurse has to secure 
perfect rest to the patient in a dark- 
ened room. Probably atropin, co- 
cain, or some other drug will have 
to be dropped into the eye at inter- 
vals. 

Catarrh. Inflammation of the 
mucous membrane, generally applied 
to the nose and throat, but also to 
the internal organs at times. Thus 
we hear of "gastric catarrh." An 
ordinary cold in the head is nasal 
catarrh. Inhalations may be neces- 
sary. 

Catechu. An astringent, given 
chiefly in diarrhea and dysenter3\ 

Catgut. The intestines of a sheep 
treated to make ligatures. 

Cathartic. A purging medicine, 
such as senna. 

Catheter. An instrument for with- 



GLOSSARY. 



431 



drawing water from the bladder; 
made either of silver, india-rubber, 
silk-elastic, or whalebone. When 
not in use, the instrument should 
be kept in i : 20 carbolic solution; 
just before and just after using, it 
should be washed through with a 
stream of warm water. The method 
of passing the catheter can only be 
learned by practice. 

Cathode. In electricity, the part 
immediately touching the negative 
pole. 

Caul. The membranes about the 
head and face of an infant at birth. 

Caustic . A substance which burns 
living tissue. The most common 
form is nitrate of silver, pointed like 
a pencil, and held in a metal clip. 
The nurse must be careful to keep 
the caustic covered, and, in using it, 
must only touch the prescribed area. 
Perchloride of iron and sulphate of 
copper are slightly caustic. 

Cauterize. To sear or bum with 
a cautery or a caustic. 

Cautery. The actual cautery is 
the application of heated metal to 
living tissue. Cautery irons are of 
different shapes, and consist of a 
straight piece of iron fixed in a han- 
dle; the tip of the iron is either a 
point, a button, or a bulb. They are 
heated in the fire till red; if then 
lightly touched on a bleeding sur- 
face will arrest hemorrhage. Gal- 
vano-cauiery is burning the tissues 
with a wire made hot by electricity. 
Potential cautery is burning the flesh 
by means of chemicals. Thermo-cau- 
tery is the cauterization of flesh by 
means of heat generated on galvanic 
principles. The gahano-cautery and 
the thermo-cantery are now largely 
replacing the actual cautery. 

Cavity. A hollow, either normal, 
as the abdomen, chest, etc., or abnor- 
mal, as a pulmonary or a dental cavity. 

Cayenne Pepper. {See Capsicum.) 

Cecum. A "bhnd pouch" or cul- 
de-sac, about 2^ inches long, situated 
between the termination of the ileum 
and commencement of the large in- 
testine. The structure and relations 
of the cecum render it pecuUarly lia- 
ble to two forms of disorder — accu- 
mulation of the contents of the ali- 
mentary canal and inflammation. 

Cellular. Relating to or com- 
posed of cells. Cellular tissue is 



the network connecting the ma- 
jority of the minute parts of the 
body. 

Cellulitis. Inflammation of the 
cellular tissue. 

Centigrade. French method of 
marking temperature; the freezing- 
point is 0°, the boiling-point 100°. 
(See Temperature.) 

Centigramme. The one-hun- 
dredth of a gramme, nearly equal to 
0.16 part of a grain avoirdupois. 

Centimetre. Cubic centimetre, 
written cc, and used in foreign pre- 
scriptions, equals 16 minims. 

Cephalalgia. Pain in the head; 
"cephalo" is used to compound many 
terms; thus, cephalometer, an instru- 
ment for measuring the head. 

Cephalhematoma. A bloody tu- 
mor on the head of an infant. 

Cephalo tribe . An instrument con- 
sisting of two blades and a screw, 
used to crush the fetal head. 

Cerate. A greasy substance con- 
sisting of wax mixed with oils, fatty 
substances, or resins, and of such 
consistence that at ordinary tempera- 
tures it can readily be spread upon 
linen or muslin, and yet is so firm 
that it will not melt or run when ap- 
plied to the skin. 

Cerebellum. The little brain at 
the back of the head, between the 
cerebrum and the medulla oblongata. 

Cerebral. Relating to the brain. 

Cerebrum. The big brain, occu- 
pying the cranium. 

Cerumen. Waxy secretion of the 
ear. 

Cervix. The neck. 

Cervix Uteri. The neck of the 
uterus. 

Cesarean Section. An abdominal 
incision for extracting the fetus from 
the uterus. It was first performed 
successfully on a woman in 1498. 

Chafing. Excoriations, abrasions, 
and inflammation produced by fric- 
tion of parts, or between the folds of 
the skin, etc. 

Chalazion. Enlargement of one 
of the glands on the border of the 
eyelids, caused by stoppage of its 
duct. 

Chalybeate. Containing iron. 

Chamomile. Antispasmodic med- 
icine. 

Charcoal. Prescribed as a med- 
icine in dyspepsia, and generally given 



432 



APPENDIX. 



as tabloids. A charcoal poultice is 
made of equal parts of flaxseed meal 
and powdered charcoal. 

Charpie. Unravelled, shredded 
linen, used for dressing wounds. 

Chart. A ruled sheet of paper on 
which the nurse records the tempera- 
ture, pulse, symptoms, etc., of a pa- 
tient. 

ChartaB. Papers on which med- 
icinal substances are spread. Thus, 
ChartoR sinapis, a leaf of mustard- 
paper. 

Chattering'. The noise made by 
the teeth striking together repeatedly 
and rapidly, as under the influence 
of cold or of fright. 

Cheese-cloth. A coarse cotton 
fabric of an open texture; ordinarily 
used in cheese-making for wrapping 
the cheese. 

Chest. (See Thorax) 

Cheyne-Stokes Breathing. Ir- 
regular respiration consisting of ten 
or fifteen short breaths and then a 
long pause. A bad symptom. 

Chicken-pox. Varicella. Rash 
appears on the chest on the first 
day; the disease runs its course in a 
fortnight. Give light food and keep 
from cold; prevent the patient from 
scratching the pimples, or scars will 
be made. Infectious. 

Chilblain. A blain or sore pro- 
duced by cold; an erythematous 
condition of the hands or feet, ac- 
companied with inflammation, pain, 
and sometimes ulceration. 

Childbirth. The act of bringing 
forth a child. 

Chill. A sensation of cold accom- 
panied by shivering, usually appear- 
ing shortly after exposure to cold or 
wet. It is usually the first symptom 
of grave acute disorders, as pneu- 
monia; and is a prominent symptom 
of various forms of malarial fever. 
(See Rigor) 

Chiropodist. One skilled in cut- 
ting and extracting corns. 

Chirurgical. Surgical. 

Chloral. White opaque hypnotic. 
Antidote for overdose, fresh air, am- 
monia, strychnin, artificial respiration. 

Chlorine. Antiseptic. Used as a 
lotion for sores; also as a gargle, in- 
halation, etc. 

Chloroform. A colorless liquid 
used to produce anesthesia by in- 
halation. Chloroform must always 



be kept in the dark. The private 
nurse has sometimes to administer 
chloroform; a simple inhaler is made 
of a small wire mask over which a 
piece of flannel is stretched, or a few 
drops of chloroform can be sprinkled 
on a towel and held close to the pa- 
tient's face. Chloroform is only safe 
when mixed with air; so at intervals 
the towel must be removed and the 
patient allowed a breath of air. Un- 
consciousness is reached when all the 
muscles are relaxed, and the patient's 
hand drops v/hen raised. The eye- 
ball should never be touched, as it 
may cause inflammation. Many 
cases have been known through this 
practice of the etherizer. Antidote 
for an overdose: Fresh air and arti- 
ficial respiration. If the nurse is ad- 
ministering the chlor<^rm, she must 
be very careful to watch the respira- 
tion of the patient. Before the anes- 
thetic is administered, false teeth and 
tight clothing must be removed. No 
solid meal must be given for six hours 
before the operation, but a little beef- 
tea may be given two hours J^efore. 
After the operation the nurse must 
be prepared for the vomiting which 
is usual. 

Chlorosis. A peculiar form of 
anemia common in females about the 
period of puberty. It causes weak- 
ness, rapid heart-action on exertion, 
and faintness, for all of which a nurse 
must be prepared. It is generally 
met by iron tonics, sea-air, and 
strengthening diet. 

Cholagogues. Agents that stim- 
ulate the secretion of bile. 

Cholera. An epidemic disease. 
Symptoms: Cramp, vomiting, and 
rice-water evacuations. "English'' 

cholera is the mild form; "Asiatic'' 
is the severe form. Much depends 
upon the nursing; the patient must 
be kept warm and recumbent, medi- 
cines for the alleviation of pain must 
be given promptly. The great dan- 
ger is from collapse. The patient 
should, if possible, be placed in a 
separate room. Only the persons in 
attendance should enter the room. 
If the apartment should not allow of 
sufficient isolation, the patient should 
be removed to a hospital. Those who 
are in continued attendance upon 
choleraic patients, or who live with 
them, should obey the following 



GLOSSARY. 



433 



rules: Neither food nor drink should 
be taken in a room occupied by a 
patient. The mouth should be care- 
fully rinsed before each meal, and the 
hands and forearms washed with a 
solution of borax. The face, head 
and hands, and, if possible, the whole 
bodj' should be washed daily with 
water containing 160 grains of borax. 
The disease runs its course swiftly, 
and has been fatal in India in a few 
hours. 

Cholera Infantum. Summer di- 
arrhea of infants; it requires immediate 
attention, or prostration soon comes 
en. Diet is of the utmost impvortance. 

Cholera Morbus. .\n acute ca- 
tarrhal inflammation of the mucous 
membrane of the stomach and intes- 
tines, with enteric pain, purging, 
vomiting, spasmodic contractions of 
the muscles, etc. It is a summer 
disease. 

Chorea. St. Vitus' dance: invol- 
untary' twitchings of the muscles; 
most common in children. These cases 
must not be left alone, and everj" 
effort must be made to prevent chil- 
dren from hurting themselves. Diet 
nourishing. Baths and gj^mnastic 
exercises^ may be ordered. 

Chorion. The vascular and outer 
envelope of the fetus. 

Chronic . A term applied to a dis- 
ease that is protracted. 

Chyle. The milk-like fluid into 
which food is transformed before it 
is absorbed into the blood. 

Chyluria. Milk-like urine. 

Chyme. The pulpy mass of food 
which passes from the stomach into 
the intestines. 

Cicatrix. The scar of a healed 
wound or ulcer. 

Cilia. Eyelashes. 

Cinchona. Peru\-ian bark, which 
>nelds quinine. A tonic, and a valu- 
able medicine in malarial fevers. 

Cinnamon. Sometimes given as 
an astringent. 

Circulation. The movements of 
the blood from the heart, through the 
arteries, veins, and capillaries back to 
the heart. 

Circumcision. The removal of 
a circular piece of the prepuce; gen- 
erally performed on yoimg children. 
The child has to be kept ver>' quiet 
for some days, and ver\' clean. 

Cirrhosis. Contracted granular 

28 



state of an organ, usually appHed 
to the liver or the lung. A cir- 
rhotic liver is generally produced by 
drink. 

Cirsoid. Resembling a varix. 
Citrate. Comix>und of citric acid 
and a base. 

Citric acid. Acid prepared from 
lemon-juice. Makes an astringent 
j-et soothing lotion. 

Clavicle. The collar-bone, going 
from each shoulder to the breast- 
bone across the front of the chest. 
Fractured claNacle is set by a firm 
pad, 4 or 5 inches square, placed in 
the axilla, the forearm is bandaged 
over the chest, and the point of the 

: elbow kept well back. Xo anesthetic 
needed as a rule. 

Clavus. A corn: a thickening of 
the skin, common on the toes. 

j Cleft Palate. A congenital split 

I in the roof of the mouth, so that the 

' nose and mouth form one cavity. 
The child must be sat upright when 
fed, and a long teat employed, and 
the milk poured slowlj- to the back 

: of the throat. It cannot suck, as it 

I cannot create a vacuum, and the 

' milk is liable to return down the 
nose. Operation usually takes place 

, about two or three years of age. 

Climacteric. The cessation of 
menstruation in females; often a 
critical period, when the health needs 

I great attention. 

' Clinic. Bedside instruction. 

Clinical Thermometer. A slen- 
der glass instrument used to discover 
the temperature of the body. (See 
Temperature). 

Clitoris. A small organ of erectile 

^ tissue, found in the female in front 
of the pubes. The seat of sexual ex- 

i citement. 

Clonic. Spasmodic contractions, 
short and frequent. 

Clot of Blood. A thickened mass 
of blood. See Emholism.) 

Cloves. The dried flower-buds of 
the clover tree. Cloves are largely 
used as a spice, and in medicine for 
their stimulant and aromatic proper- 
ties. 

Club-foot. Talipes. A congenital 
turning of the foot in a wrong direc- 
tion. GeneraUj' necessitates the wear- 
ing by the child of a light splint, which 
may effect a cure. Massage is useful 

. in the case of infants. 



434 



APPENDIX. 



Clyster. An enema, or injection 
per anus. 

Coagulation. Thickening of a 
fluid into curds. 

Cocaine . A powerful local anes- 
thetic, much used by oculists and 
dentists. It enlarges the pupil of the 
eye. Useful to stay the craving for 
opium or drink. The hypodermatic 
injection of cocaine produces severe 
symptoms in some people, and anti- 
dotes (amyl nitrite and morphin) 
should always be at hand. 

Cocainism. Chronic poisoning 
from indulgence in the drug. 

Coccyx. The tail-like termination 
of the spine. 

Cochlea. The cavity of the inter- 
nal ear. 

Codeine. A preparation of opium, 
used to soothe the nerves and in- 
duce sleep. It allays cough, and is 
useful in diabetes, etc. 

Cod-liver Oil. A medicine used 
as a restorative and nutritive, particu- 
larly in consumption cases. It ought 
to cause the patient to increase in 
weight. It should be given alter 
food, plain, if the patient will take it; 
if not, floated in milk, coffee, or orange- 
juice. 

Colchiciun. A drug used in 
gout; it reduces the blood-pressure 
and lessens muscular irritability. 
Poison. 

Colic. Severe pain in the belly; 
generally allayed by hot fomenta- 
tions. 

Colitis. Inflammation of the colon. 
Poultices, opium injections, or mor- 
phia suppositories. In membranous 
colitis or enteritis casts are passed 
from the bowel. 

Collapse. Severe sudden orostra- 
tion. Symptoms: Pallor, faintness of 
pulse, unconsciousness. Treatment: 
Lay patient perfectly flat, keep warm, 
give sal volatile or alcohol in small 
doses, watch the pulse. Hypoder- 
matic injection of brandy may be 
necessary in severe cases, or even 
artificial respiration, if the breathing 
actually stops. 

Collar Bone. (See Clavicle) 

Collodion. Gun-cotton dissolved 
in alcohol and used in surgery to form 
a false skin. When painted over a 
commencing bed-sore, for instance, it 
hardens as it dries, and forms a 
slight protection to the tender skin. 



The stopper must never be kept out 
of the collodion bottle for more than 
a moment. 

Colocynth. A drug used as a 
rapid and drastic purge. 

Colon. The part of the large in- 
testine between the rectum and the 
cecum. 

Colostrum. A watery fluid flow- 
ing from the breasts the first two or 
three days after confinement, before 
the true milk comes. 

Colotomy. Incision of the colon; 
a serious operation which may be 
performed in the limibar or inguinal 
regions, in cases of fistula, obstruc- 
tion, cancer, or ulceration of the 
rectum. 

Coma. Insensibility, stupor, sleep. 

Comatose. In a state of coma. 

Comedones. Sebaceous secretions 
of the hair-follicles, commonly called 
"black-heads," and most frequent on 
the face. 

Complication. The occurrence 
during the course of a disease of 
some other affection, or of some 
modifying symptom or group of 
symptoms not ordinarily observed. 

Compress. A tightly folded pad 
of linen used to secure local pressure. 

Conception. The impregnation 
of the ovum. 

Concretions. Bony deposits; cal- 
culi. 

Concussion of the Brain. Sud- 
den interruption of the functions of 
the brain, and consequent uncon- 
sciousness, through a blow or fall. 
Rest and quiet are necessary, and 
the application of cold to the head 
and warmth to the extremities. In 
mild cases consciousness returns in 
from a few minutes to a few hours. 
Inflammation of the brain may fol- 
low if proper quiet is not obtained. 

Condyle. A round projection at 
the ends of some bones. 

Condy's Fluid. A valuable anti- 
septic, prepared from permanganate 
of potash. Often used by the monthly 
nurse when syringing is ordered for 
her patient. 

Confections. Soft pastes contain- 
ing drugs. 

Confinement. The condition of 
women during childbirth. 

Confluent. A term applied to 
eruptions in which the pustules run 
together. 



GLOSSARY. 



435 



Congenital. Existing at birth. 
Congenital diseases or deformities are 
those present at birth. 

Congestion. Torpid stagnation 
of blood in a part of the body, as in 
the lungs or brain. Congestion of the 
lungs is brought on by chill, and the 
nursing treatment is warmth, rest, 
flaxseed-meal poultice to the affected 
part, and light diet. The temperature 
must be taken twice in the twenty- I 
four hours, as inflammation often j 
follows as the result of the conges- j 
tion. Congestion of the brain is a ' 
term sometimes appHed to brain 
fever, apoplectic strokes, or any form 
of delirium; quiet, darkness, and 
careful attention to the doctor's 
orders are necessar>'. 

Conium. Hemlock, a poisonous 
drug which quiets muscular action, 
also the central nervous system. 
Used specially in cases of mania, or 
ovarian pain. Antidotes: Stomach- 
pump, stimulants, tannin. 

Conjunctiva. The mucous mem- 
brane of the eye. 

Conjunctivitis. Inflammation of 
the membrane of the eye, ophthal- 
mia (which see). 

Constipation. A confined state 
of the bowels; the nurse must always 
report to the doctor when no action 
of the bowels takes place in twenty- 
four hours. The remedies are usu- 
ally either an enema or a laxative 
medicine. 

Consumption. The popular term 
for tuberculosis of the lungs. (See 
Phthisis.) 

Contagious. Spreading by touch; 
an infectious disease readily trans- 
missible from the sick to the well. 

Continued Fever. A simple feb- 
rile attack, such as typhoid fever, which 
runs its course uninterrupted by any 
attempt at treatment. The patient 
must be kept recumbent, cool, and 
fed on light diet. Note tempera- 
ture. 

Contraction. The act of drawing 
together or shrinking. 

Contra-indication. An indica- 
tion against a remedy or method of 
treatment. 

Contusion. A bruise. 

Convalescence. The period of 
returning strength after an illness. 
The nurse needs to amuse her pa- 
tient, prevent rash deeds, or fatigue 



arising from too many visitors; sup- 
ply light nutritive food at frequent 
intervals; avoid all talk about the 
past illness, and watch for a relapse. 

Convolutions. The folds and 
twists of the brain or the intestines. 

Convulsions. Violent spasms of 
alternate muscular contraction and 
relaxation, common in infants, and 
usually the result of too strong diet 
or of costiveness. Clonic convulsion 
is applied to spasmodic movements 
of short duration and alternate periods 
of relaxation, as in epilepsy. Tonic 
convulsion signifies a constant rigid- 
ity. Uremic is due to the altered 
state of the blood in diseases of the 
kidney. Convulsions occur in epi- 
lepsy, tetanus, hydrophobia, and 
chorea. (See Eclampsia.) 

Copaiba. A diuretic; the oleo- 
resin is also given in capsules for 
ascarides, etc. 

Cord. The connection between 
mother and child at birth; after 
washing the infant, the remnant of 
the cord should be dressed with pow- 
dered starch, and a square of anti- 
septic gauze. 

Core. The central slough or sub- 
stance of a boil or carbuncle, formed 
of dead tissue. 

Coriaceous. Of rough texture, 
coarse. 

Coriuna. The internal layer of the 
skin. 

Cornea. The clear, glass-like front 
of the eyeball. 

Corn Starch. A flour made from 
the starchy parts of Indian corn, 
used for puddings, etc. 

Coronal Suture. The joint of 
the parietal and frontal bones of the 
skull. 

Corpuscle . A minute protoplasmic 
body — for instance, the red and white 
corpuscles of the blood. 

Corrective. A drug which modi- 
fies the action of another drug. 

Corrosive. Eating into, consum- 
ing. 

Corrosive Sublimate. Bichloride 
of mercury'. Antiseptic; poisonous. 
The solution i : looo is ver>' useful 
in infectious fevers; it is seldom used 
for instruments, as it corrodes steel. 
Antidotes: Flour, milk, white of egg. 

Coryza. Cold in the head, nasal 
catarrh. 

Costal. Relating to the ribs. 



436 



APPENDIX. 



Costive. Constipation. 

Cotton. The white fibre obtained 
from the cotton plant {Gossypium). 
Absorbent cotton is the fibre prepared 
by removal of oily matters for use in 
surgical operations, etc. (See Collo- 
dion. Antiseptic cotton.) - 

Cotton-wool. {See Cotton.) 

Cough. \^iolent, sonorous expira- 
tion after closure of the glottis. 
Hacking cough is a short, broken, dry 
cough. 

Counter-extension. Extension 
by means of holding back the upper 
part of a limb while the lower is 
pulled down. 

Counter-irritants. The drugs 
used to produce counter-irritation (q. 
s.), called rubefacients, epispastics, vesi- 
cants or blistering agents, and pustu- 
lants. 

Counter-irritation. Causing ir- 
ritation of one part of the body to re- 
lieve another; also called "deriva- 
tion" and "revulsion."' 

Coxalgia. Pain in and disease of 
the hip-joint. (See Hip-joint.) 

Coxitis. Inflammation of the hip- 
joint. 

Cradle. A series of small wooden 
arches used to keep the bedclothes 
from pressing on the injured part of 
the body. 

Cramp. Sudden and violent con- 
traction of the muscles, causing great 
pain. Friction may give relief. 

Craniotomy. The operation of 
perforating the head of the fetus dur- 
ing parturition, crushing it, and re- 
moving the fragments. 

Cranium. The skull. 

Cravat. A bandage of triangular 
shape, used as a temporary dressing 
for a wound or a fracture. (See 
Bandage.) 

Creolin. A drug nearly related to 
carbolic acid; antiseptic and disin- 
fectant. 

Creosote. An oily antiseptic 

liquid got from wood-tar. Used as 
an inhalation in phthisis, and as a 
remedy for toothache; also as a stjTptic, 
an antispasmodic, and an alterative. 
Gives the urine a blackish color. 

Crepitation. The grating sound 
of two ends of a fractured bone rub- 
bing together. Also a grating sound 
heard on auscultation in cases of 



pneumonia. 

Cretinism. 



Imperfect mental. 



physical, and physiologic faculties, 
accompanied by goiter. Most com- 
mon in Switzerland. 

Crisis. The deciding point of a 
disease, from which the patient either 
begins to recover or sinks rapidh'; 
often marked by a long sleep, sudden 
drop of the temperature, profuse per- 
spiration, or other phenomena. 

Crotchet. A hooked instrument 
used to extract remnants of the fetus 
after embryotomy. 

Croton Oil. Used as a liniment 
and as a swift purge; causes red 
eruption on the skin. Poison. 

Croup . Acute inflammation of the 
laPr'nx and trachea, most common in 
young children. A nurse should 
know the breathlessness, restlessness, 
and crowing sound which are pre- 
monitory symptoms of croup; for a 
child may suffocate if attention is not 
immediate. 

Crural. Relating to the thigh. 

Cumulative. Increasing; adding 
to. Cumulative action, the produc- 
tion of a noteworthy and sudden re- 
sult, after the administration of a 
considerable number of compara- 
tively ineffective doses. The possible 
cumulative effect of certain drugs is 
one of the sources of danger that at- 
tend their administration. 

Cupping. Blood derivation by ap- 
plying cupping glasses to the surface 
of the body. Put a few drops of 
spirit of wine in the glass and swirl it 
rovmd till the inside is moist to the 
brim. A plug of cotton-wool on a 
stick should then be dipped in the 
spirit, lighted, and passed quickly 
round the glass; this will produce a 
large momentary flame, and the glass 
must be immediately pressed on the 
desired place. The flame will have 
created a vacuum in the glass, which 
will cause an immediate rising of the 
skin. So far it is dry cupping; if it is 
ivet cupping that is ordered, small 
' incisions maj' be made in the skin by 
means of a special instrument or with 
> a lancet before the cup is applied; or, 
j having been appUed, the glasses are 
I removed, numerous small incisions are 
made in the risen skin, and the glass is 
replaced (after having been exhausted 
again), and a steady flow of blood 
I will soon fill the glass. The wound 
can be dressed with some simple 
j ointment on a piece of lint. 



GLOSSARY. 



437 



Cupri Sulphas. Sulphate of cop- 
per. An astringent and emetic. Poi- 
son. 

Curette. A spoon-shaped instru- 
ment used in operations. 

Cutaneous. Pertaining to the skin. 

Cuticle. The external or scarf 
skin. 

Cutis. The derma, or true skin. 

Cyanosis. Blue disease, a con- 
gestion of the venous system so that 
the blue blood of the veins discolors 
the skin. 

Cyst. A tumor containing fluid 
or semifluid in a membranous sac. 

Cystalgia. Pain in the bladder. 

Cystitis. Inflammation or catarrh 
of the bladder; often chronic. The 
nurse will have to measure and test 
urine, and probably give douches. If 
obstinate, perineal incision in the 
male, or colpocystotomy in the female, 
may have to be performed. 

Cystocele. Protrusion of the 
bladder. 

Cystoscope. An instrument for 
examining the bladder; sometimes 
lighted by electricity. 

Cystotome . A surgical instrimient 
used in operations on the lens of the 
eye and on the bladder. 

Cystotomy. Incision of the blad- 
der; for the removal of stones or for 
drainage. The nurse must watch in 
case peritonitis supervenes. 



Dead. The laying out of the dead 
is the nurse's duty; the eyes must be 
closed by gentle pressure of the 
fingers, the jaw must be tied up by 
a bandage passing under the chin 
and tied on the top of the head. The 
body must be washed all over one 
hour after death, orifices packed with 
cotton-wool, and clean garments put 
on (see p. 298). 

Debilitants. Remedies which 

weaken. 

Debility. Weakness, loss of 

power. 

Decidud. A spongy membrane 
produced in the womb by concep- 
tion, and thrown off after parturition. 

Decoction. The extract obtained 
from any substance by boiUng. 

Decomposition. Putrefaction. 

Decussation. \n X-like crossing, 
especially of nerves or of nerve-like 
filaments. 



Defecation. The act of evacuating 

the bowels. 

Deformity. .\bnormal shape or 
structure of a body or any of its 
i parts. 

Degeneration. Abnormal changes 
in the tissues. Amyloid degeneration 
I is that of the tissues of blood-vessels, 
j spleen, liver, etc., which became wax- 
like. Fatty degeneration is when the 
^ tissue becomes converted into fat, and 

thus incapable of work. 
I Deglutition. Act of swallowing.* 
j Dejections. The fecal or other 
j excrementitious matters discharged 
by the body. 

Delirium. Extravagant talking, 
raving, generally due to high fever. 
The nurse must watch the patient 
carefully, as he is as irresponsible for 
his deeds as for his words, and may 
escape from bed, or even commit sui- 
cide. Too often a patient has com- 
mitted suicide "in the absence of the 
j nurse." The nurse should never be 
i absent, at least without leaving some 
j one in charge. 

I Delirium Tremens. Mania-a- 
\ potii. The trembling delirium due to 
excessive use of alcoholic liquors. 
The patient must be humored and 
soothed in every way, and watched 
incessantly. Collapse must be ap- 
prehended. 

Delivery. Parturition; childbirth. 
Post-mortem deliver^' is the birth of a 
fetus after the death of the mother. 

Deltoid. The muscle which forms 
the prominence of the shoulder. 
Delusion. A false belief. 
Demarcation. A Une of separa- 
tion, as between healthy and gan- 
grenous tissue. 

Dementia. A state of profound 
mental incapacity. 

Demulcents. x\gents which pro- 
tect and soothe mucous membranes. 
Dengue . Breakbone fever or dandy 
fever; a disease of southern and trop- 
ical climates marked by high fever, 
agonizing pains, and an eruption 
which may appear in spots or be 
spread over the bodj'. There is usu- 
ally swelling of the joints and the 
lymph glands. The mucous mem- 
branes become congested and may 
bleed. The treatment consists in 
easing the pains by cold sponging or 
the ice-bag; hypodermic use of mor- 
phin may be necessarj\ Careful at- 



438 



APPENDIX. 



tention should be given to the joints, 
and during convalescence massage 
should be applied. 

Dentaphone. A Httle hollow in- 
strument placed on the teeth to assist 
hearing. 

Dentine. The tissue which forms 
the body of a tooth. 

Dentition. Teething; infants have 
20 teeth: 8 incisors in front, 4 canine 
between, and 8 molars at the back. 
The incisors are cut first, in the 
seventh month as a rule; at two 
years all the teeth should be present. 
During teething the gums become 
swollen; the child must be kept from 
catching cold; diarrhea, convulsions, 
and rashes must be watched for; the 
temperature should be taken every 
evening. (See also Teeth) 

Deodorant. A substance that will 
remove or correct offensive odors, as 
chlorine, chloride of Ume, quicklime, 
etc. 

Deodorizer. Destroyer of smells; 
the chief deodorants are chloride of 
lime, sulphurous acid, nitrous acid, 
and iodoform. They are all more 
or less disinfectants. 

Depilatory. An agent for remov- 
ing superfluous hairs from the body. 

Depletion. Act of emptying; 
bleeding; purging. 

Depressant. A medicine which 
depresses the physiologic action of an 
organ, such as the heart (^cardiac de- 
pressant), etc. 

Depression. A low or depressed 
physical or mental condition. In 
surgery, displacement inward of the 
skull, often giving rise to pressure 
on the brain. 

Dermatitis. Inflammation of the 
skin. 

Desquamation . Peeling off of the 
skin. After scarlet fever the period 
of desquamation is the most infec- 
tious, and care must be taken that the 
cast skin is not allowed to blow about. 

Desudation. Excessive sweating. 

Detergents. Fluids used for 

cleansing wounds and ulcers. 

Determination. Excessive flow 
of blood to a part. 

Detritus. The waste of tissue, 
worn away by disorganization. 

Development. Growth; progres- 
sive variation toward mature or per- 
fected condition. 

Diabetes. A disease marked by 



an excessive flow of saccharine urine. 
The treatmAit almost entirely consists 
of attention to diet: sweets, pudding, 
pastry, potatoes, and bread have to 
be avoided; meat, fish, eggs, butter, 
cheese, and green vegetables are 
allowed. The nurse will have to 
measure and test urine; the quantity 
may be as much as 4 or 5 quarts in 24 
hours; the specific gravity may be 
as high as 1040; the urine in diabetes 
turns Fehling's solution yellowish 
brown. Diabetes insipidus, character- 
ized by a greatly increased flow of 
urine of a low specific gravity, asso- 
ciated with a marked degree of thirst. 
The urine is pale, almost colorless, 
and with a specific gravity but slightly 
above that of water. ^Nlany of the 
cases progressively emaciate and 
finally die of exhaustion. Diabetes 
niellitus (see Glycosuria). 

Diagnosis. The decision as to the 
exact nature of an illness, arrived at 
by studying the symptoms. 

Diaphoresis. Perspiration. 

Diaphoretics. Agents which in- 
crease perspiration. 

Diaphragm. The muscle separat- 
ing the chest from the abdomen. 

Diaphysis. The middle part of 
long bones. 

> Diarrhea. Frequent loose evacua- 
tions of the bowels. Very weakening. 
Diarrhea should immediately be re- 
ported to the doctor, and the evac- 
uations kept for inspection. It is 
especially dangerous in children, 
being liable to become chronic. 
Whenever diarrhea is present it is 
necessary to give great attention to 
the diet; see that it is fight, easily 
digestible, and suitable to the age and 
illness of the patient. Milk and lime- 
water and barley-water are alone 
allowed in serious cases. 

Diastase . A ferment which changes 
starch into dextrose. 

Diastole. *rhe dilatation of the 
heart and arteries; opposite to systole. 

Diathesis. Constitutional disposi- 
tion to certain diseases. 

Dicrotic. An apparent double 
beat of the pulse. 

Diet. System of food. As a rule, 
full diet consists of an ample allow- 
ance of meat, bread, vegetables, pud- 
dings, etc.; middle diet, of mutton, fish, 
bread, milk puddings, and eggs in 
moderate quantities; fever, or "Ught'' 



GLOSSARY. 



439 



diet, of beef-tea, chicken-broth, and 
milk; no soHds. 

Digestion. The process of con- 
verting the food eaten into chyme 
and chyle, so that it can be absorbed 
into the blood. 

Digestive. Relating to or favor- 
ing digestion. The digestive or gas- 
tric juices are the normal secretions 
of the glands of the stomach. 

Digital. Pertaining to the fingers. 

Digitalis. A drug extracted from 
the foxglove, and used to stimulate 
the action of the heart. It causes 
decrease of pulse-rate, and increase of 
urine. Poison. Marked intermittence 
of pulse to be immediately reported. 

Dilatation. Increase in size, en- 
largement. 

Diluents. Medicines that dilute 
the secretion of an organ or increase 
the fluidity of the secretions. 

Diphtheria. Infectious inflamma- 
tion of the throat, with formation of 
false membrane, which tends to close 
up the throat and cause suffocation. 
The earlier symptoms of diphtheria 
are like those of a heavy cold; the 
temperature does not run very high. 
Grayish-white patches appear on the 
tonsils and on the interior of the 
throat; this is the jalse membrane. 
The patient should be isolated, and 
thorough disinfection of everything 
used about the patient carried out. 
The nurse must be careful never to 
inhale the patient's breath. In severe 
cases, where suffocation is imminent, 
tracheotomy or intubation may be 
performed. Death may be due to 
blood-poisoning, sudden heart fail- 
ure (permit no exertion on the part 
of the patient), or secondary pneu- 
monia, as well as to suffocation. 

Diplopia. Seeing double. 

Dipsomania. An irresistible ma- 
nia for drink. The nurse attendant in 
these cases has a hard time; the gen- 
eral health of the patient must be at- 
tended to, he must never be allowed 
to get hungry or thirsty. Strong coffee 
and salt beef-tea should be given fre- 
quently. 

Director. A grooved surgical in- 
strument used to guide another in- 
strument. 

Disarticulation. Amputation at 
a joint. 

^ Discharge. Flowing out; emis- 
sion of matter evacuated. 



Disinfectants. Agents which de- 
stroy disease germs: such as heat, 
carbolic acid, sulphur, chlorine, etc. 

Disinfection. (See Fumigation.) 

Dislocation. Displacement of a 
bone out of its socket. An anesthetic 
is not usually necessary for the opera- 
tion of reducing a dislocation; all that 
will be needed will be two or three 
bandages, two or three long towels, 
and some powdered starch. After- 
ward the patient must be kept quiet. 
Compound dislocation, rupture of the 
coverings of a joint and communi- 
cating with the air. Simple disloca- 
tion, without laceration of surround- 
ing parts. 

Disorder. A slight form of dis- 
ease. Functional disorder is an un- 
explainable disorder in the working 
of an organ. 

Dispensing. The mixing and pre- 
paring of drugs sometimes falls to 
the lot of a nurse; it needs special 
training. 

Dissection. The cutting up of 
dead bodies for the purpose of study. 

Dissolution. A term for death. 

Distal Aspect. Aspect away from 
the centre of the body. 

Distention. The state of being 
stretched or dilated; inflation. 

Distortion. A deformity or mal- 
formation, acquired or congenital. 
Also, a writhing or twisting motion, 
as of the face. 

Diuresis. Increased flow of urine. 

Diuretics. Medicines which cause 
an increased flow of the urine. 

Dizziness. (See Vertigo.) 

Donovan's Solution. Contains 
mercur>' and arsenic. Give after 
meals. 

Dorsal . Relating to the back. 

Dorsum. The back. 

Dose. The quantity of a medicine 
which when taken will produce thera- 
peutic effect. 

Douche . A stream of water direc- 
ted against a part. Hot douche 112° F., 
cold douche 50° F. 

Dover's Powder. A favorite sed- 
ative medicine of which thi chief in- 
gredients are ipecacuanha and opium. 
It increases perspiration. 

Drachm. Weight of 60 grains, or 
in fluid measure 60 minims (about 
one teaspoonful). 

Drainage-tubes. India-rubber 
tubes of different sizes for inserting 



440 



APPENDIX, 



in suppurating wounds and sores. 
When not in use, they should be kept 
in I : 40 carboUc solution in glass jars. 
When used they are snipped up and 
down each side, and a safety-pin or 
some long threads of silk are put at 
the mouth, to keep the tube from 
slipping out of sight into the wound. 

Drastic. Strong, severe. 

Dressing. The cleansing and ap- 
plj^ing of healing remedies to a wound. 
A nurse must alwaj^s have ready the 
applications for a dressing before the 
appearance of the surgeon or student 
who is going to perform it. Surgical 
dressings are those applied in opera- 
tions (see p. 193). 

Dropsy. An unnatural effusion of 
watery fluid into the tissues or cavi- 
ties of the body. Dropsy has been 
said to be a symptom, not a disease, 
and it frequently sets in toward the 
end in cases of cancer, heart disease, 
etc. Dropsical patients need the 
greatest care in moving them. The 
operation most likely to be performed 
is aspiration. 

Drown. To deprive of life by im- 
mersion in a fluid. 

Drug. Any chemical substance 
(simple or compound) used in the 
treatment of disease. 

Dry Heat. Heat without moisture. 

Duct. A canal or tube; usually a 
passage through which the secretion 
of a gland empties. The biliary ducts 
are the hepatic, cystic, and com- 
munis choledochus ducts of the liver 
and gall-bladder. Lactiferous ducts 
are the canals of the mammary glands. 

Duodenum. The first part of the 
small intestine, beginning at the 
stomach. 

Dura Mater. A strong membrane 
lining the interior of the cranium and 
spinal column. 

Dysentery. Inflammation of the 
intestine, accompanied by bloody 
evacuations. Absolute rest, attention 
to diet, and regular administering of 
remedies. Chills must be avoided. 
Enemas are frequently ordered. The 
movements of the bowels must be 
counted and kept for inspection. The 
patient is liable to suffer from weak- 
ness and depression. 

Dysmenorrhea. Painful or diffi- 
cult menstruation. It may be de- 
pendent on anemia, and disappear 
with th^ cure of the latter; or it 



may be due to causes which require 
surgical interference. If only occa- 
sional, hot fomentations to the abdo- 
men, hot drinks, and a hot bottle to 
the feet and back may give relief. 

Dyspepsia. Indigestion: careful 
attention to diet. Note the condition 
of the tongue and the evacuations. 
Be prepared for irritability and mel- 
ancholy on the part of the patient. 

Dysphagia. Difiiculty in swallow- 
ing. 

Dysphasia. Difficulty in speaking. 

Dysphrasia. Loss of power to 
speak the words wanted. 

Dyspnea. Difficult breathing. 

Dystocia. A difficult labor. 

Dysuria. Difficult discharge of the 



E. 

Eau. Water; eau-de-vie is ardent 
spirit. 

Ecchondroma. A tumor consist- 
ing of cartilage. 

Ecchymosis. A bruise; an effu- 
sion of blood under the skin. 

Eclampsia. Serious puerperal 
convulsions, with clonic and tonic 
spasms. 

Ecraseur. An instrument for re- 
moving piles, malignant growths, etc. 

Eczema. An eruption on the skin; 
not contagious, but very unpleasant, 
and causing great irritation. The 
local remedies are often left to the 
nurse to apply; washing is to be 
avoided as a rule, and no soap used. . 
To remove crusts, soak with oil or 
apply poultices; some dusting-powder 
will probably be ordered. For the 
face, ointment, as a rule, is applied 
on a mask of lint. Children's hands 
must be gloved or tied to their sides 
to prevent scratching. A chill will 
increase the disease in children. 

Edema. Swelling of a dropsical 
nature; when the finger is pressed on 
the part affected the flesh pits and 
does not regain its color and form for 
some seconds. In case-taking any 
edema should be noted. 

Effervescent. A fizzing medicine. 

Effleurage . A massage movement, 
light and gentle, between stroking 
and friction, done with the finger- 
tips. 

Effusion. A flow of fluid into tis- 
sues. 

Elaterium. A drastic purge some- 



GLOSSARY. 



441 



times given in dropsy. May cause 
nausea. 

Elbow- joint. The articulation of 
the arm and forearm. 

Electricity. A natural force gen- 
erated by chemical action, friction, or 
magnetism. 

Electrode. An instrument at- 
tached to the wires of a battery and 
used to conduct or introduce electricity 
into the body. 

Electuary. A concoction of pow- 
ders and syrup, making a sweet me- 
dicinal draught. 

Elephantiasis. A skin disease, 
causing terrible enlargement of the 
limb or limbs affected. It is chronic; 
the skin thickens until it somewhat 
resembles an elephant's hide. 

Elevator. A muscle which raises 
a limb. 

Elixir. A term sometimes applied 
to certain medicinal spirituous prepa- 
rations having a sweet taste. 

Emaciation. General thinness of 
the body. Wasting. 

Embolism. The obstruction of a 
blood-vessel by an embolus (usually a 
blood-clot) brought from another part 
of the body. 

Embrocation. A lotion for rub- 
bing on the body. 

Embryo. Term for the fetus be- 
fore it has quickened. 

Emergency. A sudden, pressing, 
and unforeseen occasion for action. 
An accident or condition unlocked 
for and calling for prompt decision. 

Emesis. Vomiting. 

Emetic. Any means used to pro- 
duce vomiting. Tickling the throat 
with a feather; large draughts of 
tepid water, salt water, or mustard 
and water will produce the desired 
effect. 

Emmenagogue. A medicine which 
promotes the menstrual flow. 

Emollients. Softening and sooth- 
ing applications or liniments. 

Emphysema. SweUing produced 
by an abnormal collection of air in 
a part. 

Empiricism. Treatment founded 
on experience only, not on learning. 

Emplastriun. A plaster. 

Emprosthotonos. Spasms caus- 
ing the body to bend forward. 

Empyema. A collection of pus in 
one or both of the cavities of the 
pleura. 



Emulsion. A mixture of oil, such 
as cod-liver oil, with water, by aid of 
gum, etc. 

Enamel. The hard outer coating 
of the tooth. 

Encephalocele . Protrusion of the 
brain through the skull. 

Encephalon. The brain. 

Encysted. Tumors contained in 
a sac or cyst. 

Endarteritis. Inflammation of 
the lining membrane of the arteries. 

Endemic. A disease prevalent in 
a particular locality. 

Endocarditis. Inflammation of 
the lining membrane of the heart. 
Often occurs after rheumatism or 
renal disease. 

. Endocardium. The lining mem- 
brane of the heart. 

Endometrium. The Hning mem- 
brane of the uterus. 

Endothelium. The lining mem- 
brane of blood-vessels, lymphatics, 
and serous cavities. 

Enema. A rectal injection for 
medicinal or nutritive purposes. Plu- 
ral, Encmata (see pp. 63-68). 

Enterectomy. Excision of part of 
the intestine; a serious operation. 

Enteric Fever. (See Typhoid 
Fever.) 

Enteritis. Inflammation of the 
small intestine. A disease accom- 
panied by much pain and needing 
careful nursing. No solid food is 
permitted, and absolute rest in the 
recumbent position is necessary. 

Enterocele. Hernia, consisting of 
a protrusion of the intestine. 

Enterotomy. Opening the peri- 
toneal cavity and raising and opening 
the distended bowel. Like all forms 
of intestinal surgery, it is serious and 
needs careful nursing. 

Entozoa. Parasites living within 
the body. 

Enuresis. Involuntary discharge 
of urine.' Give no "liquid near bed- 
time. 

Epidemic. A disease attacking a 
number of people in the same place 
at one time. Epidemics are usually 
accounted for by the disease being 
either infectious or contagious. 

Epidermis. The outermost layer 
of the skin. 

Epigastriimi. The region over 
the stomach. 

Epiglottis. The thin flap of car- 



442 



APPENDIX, 



tilage which guards the entrance to 
the glottis or windpipe. 
^ Epilepsy. A disease of the brain 
marked by the occurrence of con- 
vulsive fits. Perseverance in treat- 
ment is the chief hope of cure, hence 
it behooves nurses or attendants to 
be very patient and careful. A 
sUght fit is called petit mal; a severe 
fit, grand or haut mal. The fits are 
often brought on by excitement or 
any slight ill health, lack of attention 
to the bowels, for instance. The 
nurse must note if the fit commences 
with a cry, where the convulsions 
begin and how they spread, if the 
thumb is flexed, and how long the fits 
last. There is nothing to be done 
for the patient but to put him flat on 
the floor, loosen tight clothing, put 
a cork or pencil between the teeth to 
prevent the tongue being bitten, and 
otherwise prevent him from injuring 
himself. 

Epiphysis. A process of bone at- 
tached by cartilage to the ends of 
bones, and from which growth takes 
place. 

Epiploon. The omentum, a mem- 
branous expansion which floats upon 
the intestines. 

Episiotomy. Incision of labia in 
difficult parturition. 

Epispastics. Agents appHed to 
the skin to produce discharge, such 
as blisters or vesicatories. 

Epistaxis. Bleeding from the 
nose, apt to become serious in debili- 
tated or anemic persons. Applica- 
tions of ice-bags to the back of the 
neck and to the forehead, or plug the 
nose with lint dipped in vinegar or 
lemon-juice. 

Epithelial Casts. Tube casts 
with attached kidney epithelium found 
(by microscopic examination) in the 
urine in nephritis. 

Epithelium. The outermost 
bloodless layer of the mucous mem- 
brane and the skin. 

Ergot. A drug derived from a 
fungus which grows on rye; it is used 
especially in labor cases to contract 
the uterus and arrest hemorrhage. It 
prolongs the length and force of pains 
in a parturient uterus. 

Ergo tin. A form of ergot specially 
used hypodermatically to arrest bleed- 
ing. 

Erosion. Ulceration of parts. 



Eructation. Belching. 

Eruption. A breaking Dut on the 
skin. 

Erysipelas. Contagious inflam- 
mation of the skin, tending to spread, 
accompanied by fever and pain in 
the part affected. It is necessary for 
a surgical nurse to keep watch for 
erysipelas, though, in these days of 
antiseptic surgery, it seldom ap- 
pears. The symptoms are redness 
around the edges of the wound, vom- 
iting, rigors, and a rise of tempera- 
ture — all this must immediately be 
reported to the surgeon. The pa- 
tient and nurse are isolated and great 
care must be taken to disinfect all ar- 
ticles used. The period of incubation 
for erysipelas is from three to seven 
days; on the second or third day 
after rigor a diffuse red rash with 
swelling appears. Constitutional ery- 
sipelas of the head and face is not 
uncommon. Erysipelas contagion pro- 
duces puerperal fever in parturient 
women. 

Erythema. Non-contagious cir- 
cumscribed inflammation of the skin. 
If acute, often followed by rheumatic 
fever. 

Eschar. A dry healing scab on a 
wound; generally the result of the 
use of caustic. Also the mortified 
part in dry gangrene. 

Esophagus. The canal which runs 
from the throat into the stomach. 

Essences. Strong solutions of one 
part volatile oil in four of rectified 
spirits. Usually given in a few drops 
on sugar. 

Ether. A volatile liquid much 
used as an anesthetic. It must never 
be used near an uncovered light, as it 
is very inflammable. Spirits of nitrous 
ether are diuretic and carminative. 

Etherization. Anesthesia or un- 
consciousness produced by the in- 
halation of the vapor of ether. 

Ethmoid. A bone of the nose, 
through which the olfactory nerve 
passes. 

Etiology. The science of the 
causation of disease. 

Eucalyptus. An antiseptic much 
used in catarrhal affections; it is used 
as an inhalation in phthisis. It is a 
colorless, oily liquid, with a pungent, 
resinous smell. 

Eustachian Tube. The canal 
from the throat to the ear. 



GLOSSARY. 



AAl 



Eustachian Valve . A fold in the 
membrane of the right auricle of the 
heart. 

Evacuation. Discharge of excre- 
ment from the body. (See Move- 
ments.) 

Eventration. Protrusion of the 
intestines. 

Eversion. Folding outward. 

Exacerbation. A return of fever; 
a paroxysm of disease. 

Exanthemata. Diseases accom- 
panied by eruptions or rashes. 

Excision. Act of cutting away. 

Excoriation. Abrasion of the skin. 

Excrescence. An unnatural pro- 
truding growth. 

Excreta. The urine and feces. 

Excretion. The throwing oflf of 
waste matter. 

Exfoliation. Scaling ofif of a dead 
bone or tissue in thin flakes. 

Exhaustion. Great loss of vital 
and nervous power from fatigue or 
protracted disease. 

Exostosis. A bony tumor grow- 
ing from bone. 

Expectant. Treatment which re- 
moves obstacles and then watches the 
course of events without using medic- 
inal remedies. 

Expectoration. Secretions from 
chest coughed up. The nurse must 
note the quantity and character of 
the expectoration. In pneumonia it 
is viscid, tenacious, sticks to the sides 
of the sputum-cup, and is of rusty ap- 
pearance, or may even be of a prune 
color; in bronchitis the expectora- 
tion is frothy, abundant, and often 
streaked with black, and of a green- 
ish-yellow color, from the presence 
of pus; in consumption the expectora- 
tion varies from a small quantity of 
frothy fluid to abundant greenish- 
yellow offensive phlegm or sputum, 
often streaked with blood. 

Expression. The recognizable 
manifestation through the facial line- 
aments or the voice of any subjective 
feeling. 

Expulsion. The act of driving out. 

Extension. A certain pull or 
weight applied to a fractured or dis- 
located limb to keep it straight. 

Extensor. A muscle which ex- 
tends a part. 

Extirpate. To completely re- 
move. 

Extracts. Medicinal preparations 



made by extracting the ingredients 
of vegetable substances. An extract 
is a solid preparation; a fluid extract 
is a liquid preparation. 

Extra-Uterine Gestation. Preg- 
nancy outside the uterus; in the ab- 
dominal cavity, for instance. 

Extravasation. Escape of fluid 
from its proper channel into sur- 
rounding tissue. 

Extremities. The limbs; the ter- 
minal end of an organ. 

Exudation. Oozing; slow escape 
of liquid. 

Eyeball. The globe of the eye. 

Eyes. The organs of vision or 
sight. 

Eye-teeth. The canine teeth. 
(See Teeth.) 



Facial. Relating to the face. 

Fahrenheit. The scale of most 
thermometers used in America; the 
freezing-point is 32°, the normal heat 
of the human body 98.4°, the boiling- 
point 212.° (See Thermometer) 

Faint. A short swoon. Lay the 
patient flat, and let him have plenty 
of fresh air. Consciousness will soon 
return. Patients are very liable to 
faint the first time they are allowed up 
after a long illness, unless the nurse 
is careful strictly to limit the exertion 
allowed. 

Faintness. (See Syncope.) 

Fallopian Tubes. Two trumpet- 
like canals, about 3 inches long, 
passing from the womb to the ovaries. 

Faradism. Electricity generated 
by induction. 

Farinaceous . Containing flour or 
grain. Farinaceous diet consists of 
puddings, gruel, bread, etc.; no meat. 

Fascia. The sheet of fibrous tissue 
which encloses the muscles and also 
envelops the body underneath the skin. 

Fauces. The throat, the back of 
the mouth. 

Favus. A contagious cutaneous 
disease, most common on the scalp. 
It is marked by a honeycombed 
scab. The nurse must be careful 
about disinfection. 

Febrifuge. An agent for allaying 
fever. 

Febrile . Relating to fever. 

Fecal. Relating to the feces. 

Feces. The refuse material ex- 
pelled from the bowels by the anus. 



444 



APPENDIX. 



Fecundation. Impregnation or 
fertilization. 

Feeble. Lacking strength; weak. 

Feeding. Artificial feeding is the 
introduction of food into the body 
by artificial means, such as the stom- 
ach-pump, or in the form of an enema. 
Also, the nourishing of a child by food 
other than the mother's milk. 

Felon. Inflammation with suppu- 
ration of the structures in the end of the 
finger, especially around the nail. 

Femoral Artery. The artery of 
the upper leg, from the thigh to the 
knee. 

Femur. The thigh-bone. 

Fenestrum. An aperture or fora- 
men, as in certain bones. 

Ferrum. Iron. The most impor- 
tant of tonics; to be given after food, 
because if given on an empty stomach 
it decomposes the digestive fluid. 

Fester. Inflammation, with col- 
lection of pus. 

Fetal Movements. The muscu- 
lar movements of the fetus in liter o. 

Fetid. Ofi'ensive smelling. 

Fetor. Strong vmpleasant smell. 

Fetus. An unborn child, espe- 
cially from the fourth month. 

Fever. Disease marked by heat 
of the body, quick pulse, lassitude, 
and often delirium. The nursing 
treatment of every fever is rest, free- 
dom from chills, and light nourishing 
diet. 

Fibre. Thread-like structure. 

Motor fibres are centrifugal nerve-fibres 
exciting contraction of the muscles. 
Sensory nerve-fibres, centripetal fibres 
conveying sensory impulses to the 
brain. 

Fibrin. Albumin of the blood, 
which solidifies when exposed to the 
air and causes coagulation. 

Fibula. The small bone on the 
outer side of the lower leg. 

Fimbriae. The fringe-like proc- 
esses of the outer extremity of the 
oviduct. 

First Intention. A surgical term 
for healing of a wound by bring- 
ing the edges directly together, so 
that they unite without the neces- 
sity of new granulations to fill in 



Fissure. A term applied to va- 
rious grooves of the body. 

Fistuhi. Any unnatural passage 
by which an internal organ or pus- 



sac communicates with another or 
with the external air. 

Fit. A sudden convulsive attack. 
The nurse must prevent the patient 
from injuring himself, and loosen 
any tight clothing. She must note 
i where the spasms commence, how 
they spread, and how long the fit 
lasts. 

Flabby. Deficient in firmness. 

Flatulence. Wind or gas in the 
intestines; sometimes causing severe 
pain, but, as a rule, merely discom- 
fort. 

Flexion. Being bent; the oppo- 
site to extension. 

Flexor. A muscle which causes 
flexion. 

Floccillation. Carphology. Pick- 
ing the bed-clothes: a grave symp- 
tom in acute diseases. 

Flooding. Excessive bleeding 
from the uterus during parturition. 
(See Post-partum.) 

Flow. (See Menstruation) 

Fluor Albus. White discharge 
from the vagina or uterus. Leukorrhea. 

Flush. A temporary redness, as 
the hectic flush. 

Flux. A flow of liquid. 

Follicle. A minute bag contain- 
ing some secretion. (See Graafian) 

Fomentation. Flannel wrung 
out in some hot fluid and applied 
for the alleviation of pain. The 
flannel should be put in a basin and 
boiling water poured over it, then 
lift it quickly into the centre of a 
towel; catch the towel with one end 
in each hand, twist opposite ways till 
the flannel is well wrung out, apply 
as hot as can be borne, and cover 
with a dry flannel bandage. For a 
turpentine fomentation, sprinkle 20 to 
30 drops of turpentine on the flannel 
immediately before application; for 
an opium fomentation, sprinkle 15 to 
20 drops of laudanum on in the same 
way. Fomentations need frequent 
changing, every hour or oftener. 

Fontanelle. A soft space in the 
skull bone of an infant before the 
skull has hardened. 

Foramen. A hole; an opening 
into the body. For instance, the 
foramen ovale, which separates the 
left and right auricles in the fetus. 

Forceps. Surgical pincers used 
for lifting and moving instead of 
using the fingers. Dressing forceps 



GLOSSARY, 



445 



are shaped Hke scissors, with blunt, 
flat points; dissectmg forceps are 
shaped like sugar-tongs. Every nurse 
should carry forceps, and use them; 
they need to be kept clean, and to 
be disinfected always before and 
after use. Obstetric forceps are of 
different sizes and shapes, and are 
used for grasping the head of the 
fetus in difficult labor; there are also 
many other kinds of forceps. 

Forearm. That part of the arm 
between the wrist and the elbow. 

Forehead. That part of the face 
between the orbits of the eyes, the 
hair above, and the temples. 

Formula. A prescription. 

Fossa. Little depressions of the 
body, such as fossa lacrymalis, the 
hollow of the frontal bone, which 
holds the lachrj^mal gland. 

Fourchette. The commissure join- 
ing the labia majora of the puden- 
dum posteriorly. 

Fracture. A broken bone. Symp- 
tom: Crepitus, limb shortened and 
helpless, pain. Keep the limb at 
rest in a natural position between 
sand-bags. For setting a fracture, 
an anesthetic is usually given. Per- 
fect rest is the only cure, and the 
nurse must see that it is carried out. 
Colics' fracture, a fracture of the 
wrist; comminuted fracture, when the 
bone is splintered; complicated frac- 
ture, some injury is added to the 
fracture: thus fractured ribs may be 
complicated by injury to the lungs; 
compound fracture, a fracture with an 
open wound from the skin to the 
broken bone; green-stick, one side 
of the bone being broken, the other 
bent; impacted, the end of one frag- 
ment being firmly driven into the 
tissue of the other; simple, one in 
which the seat of fracture does not 
communicate with the air. 

Friction. Medical rubbing or 
shampooing. Should always be done 
from the extremities toward the heart. 

Frontal. Relating to the fore- 
head. 

Frost-bite. Injury to the skin or 
a part of the body from extreme 
cold. 

Fuller's Earth. Consists of silica, 
alumina, and oxide of iron. Basis of 
so-called clay poultices, such as anti- 
phlogistine. 

Fumigation. Following the death 



or recovery of a patient who has had an 
infectious or contagious disease, the 
room with all furniture and clothing 
should be subjected to disinfecting 
vapors in order to kill the germs that 
have been left by the disease. This 
process is called fumigation and is 
described on p. 263. 

Function. The special work of an 
organ. 

Fundament. The anus. 

Fundus. The base of an organ, 
usually applied to the uterus. 

Fungus . A microscopic, parasitic 
vegetable growth. 

Funis. The umbilical cord. 

Fur. An unnatural coating of the 
tongue, common in fevers. 

Furunculus. A little boil. con- 
taining a central core. 



Galactia. Disorder of the milk 
secretion. 

Galactorrhea. Excess of milk. 

Gall. A bitter secretion formed by 
the liver. Bile. 

Gall-bladder. The membranous 
sac which holds the bile. 

Gall-ducts. Ducts conveying the 
bile. 

Gall-stone. Calculus in the gall- 
bladder. If the stone passes into the 
duct and thence to the duodenum, 
there is great pain. Local applica- 
tion of heat and injections of morphia 
are usual. Diet important. 

Gallic Acid. An astringent; used 
to control bleeding and lessen the 
night-sweats of phthisis. 

Galvanism. Electricity generated 
by means of a battery of cells with 
carbon and zinc plates in acid solu- 
tion. Practically the application of 
continuous currents as distinct from 
alternate currents. 

Ganglion. An enlargement of a 
nerve forming a semi-independent 
nerve-center. Also 'swelling of the 
sheath of a tendon. 

Gangrene. Death of a part. It 
begins with discoloration of one of 
the extremities, generally the toes, 
and gradually becomes mortification. 
The hardening of the arteries and 
consequent defective circulation of a 
part in old people sometimes brings 
on a form of dry gangrene called 
"senile gangrene." Moist gangrene 
is a form with abundant serous exu- 



APPENDIX. 



dation and rapid decomposition. The 
nurse's duty is strict cleanliness; the 
only cure is amputation. Fresh air 
and nourishing food are necessary. 
Raise the hmb. Keep the part warm 
by the aid of hot-water bottles. 

Gargle. A liquid medicine for 
washing out the throat. 

Garrot. An improvised tourni- 
quet, consisting of a handkerchief, a 
stone, and a stick. 

Gastralgia. Unpleasant burning 
feeling or acute pain in the stomach 
due to indigestion. 

Gastric. Relating to the stomach. 

Gastric Fever. A term loosely 
used to indicate fever associated with 
abdominal symptoms. Usually ty- 
phoid fever. 

Gastric Juice . The digestive fluid 
of the stomach. 

Gastritis. Inflammation of the 
stomach. 

Gastrohysterotomy. Opening 
into the uterus through the abdomen. 
Porro-Cesarean operation. 

Gastrostomy. Making an artifi- 
cial mouth into the stomach. 

Gauze. A kind of cloth similar to 
cheese-cloth, that is used for surgical 
dressings. 

Gavage. Feeding by means of a 
stomach-tube. 

Gelsemium. A nerve-soothing 
drug prescribed in tetanus, mania, 
and nervous affections. Contracts 
the pupil. Watch for frontal head- 
ache or double vision. Poison. 

Generation. Production of human 
beings. 

Genitalia. The outer generative 
organs, or privates. 

Gentian. A useful drug, very 
bitter, acts as a stomachic tonic. 

Genu Valgum. Knock-knee. 

Germ. A microbe or bacterium. 

Gestation. The period of carry- 
ing the young in the womb. 

Giddiness. A sensation of un- 
steadiness of the body, usually ac- 
companied with more or less nausea. 
(See Vertigo.) 

Ginger. Carminative and stimu- 
lant. 

Gingivitis. Inflammation of the 
gums. 

Glanders. A febrile disease with 
inflammation of the nasal cavities, 
communicable to man from the horse, 
ass, and mule. Often fatal. 



fV^ Glands. Small bodies occurring 
in different parts of the body and 
having the power of secretion. Con- 
catenate glands of the neck, Coivper's 
glands of the prostate, Brunner's 
glands of the duodenum, etc. Cow- 
per's glands are two small glands like 
peas above the bulb of the urethra; 
Lachrymal glands are those which 
secrete the tears; Salivary glands 
are three glands at the back of the 
lower jaw. 

Glans. Bulbous extremity of the 
penis and clitoris. 

Glauber's Salt. Sulphate of soda, 
a purge. 

Glaucoma. A disease of the eye- 
ball characterized by increased ten- 
sion within it. 

Glenoid. A cavity; a term appHed 
to the socket of the shoulder-joint 
and similar parts. 

Globule. A very little pill. 

Globulin. A form of proteid mat- 
ter. 

Globus Hystericus. Hysterical 
choking feeling, as of a ball in the 
throat. 

Glonoin. Nitroglycerin; used as 
a drug to accelerate the heart's action 
in angina pectoris, shock, etc. 

Glossitis. Inflammation of the 
tongue. 

Glottis. The opening into the 
windpipe. 

Glycerin. A sweet, colorless 

liquid, obtained from oils and fats. 
Used as an emollient ointment. 
Also in enemata as an aperient; one 
teaspoonful is injected from a special 
piston-syringe. 

Glycosuria. Grape-sugar or glu- 
cose in the urine, a symptom in dia- 
betes. Sometimes a transitory state 
only. 

Gnathic. Relating to the jaw or 
cheek. 

Goiter. Enlargement of the thy- 
roid gland of the throat, common in 
Switzerland, where it is ofteri associ- 
ated with cretinism. 

Gonorrhea. Inflammation of the 
genitals and flow of pus. Contagious: 
The nurse must be very careful to 
burn all soiled dressings, and always to 
use forceps. If the patient is a fe- 
male, frequent baths and hot douches 
of warm water may be ordered. In- 
flammation of the external genitals 
must be watched for. (See p. 261.) 



GLOSSARY. 



447 



Gorget. A blunt grooved instru- 
ment used in operations for stone in 
the bladder. 

Gouge. A grooved instrument of 
steel or bone used to scoop out dead 
bone. 

Gout. A disease marked by at- 
tacks of acute pain and swelling of 
the joints, usually of the big toe or 
the thumb. Chalky concretions form 
about the joints in time. The nurse 
has to attend to the local applications 
(often tincture of opium, iodide of 
potassium, or carbonate of lithia, ap- 
plied on charpie and covered with 
oiled silk); she has also to see to the 
diet, for dyspepsia generally accom- 
panies gout. Hot baths followed 
by passive manipulation may be 
ordered. The urine must be meas- 
ured and tested, the presence of 
Hthates being specially watched for. 

Graafian Follicles. Small vesicles 
found near the surface of the ovary. 

Grafting. Snipping minute por- 
tions of the skin from a healthy part 
and planting them on some sore or 
wound where there is no skin, that 
they may grow there and help the 
wound to heal over. 

Gramme. Unit of metric weight, 
15.5 grains. 

Granulation. The process by 
which tiny granules of flesh form on 
the face of a wound during its heal- 
ing. This is healing by second inten- 
tion {q. v). 

Granule. Small particle or grain. 

Grape-sugar. Glucose. 

Gravel. A popular term for stone 
of the bladder. 

Gravid. Term applied to the 
womb during gestation. 

Gray Matter. The gray substance 
of the brain. 

Groin. The depression betw^een 
the thigh and the abdomen. 

Gruel. A decoction made of oat- 
meal, corn-meal, etc. 

Guaiacum. A drug used as an 
alterative and a diaphoretic. 

Gurgling. Sound of bubbling 
heard in a lung cavity by means of 
the stethoscope, and heard also upon 
palpating the abdomen in certain 
conditions, such as typhoid fever, in 
which the bowel is distended with 
gas and contains fluid feces. It is 
caused by gas passing through fluid. 

Qutta. A drop or minim. 



Gynecologist. A physician who 
is a specialist in the treatment of dis- 
eases peculiar to women. 

Gynecology. The study of the 
diseases special to women. 



Habit. That condition or quality 
one naturally possesses or acquires. 

Hair. The hirsute appendage of 
the skin. Each hair consists of a 
bulb and a shaft. 

Hair-follicle. Little pit in the 
skin in which the root of the hair is 
fixed. 

Hallucinations. A false sense- 
perception, one of the symptoms of 
mental disease. (See p. 326.) 

Hamamelis. Witch-hazel, pre- 
scribed for piles, diarrhea, and bleed- 
ing from various parts. 

Harelip. A congenital slit in the 
upper lip, sometimes double, and 
then consisting of two slits. The 
child is generally operated on very 
young, and the slit strapped up by 
specially cut strapping. It is most 
necessary to prevent the child crying, 
and to feed it with great care, or the 
slit may open again. Hare-lip is fre- 
quently associated wath cleft palate 
(which see). 

Hartshorn. Ammonia; ordinary 
smelling-salts is a carbonate of am- 
monia, and in that form is generally 
called "hartshorn." Poison. 

Haversian Canals. The minute 
canals which permeate bone. 

Hay Fever. Attacks of parox- 
ysmal sneezing supposed to be caused 
by the pollen of plants irritating the 
nose; it occurs late in the summer. 
Inhalations of iodides and antiseptics 
is the usual local treatment. A res- 
pirator may be worn with advan- 
tage. Sea-bathing and tonics may be 
ordered. 

Headache. Pain in the head, 
especially in the frontal region. Sick 
and bilious headaches are due to dis- 
orders of the digestive system; head- 
aches at the vertex, to cerebral troubles; 
and occipital headache to anemia. 

Healing. (See Union.) 

Heart. The muscular organ which 
pumps the blood through the body. 
The heart is situated directly behind 
the breast-bone, with the apex, or 
small end, pointing to the left under 
the left breast. All heart cases need 



448 



APPENDIX. 



the most incessant care and unbroken 
quiet, as the sHghtest movement or 
excitement may be attended with 
serious consequences. 

Heartburn. Uneasiness and burn- 
ing in the stomach and cardiac region 
in indigestion; a gnawing sensation. 

Heart-failure. Failure of the 
heart to act. 

Heat. Body heat indicates a tem- 
perature of above 98.6° F. 

Hectic Flush. The reddening of 
the cheeks in tuberculosis. 

Heel-bone. The largest bone of 
the foot, the calcaneum. 

Hellebore. \ poisonous drug, 
used as a depressant. Antidote for 
overdose: Stimulants. 

Hematemesis. Vomiting blood 
from the stomach. Dark colored and 
often in clots. Recumbent position, 
ice to suck ;_ notice the color of stools. 

Hematin. A decomposition prod- 
uct of hemoglobin (the coloring-mat- 
ter of the blood). 

Hematocele. A tumor containing 
extravasated blood. 

Hematoma. A blood-tumor. 

Hematosalpinx. Distention of 
the Fallopian tube with blood. 

Hematoxylon. Logwood; a dis- 
infectant, chiefly used for sores. 

Hematuria. Blood in the urine; 
may be a sign of malignant disease 
of the kidney. Urine looks smoky or 
claret colored. Rest; ice-bags to the 
back. Astringents will probably be 
given internally. 

Hemicrania . i . Headache on one 
side of the head only. 2. Imperfect 
development of one side of the skull. 

Hemiplegia. Paralysis of one side 
of the body. Watch for constipation. 

Hemispheres. The two sides of 
the brain. 

Hemoglobin. The coloring-mat- 
ter of red blood-corpuscles. 

Hemoptysis. Coughing up blood 
from the lungs. Frothy, and of a 
bright red color. Rest, no talking, 
ice to suck. All food must be cold, 
no stimulants. Watch thd tempera- 
ture and pulse. 

Hemorrhage. A flow of blood. 

Hemorrhoids. Piles, small tumors 
about the anus. Usually the result 
of constipation or pregnancy. Regu- 
larity of the bowels must be secured. 
Bleeding piles may necessitate injec- 
tions of iced water or mild astringents. 



Hemostatic. An agent to arrest 
a flow of blood. 

Hepatic. Relating to the Uver. 

Hepatica. Medicines acting on 
the Uver. 

Hepatitis. Inflammation of the 
liver. 

Hereditary. Transmitted from 
one's parents. 

Hermaphrodite . One whose gen- 
erative organs are neithei entirely 
male nor female. 

Hernia. Commonly called "rup- 
ture"; protrusion of any of the inter- 
nal organs through the surrounding 
tissues, most common in the case of 
the bowels. Inguinal hernia is through 
both abdominal rings; direct through 
the external ring, and oblique through 
the internal ring. Strangulated, so 
tightly constricted that gangrene 
results if operation does not re- 
Ueve. Scrotal is descending into 
the scrotxim, and umbilical is her- 
nia at the navel. Taxis is the usual 
means of returning the protruded 
part if possible, and a truss is then 
worn to prevent the rupture oc- 
curring again. A rupture not amen- 
able to taxis is termed irreducible. 

Herniotomy. Di\'iding the con- 
stricting band of a strangulated 
hernia and returning the protruding 
part. The patient, after the operation, 
must be kept recimibent; no food must 
be given save the light diet ordered. 

Heroic. Severe treatment of the 
kill-or-cure type. 

Herpes. Acute inflammation of 
the skin, with eruption. Herpes zoster 
shows in rings of vesicles around the 
body, and is usually called "shin- 
gles"; circinatus, chiefly about the 
head, is called "ring-worm." Local 
treatment consists of protection from 
irritation, a dusting-powder, or a 
mild astringent lotion. 

Hiccough. A short, noisy, invol- 
untary inspiration, caused by a spas- 
modic contraction of the diaphragm 
followed by a sudden closure of the 
glottis. A grave s^'mptom when occur- 
ring in a serious case of illness. 

Hip- joint Disease. A tubercu- 
lous lesion of the hip-joint, most com- 
mon in children, and extremely painful. 
The child is usually put in splints, and 
extension applied to prevent the 
painful jerking of the inflamed joint. 
The nurse's duty is to avoid any jar- 



GLOSSARY. 



449 



ring or movement of the patient, 
to keep the bed fresh and sweet, and 
the general health good, and to be 
very careful in lifting the patient, and 
to move slowly and gently. Abscesses 
often accompany hip-joint disease. 

Hirsute. Hairy. 

Histology. Science of the minute 
tissues of the body. 

Homeopathy. Medicine worked 
on the system of like cures like. 
Started by Hahnemann. Homeo- 
pathic medicines are mostly given in 
infinitesimal doses. 

Hookworm Disease. A disease 
of the Southern United States with 
symptoms that resemble anemia, 
caused by the presence in the intes- 
tine of a worm, Uncinaria or Anchy- 
lostoma, which sucks the blood from 
the intestinal walls. 

Hordeolum. A stye. 

Hot-water Bag. A rubber bag in 
which hot water of any degree can 
be introduced for topical application. 
Hot-water bottle answers the same 
purpose. 

Humerus. The bone of the upper 
arm. 

Humor. Any fluid of the body 
other than the blood. 

Hydragogue. A medicine which 
helps the discharge of water from the 
system. 

Hydrargyria. Symptoms due to 
protracted use or too large doses of 
mercury. 

Hydrarthrosis. Accummulation 
of fluid in a joint, most common in the 
knee; white sweUing. 

Hydrastis . A drug procured from 
the plant of Golden Seal, and used as 
a stomachic tonic, and as a local ap- 
plication for sores and ulcers. 

Hydremia. Excess of water in 
the blood. 

Hydrocele. Watery tumor in the 
scrotum. In infants, acupuncture may 
be performed; in adults, the treatment 
is usually injection, with a stimulating 
fluid, or excision. 

Hydrocephalus. Water on the 
brain; a disease, most common in 
children, that causes the head to 
swell to an enormous size. The vic- 
tim is usually idiotic. 

Hydrocyanic Acid. The most 
violent poison known. In small doses 
a local sedative, allays irritation. Also 
antispasmodic. (See Prussic Acid) 

29 



Hydroma. Watery swelling of a 
limb; a watery tumor. 

Hydrometra. Accummulation of 
water in the womb. 

Hydropathic. Relating to cure 
by means of water; by baths; and by 
the absence of alcohol as a drink. 

Hydrophobia. Madness of an 
acute form, contracted by the bite 
of a rabid dog. Tranquillity is of 
the greatest importance, and the 
nurse may do much to secure this 
and allay the terrible fears of the 
patient. Keep the room dark and 
quiet. The saliva of a hydrophobic 
patient is supposed to be capable of 
conveying infection, so a nurse must 
be careful on this point. 

Hydrosalpinx. Inflammation of 
the Fallopian tube, with the formation 
of fluid in the tube. 

Hydro therapeutics. The water- 
cure from a scientific standpoint. 

Hydrothorax. Fluid in the cavity 
of the chest. 

Hygiene. The science of the pres- 
ervation of health by means of atten- 
tion to sanitary surroundings and 
habits. 

Hymen. A fold of membrane at 
the entrance to the vagina. 

Hyoid. The name of a bone shaped 
like a V, at the root of the tongue. 

Hyoscyamus. Henbane, a poi- 
sonous antispasmodic and narcotic. 
Enlarges the pupil of the eye. Anti- 
dotes: Emetic of sulphate of zinc, am- 
monia, and stimulants. 

Hyperemia. Excess of blood in 
a part. 

Hyperesthesia. Excessive sensi- 
bility in a part. 

Hyperidrosis. Excess of per- 
spiration. 

H3rperinosis. Excess of fibrin in 
the blood. 

Hyperplasia. Excessive growth 
of tissue. 

HsHperpyrexia. ■ Excess of fever, 
shown by a very high temperature. 
Cold baths (temperature 65°) or cold 
packs with ice-water are often used 
to reduce the temperature; quinine, 
salicylic acid, and other drugs are 
sometimes given to reduce the tem- 
perature. (See Pack) 

Hypertrophy. Excessive growth 
of a part; it is called /a/^c when caused 
by a deposit within the part and not 
by the general growth. Counter-irri- 



450 



APPENDIX. 



tants and stimulants, such as iodine, 
are sometimes applied locally. 

Hypnone. A colorless, pungent 
fluid, used rarely as a soporific. 

Hypnotic. Agent for causing sleep. 

Hjrpnotisin. State of unconscious- 
ness caused by straining the eyes to 
look at some bright object; a form 
of mesmerism. 

Hypochondriasis. Slight melan- 
cholia. The chief symptom is mental 
distress about the health, and delu- 
sions that the patient is the victim of 
many diseases. The attention should 
be distracted as much as possible. 

Hypodermatic. Under the skin; 
a term applied to injections given 
under the skin by means of a hypo- 
dermic syringe. (See p. 83.) 

Hypodermoclysis. Subcutaneous 
injection, usually of normal saline 
infusion, to supply blood lost or to 
dilute poisons, etc. 

Hypogastric. Term apphed to 
the region of the abdomen just be- 
low the umbilicus. 

Hypoglossal. The controlling 
nerve of the tongue, situated under 
it toward the back. 

Hysteralgia. Pain in the womb. 

Hysterectomy. Complete or par- 
tial removal of the womb, either 
through the abdomen or the vagina. 

Hysteria. A nervous disease 

marked by convulsive seizures, and 
very often by disUke to food, painful 
impressions, and untruthfulness. The 
nursing of these cases is very trying, 
and can only be successfully carried 
on if the patient is removed from her 
usual surroundings, and her family 
kept at a distance. Infinite patience, 
and persistent cheerfulness mingled 
with a certain amount of sympathy, 
may work wonders. A good nurse 
will soon persuade a patient who has 
fasted for months to take food natu- 
rally again. Terrible weakness and 
even paralysis are brought on by 
hysteria. 

Hysterics. A term vulgarly ap- 
plied to screaming and crying fits in 
women, who cannot or will not con- 
trol their emotions. 

Hysterocele . Hernia of the womb . 

Hysteroscope. Mirror for reflect- 
ing light in examining the womb. 

Hysterotomy. Cesarean section, 
opening into the womb. The instru- 
ment used is caJi«^.d a "hysterotome." 



I. 

Ice-bag. A bag of waterproof 
material filled with ice for applica- 
tion to any part of the body. 

Ichor. The thin colorless discharge 
from ulcers and other sores. 

Icterus. Jaundice: a yellow dis- 
coloration of the skin, caused by 
absorption of bile into the blood. 

Idiocy. Mental weakness, which 
dates from birth; feeble-mindedness. 
Few know how much can be done 
with idiot children by patience. The 
kindergarten method of teaching 
them is admirable. Physical train- 
ing forms an important part of the 
treatment. A nurse who can secure 
the touching devotion of an idiot 
child will be able to cure him of all 
dirty habits, and even train his mental 
faculties to a varying degree. An 
idiot child should be placed in a 
home. 

Idiopathic. A morbid condition 
arising primarily, and not following 
on any disease or accident. 

Idiosyncrasy. An individual pe- 
culiarity in regard to the action of 
certain drugs, their action and effect 
being entirely different to what is 
expected. 

Ileocecal Valve. Valve at the 
junction of the large and small in- 
testine. 

Ileum. The lower portion of the 
small intestine. 

Iliac Arteries. There are five 
iliac arteries: i. Circumflex, arising 
from the external iliac; 2. common, 
the continuation of the abdominal 
aorta, dividing into (3) the external, 
and (4) the internal iliac. The bifur- 
cation is about at the last lumbar 
vertebra. The external iliac becomes 
the femoral after passing under Pou- 
part's ligament. The branches of 
the internal iliac supply nearly all the 
pelvic organs. 

Iliac Region. The region contain, 
ing the cecum, vermiform appendix- 
and some coils of the small intestine. 

Ilium. The upper part of the os 
innominatum. Crest of the ilium is the 
prominent part of the hip. 

Illusion. A false sense-perception 
of an external object. (See p. 327.) 

Immunity. Exemption from dis- 
ease by vaccination or by some analo- 
gous procedure, or by previous illness. 



GLOSSARY. 



451 



Impaction. State of being wedged 
in. 

Impetigo. A skin rash of an 
acute kind, chiefly seen in weakly 
women and children. Nutritive diet, 
and locally zinc ointment, will prob- 
ably be ordered. 

Impregnation. Act of rendering 
pregnant. 

Lmprovise. To do or to perform 
anything on the spur of the moment 
for a special occasion; to contrive. 

Impulse. In mental disease, an 
impulse is a morbid action, performed 
without the intervention of the will. 

Impulseof the Heart. Sensation 
of a stroke felt on placing the hand 
on the heart, occurring as the ventricles 
contract. 

Inanition. Exhaustion from want 
of food. 

Incarcerated. Applied to a hernia 
which cannot be reduced. 

Incision. Act of cutting into with 
a sharp instrument. 

Incisors. The eight front teeth. 

Incompressible . A full pulse, the 
beat of which cannot be arrested by 
pressure. 

Incontinence. Inability to retain 
the evacuations of the bladder or of 
the bowels. Incontinence of urine is 
often a disease of childhood. Much 
depends on the patience and firmness 
of the nurse in training in good habits. 
(See Enuresis.) 

Incubation. The period between 
the implanting of the disease germs 
and the development of the symptoms. 

Incubator. A sort of glass-cov- 
ered box warmed by hot-water cans, 
in which premature infants, born at 
the sixth or seventh month, are kept. 
The child is swathed in cotton, and 
never taken out of the box except to 
change the diaper. Great care is 
necessary to keep the box at the 
ordered temperature. 

Incus. A small anvil-shaped bone 
of the inner ear. 

Indigestion. Failure of the di- 
gestive powers; generally accompa- 
nied by morbid appetite and mental 
irritation. 

Indolent. A term applied to a 
painless sore which is slow to heal. 

Induration. The process of hard- 
ening. 

Inertia. Sluggishness; applied to 
the womb when it will not contract. 



Infant. A new-born child; a male 
should weigh at birth 7^ lbs., a female 
7 lbs.; it should increase 6 to 7 ounces 
in weight weekly. 

Infection. The communication of 
disease germs by any means. It is 
particularly the nurse's duty in in- 
fectious cases to prevent the spread 
of the disease to others by thorough 
disinfection. 

Inferior Vena Cava. The chief 
vein of the lower part of the trunk of 
the body. 

Infiltration. An efifusion of fluid 
into the connective tissue. 

Inflammation. A diseased state 
marked by heat, redness, swelling, 
pain, and fever; it begins with con- 
gestion of the parts, and possibly 
may go on to suppuration or mortifi- 
cation. The Greek term for inflam- 
mation is "itis"; hence we get glos- 
sitis, inflammation of the tongue; 
peritonitis, inflammation of the peri- 
toneum; and so on. 

Inflation. Blown out or expanded 
by air or gas. 

Influenza. Epidemic catarrhal 
fever. 

Infundibulum. A term applied to 
several funnel-shaped organs of the 
body. 

Infusum. An infusion: prepared 
by pouring boiling water on a drug, 
letting it stand and then strain- 
ing. 

Ingesta. Food taken into the 
body through the mouth. 

Inguinal. The region at the lowest 
part of the abdomen on either side 
of the symphysis pubis. 

Inhalation. Act of breathing in 
vapor or fumes into the mouth, a 
form of treatment frequently ordered 
in disorders of the throat or chest. 
The ordinary inhaler consists of a 
vessel fitted with a mouth-piece com- 
ing out of the lid; the hot water and 
the medicament ordered are put in 
the vessel and the patient takes the 
mouth-piece in his mouth and in- 
spires the vapor which rises through 
it. A teapot makes a very good in- 
haler, the patient keeping the spout 
in his mouth. 

Inhibition. The arrest of some 
activity by the restraining influence 
of a nerve-centre. 

Injection. A watery or other so- 
lution thrown into the vessels, be- 



452 



APPENDIX. 



neath the skin, or into any cavity of 
the body. 

Innominate. Name of the large 
artery of the body proceeding from 
the aorta. 

Innominatiun. The pelvic bone. 

Inoculation. The injecting of 
diseased fluid from the body of one 
creature into the body of another, as 
calf lymph is used to vaccinate chil- 
dren. 

Insanity. Madness; mental de- 
rangement. 

Insertion. The attachment of a 
muscle to the part it moves. 

Insomnia. Sleeplessness; often a 
troublesome compUcation during con- 
valescence. 

Inspiration. Drawing in the 
breath. 

Instillation. Pouring in drop by 
drop. 

Instrument. Any mechanical de- 
vice or tool used in operation or treat- 
ment. 

Insufflation. Blowing air, gas, or 
vapor, or any finely divided substance 
into a cavity or on a surface of the 
body. 

Insulation. State of a body sur- 
rounded by non-conductors of elec- 
tricity. 

Integument. The skin. 

Intestines. The alimentary canal 
from the stomach to the anus. 

Intolerance. Constitutional in- 
capacity to endure or benefit by a 
remedial agent. 

Intoxication. The effect of the 
excessive use or an overdose of alco- 
holic liquor; in a wider sense, any 
poisoning. Auto-intoxication is the 
effect of reabsorption of the poisons of 
the body. 

Intravenous. Denoting within or 
into the veins. An intravenous injec- 
tion is the introduction into the vein 
of a saline solution or other liquid. 

Intubation. Passing a tube down 
the throat and leaving it there; an 
operation sometimes performed on 
children with diphtheria instead of 
tracheotomy. It needs careful nurs- 
ing, for the tube may be coughed up 
or may be swallowed. 

Intussusception. The reception 
of one part of the intestine into an- 
other; common in children and caus- 
ing obstruction of the bowels, and 
calling for prompt treatment. 



Inunction. Rubbing in of medi- 
cines with a view to effect absorption. 
Generally resorted to when the stom- 
ach will not tolerate the medicine. 

Invagination. Another term for 
intussusception. 

Inversio Uteri. Inversion of the 
womb, so that it is turned inside out, 
and generally falls into the vagina. 

Involuntary. A term appUed to 
certain motions and functions of the 
various organs of the body that are 
not controlled by, or are not depend- 
ent on, the will. 

Involution. The shrinking of the 
womb after labor. The womb, from 
weighing a pound and a half at labor, 
shrinks in eight weeks to the weight 
of an ounce and a half. Any chill 
may arrest this involution and cause 
great mischief. 

Iodine. A poisonous element ob- 
tained from the ashes of seaweed. 
Very useful as an antiseptic. The 
solution is painted on the skin to 
cause absorption. The tincture is 
given internally for scrofula, etc. Re- 
port at once any catarrhal symptoms. 

Iodoform. A form of iodine con- 
sisting of yellow crystals or a prim- 
rose-colored powder. It possesses a 
strong and lasting odor. It is largely 
used to dust on wounds, its action 
being antiseptic and stimulating. 
Iodoform gauze, wool, and lint are 
employed. The symptoms of poi- 
soning from iodoform are vomiting, 
hallucinations, red skin rash, and 
dusky urine. 

lodol. Ointment containing iodine, 
and having the same properties as 
iodoform, without the strong smell. 

Ipecacuanha. A prompt emetic, 
secured from the root of a Brazilian 
plant. Greatly used for children in 
cases of croup and whooping-cough. 
In small doses it is a stomachic and 
expectorant; when used as an emetic, 
some 60 drops are given. 

Iris. The colored circle surround- 
ing the pupil of the eye. 

Iritis. Inflammation of the iris. 

Iron. When ordered as a medi- 
cine, should be given after food and 
through a tube. Dialyzed iron does 
not injure teeth. Iron causes black 
stools. 

Irreducible. That which is inca- 
pable of being returned to its proper 
place by manipulation. 



GLOSSARY. 



453 



Irrigation. Constant application 
of a lotion to a part. !!! 

Irritant. A drug which causes 
excitation and stimulates action. 

Irritation. .\n inflamed state; 
also, the stimulus necessary to the 
performance of the functions of an 
organ. 

Ischium. The hip-bone; the back 
part of the os innominatum. 

Isolation. Set apart; an isolation 
room or ward is one kept for con- 
tagious or infectious diseases, and the 
nurse has to follow strict rules to 
prevent the spread of the disease. 
A sheet hung over the door of such 
a room, and kept saturated with car- 
bolic or some other disinfectant, to 
prevent the disease germs that are in 
the air getting out at the door and 
into other parts of the building. 

Itch. A skin eruption. (See 

Scabies) 

J. 

Jaborandi. A drug containing 
pilocarpin and jaborin. It increases 
perspiration and stimulates the heart. 

Jalap. A drug which purges rap- 
idly, acting in from two to four hours. 

Jaundice. Discoloration of the 
skin, mucous membranes, and secre- 
tions of the body due to obstruction 
of the biliary passages, and conse- 
quent accumulation of bile coloring- 
matters in the blood. 

Je j unum . The mid portion of the 
small intestine. 

Joint. Point of union of two bones. 
(See Articulation.) 

Jugular. Relating to the neck. 



Keloid. A connective-tissue 

growth of the skin. 

Keratitis. Inflammation of the 
cornea of the eye. 

Kidneys. Two organs in the re- 
gion of the hollow of the back which , 
secrete the urine. In all diseases of ' 
the kidneys, the nurse has to measure i 
and test the urine. 

Kilogramme . One thousand 
grammes, equal to 2.2 pounds avoir- 
dupois. 

Kino. An astringent. 

Knock-knee. The inward curving 
of the knee. 

Koumyss. Fermented mare's milk; 



nutritive and easily digested. Given 
in cases of wasting. (See p. 383.) 

Kyphosis. Hump-back deformity 
(curvature) of the spine. 



Labial. Relating to the lips. 

Labia Majora. Two large folds 
at the mouth of the pudendum; called 
also the "labia pudendi majus." 

Labia Minora. Two smaller folds 
within the majora; called also the 
"nymphaj.'' 

Labor. The progress of the birth 
of a child. There are three stages: 
(i) The dilatation of the mouth of 
the womb. (2) The passage of the 
fetus through the canal and its birth. 
(,3) From the birth of the child to the 
coming away of the placenta. Prema- 
ture labor is the birth of a child after 
the seventh month, but before full 
time. 

Labor-pains. The pains of, or 
the contraction of, the uterus during 
labor. False labor-pains are irregu- 
lar and short, resembling colic, and 
occur with a certain regularit}'. 

Labsnrinth. The internal ear, con- 
sisting of a series of cavities. 

Lacerated. A lacerated wound is 
one with torn or irregular edges; not 
clean-cut. 

Lachr37mal. Relating to the tears 
and the glands which secrete them. 
The lachr\-mal or nasal duct conveys 
the tears from the lachrj'mal sac into 
the inferior meatus of the .nose. 

Lachrymation. Excess of tears. 

Lactagogue. Drug for inducing 
milk secretion. 

Lactation. The process or period 
of sucking. 

Lacteals. The Ij'mphatic vessels, 
which convey the chyle from the in- 
testinal canal. 

Lactiferous Ducts. The canals 
of the mammary gland. 

Lactose or Lactin. Sugar of milk. 

La Grippe. (See Influenza.) 

Lancet. Surgical knife, with point 
and two edges, sharp. 

Lancinating. An adjective ap- 
plied to sharp cutting pains. 

Lanugo. The downy growth or 
first hair of the fetus. 

Laparotomy. Cutting into the 
abdomen; a serious operation in the 
removal of a tumor, etc. 



454 



APPENDIX. 



Laryngeal. Relating to the 

larynx. 

Laryngismus Stridulus. Spas- 
modic croup accompanied by a crow- 
ing noise; most common in infants. 
(See Croup.) 

Laryngitis. Inflammation of the 
larynx, causing loss of voice. Com- 
mon in clergymen and public speak- 
ers. May be chronic or acute; the 
latter is serious. 

Laryngoscope. A reflector used 
for examining the throat. 

Larynx. The upper part of the 
windpipe, from which the voice- 
sounds proceed. 

Lassitude . A state of exhaustion 
or weakness arising from causes other 
than fatigue. 

Latent. Not visible, lying hid for 
a time. 

Lateral. Relating to the side. 

Laudanum. Tincture of opium, 
poison. Given in a few drops it re- 
lieves pain and procures sleep; it 
also arrests diarrhea. Sprinkled on 
a poultice or fomentation it allays 
pain. For an overdose the antidotes 
are emetic, external stimulation, walk- 
ing patient about, artificial respiration. 

Laughing-gas. Nitrous-oxid gas, 
given particularly by dentists to se- 
cure short anesthesia. 

Laxative. A mild purgative. 

Lead. The acetate is given in small 
doses as an astringent. The lotion 
evaporates rapidly and is cooling. 
The iodid makes a soothing ointment. 

Lead-poisoning. Difl&cult cases 
to nurse, owing to the frequent severe 
colic. Baths and opium fomentations 
are part of the treatment the nurse 
may have to look after. The diet is 
light but nutritive, with plenty of 
lemonade. Note blue line on gums. 
Lead-poisoning is common among 
painters and other lead-workers. 

Leech. An aquatic worm used for 
the local abstraction of blood. Leeches 
should be kept in a cool place, in a glass 
jar filled with rain- or river-water. 
The top of the jar must carefully be 
covered with muslin. (See p. 102.) 

Le iter Apparatus. Coils or tubes 
of flexible metal designed for appli- 
cation about any part of the body. 
Cold water is passed through the 
tubes, thereby reducing the tempera- 
ture of the parts encased. 

Leprosy. A constitutional malig- 



nant disease, cutaneous in its earlier 
stages, but afterward involving both 
tissue and bone. 

Lesion. Any injury or morbid 
change in the function or texture of 
an organ. 

Lethargy. Unnaturally deep 

sleep; not quite so decided as coma. 

Leukemia. Increase of white cor- 
puscles of the blood. 

Leukocytes. White corpuscles of 
the blood. 

Leukomaines. Certain alkaloids 
developed in living tissue. 

Leukorrhea. A whitish discharge 
from the vagina, commonly called 
the "whites"; a sign of weakness. 
Must be reported to the doctor. 

Levator. A muscle which lifts up 
a part. 

Lichen. A term for a group of 
skin diseases in which the striking 
feature is inflammatory papules. 

Licorice Powder. A preparation 
containing senna; a purge. 

Lieberkiihn's Glands. Tubular 
glands of the small intestine. 

Ligament. A tough band of 
fibrous tissue connecting the bones at 
the joints, or supporting viscera. 

Ligatures. Threads of silk, wire, 
catgut, etc., used to tie arteries or sew 
up parts. The nurse has to see that 
all Ugatures are sterihzed and count 
the number used. Catgut, the most 
common ligature, may be kept in a 
solution of carbolic (i : 10) and cut 
into lengths of 11 inches when re- 
quired for use. 

Lime, Chloride of. A deodorant 
powder. 

Lime-water. Used to dilute milk 
for infants, and generally to counter- 
act acidity. Mixed with equal parts 
of olive oil, it makes carron oil, a 
dressing for scalds and burns. 

Lingual. Relating to the tongue. 

Liniment. A liquid for external 
application. 

Lint. Loosely woven cotton ma- 
terial, having one side smooth and 
the other side rough. As a rule, the 
smooth side is applied next the skin. 
The name "Hnt" is also given to 
scraped or unravelled linen, though 
the proper term for this is "charpie." 

Liquor Amnii. The watery fluid 
in which the fetus floats. 

Liquores. Solutions of active 
substances in water. 



GLOSSARY. 



455 



Liquor Sanguinis. Liquid por- 
tion of the blood. 

Lister ism. Antiseptic surgery. 

Lithemia. An excess of lithic 
acid in the blood, producing gouty 
dyspepsia. 

Lithia. An alkali, given in gout, etc. 

Lithoscope. Instrument for ex- 
amining the bladder. 

Lithotomy. Operation of cutting 
into a bladder to remove a stone. 

Lithotrity. Operation of crushing 
a stone in the bladder. Nursing ! 
treatment similar to that in lithotomy, 
but the urine must be measured and 
strained, and all fragments of stone 
kept for the surgeon's inspection. 

Lithuria. Excess of lithic or uric 
acid and its salts in the urine. 

Litmus Paper. Used in testing: j 
acid turns the blue paper red; alkali 
turns the red paper blue. 

Litre. About i quart; or 33.81 
fluidounces. 

Liver. The organ which secretes 
the bile; it is situated in the abdomi- 
nal cavity on the right side. A yellow 
tinge of the skin marks derangement 
of the liver; the nurse must be care- 
ful that her patient gets no chill. 

Lobe. Roimded division of an 
organ. 

Lobelia. A drug used as an anti- 
spasmodic, and also in enemata. May 
cause poisoning. 

Lochia. The discharge following 
confinement; it is for two days al- 
most pure blood, then turns reddish 
gray, and becomes clear by the ninth 
day, and then ceases. 

Lock-jaw. (See Tetanus) 

Locomotor Ataxia. Impaired 
gait in walking, due to a disease of the 
spinal cord. 

Lordosis. Anterior curvature of 
the spine. 

Lotion. A solution for external 
use. Evaporating lotions are used 
to procure local coldness. Lead lotion 
or eau-de-Cologne and water are the 
commonest. 

Lubrication. Making smooth, 
oily, or slippery. 

Lumbago. A rheumatic affection 
of the loins; painful but not serious. 
Cold must be avoided. Rubbing in 
of such liniments as turpentine and 
chloroform, or aconite, may fall to the 
nurse's share; or galvanic currents or 
hot baths. 



Lumbar. The region of the loins, 
right and left of the umbilicus. 

Lunar Caustic. Nitrate of silver, 
used to cauterize wounds or arrest 
the growth of proud flesh. 

Lungs. The two organs of respira- 
tion, situated in the right and left 
side of the cavity of the chest. For 
nursing treatment of congestion of 
the lungs see Pneumonia. 

Lupulin. Hops; the tincture is a 
sedative and stimulant. 

Lupus. A tuberculous disease of 
the skin, most common on the face 
in young people of a consumptive or 
scrofulous tendency. Nourishing diet. 

Luxation. (See Dislocation.) 

Lying-in. Pertaining to the state 
of childbirth; parturition. 

Lymph. A colorless alkahne fluid 
found in the lymphatic vessels. 

Lymphadenitis. Inflammation of 
the lymphatic glands. Tonics and 
nourishing diet. 

Lymphatics. Small vessels per- 
vading the body, and containing 
lymph. 

Lysis. Gradual decline of a fever. 

M. 

Macrocephalous. Very large 
headed. 

Macrocytes. Abnormally large 
corpuscles present in the blood in 
anemia. 

Magnesia. A laxative and antacid. 

Malaria. An infectious disease 
due to the Plasmodium of malaria and 
transmitted by mosquitoes. (See p. 

255-) 

Malignant. An adjective applied 
to very virulent and dangerous forms 
of disease which run a more rapid 
course than the milder forms. 

Malignant Pustule. Anthrax 
contracted from cattle, causing gan- 
grenous carbuncle. 

Malingering. Shamming sick- 
ness. 

Malleolus . A process on the lower 
end of the tibia, also on the fibula, 
which together form the projections of 
the ankle. 

Malleus. A little bone of the 
; middle ear. 

Malpighian Bodies. Small capil- 
j lar>' masses in the structure of the 

kidney. 
I Malpresentation. Unusual pres- 



456 



APPENDIX. 



entation of the fetus at birth; for 
instance, feet first. 

Malta Fever. An infectious dis- 
ease seen chiefly along the shores of 
the ^Mediterranean, but also in Porto 
Rico and Alanila. The incubation 
period is from six to ten days. The 
fever is intermittent, rising and fall- 
ing through irregular periods. There 
are neuralgic pains, swelling of the 
joints, constipation, and anemia. The 
nursing is the same as that of typhoid 
fever. 

Mammae. The breasts, or milk- 
supplying glands. 

Mammary. Relating to the 

breasts, 

Mammitis. Inflammation of the 
breasts, generally occurs during lac- 
tation, and points to improved diet. 

Mandibulum. The lower jaw. 

Manganese. A drug used in skin 
diseases, in diseases of the kidney, 
and also to induce menstruation; it 
is tonic in its action. 

Mania-a-potu. Drink madness; 
delirium tremens (g. v'). 

Manikin. A small representation 
of the human body used for teaching 
purposes. 

Manipulation. Rubbing and 
working with the hands to procure 
some healing result. 

Marasmus . Simple wasting of the 
tissues due to malnutrition. It occurs 
in infants, and independent of any or- 
ganic disease, is due to bad hygiene and 
improper feeding. 

Massage. Scientific rubbing and 
manipulation of the body; strength- 
ens the tissues and restores tone gen- 
erally, acting as mild and thorough 
exercise for the patient. All move- 
ments are from the extremities toward 
the heart, and consist of kneading, 
rolling, beating, and rubbing move- 
ments. Effleurage, tapotement, and 
petrissage (which see) are the terms 
used for the chief movements, though 
each school of massage has its own 
terms and methods. 

Masseter. A strong facial muscle 
which moves the lower jaw. 

Masseur. A male practitioner of 
massage. 

Masseuse. A female practitioner 
of massage. 

Mastitis. Inflammation of the 
breast. 

Mastoid. Having the shape of the 



breast. Mastoid process, the pro- 
truding part of the temporal bone 
felt behind the ear. 

Mastoiditis. Inflammation of the 
mastoid cells; a disease which calls for 
early diagnosis and prompt treatment, 
as it may lead to great destruction of 
bone tissue, and find entrance to the 
brain, causing meningitis or brain ab- 
scess. 

Materia Medica. The branch of 
medical science which deals with the 
character and use of drugs. 

Maxilla. The jaw-bone. Inferior 
maxillary is the bone of the lower 
jaw. 

Measles. An eruptive fever com- 
mon in children. First stage of coryza 
is infectious; the rash appears on 
the third day, commencing on neck 
and face, and lasting three days. 
Keep the patient in bed and feed with 
light diet. Watch for bronchitis or 
inflammation of the eyes or ears. A 
cough is usual in measles. The 
period of infection is supposed to last 
a month. German measles is a milder 
disease, the rash appearing on the 
fourth day, the period of incubation 
being ten days. Convalescence is 
usually rapid and uninterrupted. 

Meatus. An opening into a pas- 
sage. Meatus urinarius, the orifice 
of the urethra. 

Meconium. A black, sticky sub- 
stance voided from the bowels of an 
infant during the first day or two of 
its life. 

Median. In the middle; an imag- 
inary longitudinal line dividing the 
body down the centre; mesial. 

Medulla Oblongata. The en- 
larged portion of the spinal cord where 
it enters the base of the brain at the 
back of the head. 

Medullary. Relating to the mar- 
row. 

Melancholia. Morbid depression, 
a form of insanity. Watch for con- 
stipation. 

Melena. A discharge of black 
blood from the bowels. 

Membrane. A thin expanding 
tissue lining the cavities of the body. 
False membrane is a growth caused 
by inflammation, as in diphtheria. 
Mucous membrane, the continuation 
of the skin which lines those internal 
cavities and organs exposed to or 
communicating with the air. 



GLOSSARY. 



457 



Meninges. The membranes of the 
brain. 

Meningitis. Inflammation of the 
membranes of the brain, a serious 
disease, often ending fatally. Cerebral, 
that effecting the membranes of the 
brain; spinal, of the spinal cord; cere- 
brospinal, of the brain and spinal cord 
both. 

Meningocele. Protrusion of the 
brain membranes (and often also the 
brain tissue) through the skull. 

Menopause. Change of Hfe; the 
cessation of the menses, occurring 
about the forty-fifth year, and gen- 
erally a somewhat critical period. 

Menorrhagia. Excessive flow of 
the menses; may be due to many 
causes. Rest, flat on the back, and 
hot vaginal douches are almost cer- 
tain to be left to the nurse to see 
carried out. 

Menorrhea. The menstrual flow. 

Menses. The menstrual flow. 

Menstruation. Monthly dis- 
charge from the vagina, common in 
healthy females between the ages of 
thirteen and forty-five. 

Menthol. A local anodyne. 

Mercurialism. Poisoning caused 
by long use of mercury. 

Mercury. An alterative and pur- 
gative given hypodermatically and 
internally in cases of syphilis and in 
skin diseases. It is a poison in large 
doses, and the antidotes are white of 
egg and milk and water. (See Mer- 
curialism.) 

Mesentery. A large portion of 
the peritoneum to which the small 
intestines are attached. 

Mesmerism. The control of one 
will over another; the influence be- 
ing supposed to be obtained by 
making passes with the hands. 

Metabolic. Pertaining to metab- 
olism, the process whereby the tissues 
are renewed, nourished, and perform 
their functions. 

Metacarpus. The five bones of 
the hand joining the fingers to the 
wrist. 

Metastasis. Shifting of a disease 
from one organ to another. 

Metatarsus. The five bones of the 
foot between the ankle and the toes. 

Metritis. Inflammation of the 
womb. 

Metrorrhagia. Bleeding from the 
uterus other than at the period. 



Miasm. A noxious emanation gen- 
erating in marshy localities; loosely 
and incorrectly applied to malaria. 

Microbes. Germs capable of 

rapid increase; disease-germs or bac- 
teria. 

Micrococci. Microscopical or- 
ganisms of spherical form. 

Micturition. The act of passing 
urine. 

Midriff. The diaphragm or muscle 
which divides the chest from the ab- 
domen. 

Midwife. A w-oman trained to 
attend confinements, and fulfil all 
duties so long as the labor is a nat- 
ural one. 

Midwifery. Obstetrics; the knowl- 
edge necessary to performing the 
duties of a midwife. 

Migraine. Headache usually 

known as "sick headache" coming 
on periodically. 

Miliaria. Prickly heat; an afifec- 
tion due to sweat-secretion and want 
of action of the skin. Sometimes 
occurs after operations or fevers, and 
causes rise of temperature. 

Minim. The sixtieth part of a 
fluidrachm; practically one drop. 

Miscarriage. Premature birth of 
an infant before seventh month. 

Mitral Valve. The valve of the 
heart between the left auricle and the 
left ventricle. 

Modus Operandi . The method of 
operating. 

Molluscum. Skin disease, either 
conlagiosum, common in childhood, 
or fibrosum, involving the tissue. 

Monoplegia. Paralysis of one limb 
only. 

Monster. A creature bom of 
woman, but so malformed as to have 
but slight resemblance to a human 
being. 

Mons Veneris . The eminence just 
over the os pubis in women. 

Morbid. Unn'atural, diseased. 

Moribund. In a dying state. 

Morning Sickness. The nausea 
of pregnant women, occurring chiefly 
in the early months of gestation. 

Morphine. A vegetable alkaloid 
used as a sedative or anod5''ne. In- 
jected under the skin, it causes the 
pain to decrease, and sleep is in- 
duced. An overdose causes death, 
chiefly by paralysis of the muscles of 
respiration. Stimulation, artificial res- 



458 



APPENDIX. 



piration, and an emetic are the anti- 
dotes. 

Morphinism. Chronic poisoning 
from indulgence in morphin. 

Mortification. The death of a 
part, gangrene. Always serious; the 
nurse must pay great attention to 
cleanliness and use disinfectants. 

Movements. The evacuations of 
the bowels, which it is the duty of 
the nurse to note on her nursing chart 
in every case, and call the attention 
of tne doctor if they exceed 2 in the 
24 hours (except in children), or if the 
patient goes more than 24 hours 
without any. The nurse should also 
note if they are streaked with blood, 
contain mucus, or undigested food, or 
worms. The color should be noticed; 
it is Uke pea-soup in typhoid, light in 
jaundice, green in mercurialism. 

Mucoid. Resembling mucus. 

Mucopurulent. Containing mu- 
cus mingled with pus. 

Mucus. A viscid fluid of the body 
secreted by the mucous membranes. 
Mucus in the urine shows as a heavy 
white sediment, clinging to the bottle 
when it is shaken. 

Multipara. A woman who has 
had more than one child. 

Mumps. Parotiditis. A highly 
infectious swelling of the salivary 
glands. Keep the patient isolated in 
a warm room; take the temperature 
night and morning; give light nutri- 
tive diet. 

Murmur. A sound of the heart 
or the lungs heard upon ausculta- 
tion. 

Muscle. The contractile tissue of 
the body, the means of animal motion. 
Muscular tissue forms the fleshy part 
of the body. Involuntary muscle, one 
not under the control of the will. The 
organs of the body are supplied with 
involuntary muscles. 

Mutter. To utter with imperfect 
articulation, or in a low murmuring 
tone. 

Mycoid. Resembling a fungus. 

Mydriatics. Drugs used to dilate 
the pupil of the eye. 

Myocarditis . Inflammation of the 
muscular tissue of the heart. Often 
follows acute rheumatism: chances 
of recovery small. 

Myopia. Near-sightedness. 

Myotics. Drugs which cause the 
pupil to contract. 



Myrrh. A stimulant and astrin- 
gent of vegetable origin. 

N. 

Naboth's Glands. Small gland- 
ular bodies situated at the neck of the 
uterus. 

Naphthalin. An antiseptic and 
expectorant. Given for indigestion. 

Narcosis. A state of unconscious- 
ness produced by the use of nar- 
cotics. 

Narcotic. A medicine which in- 
duces sleep. 

Nares. The nostrils. 

Nasal. Relating to the nose. 

Nates. The buttocks. 

Nausea. A feeling of sickness, but 
without actual vomiting. 

Navel. The umbilicus, the point 
of connection of the cord. 

Necrosis. Death of a part; usu- 
ally applied to bone. Where there is 
dead bone there is always a sore, and 
pieces of dead bone at times work 
out through the sore: they should 
always be kept for the doctor to 
see. 

Negative Pole. That connected 
with the least active plate of a galvanic 
battery. 

Negativism. In mental disease, 
opposition in thought and action to 
everything that is suggested. 

Nematoid. Thread-worms. 

Neonatorum. Of the new-bom. 

Neoplasm. A new growth or 
tumor. 

Neoplasty. Any operation which 
restores lost tissue. 

Nephritis. Inflammation of the 
kidney. Measure and test m-ine, and 
watch for renal casts, pus, etc. Put 
patient between blankets. 

Nephrotomy. Cutting into the 
kidney. 

Nerve. A bimdle of fibres con- 
veying sensation and volition to and 
from the organs. Motor nerves are 
those nerves which, passing jrom 
a nerve-centre, convey an order 
of motion; the opposite of sensory 
nerves, which, passing to a nerve- 
centre, convey a sensation to the 
brain. Optic nerve, the nerve of 
sight arising in the occipital lobe and 
distributed to the retina of the eye. 
Sympathetic nerve is one of a system 
which controls the blood-vessels and 
the viscera. Vasomotor nerves are of 



GLOSSARY. 



459 



two kinds, those which cause con- 
traction, and those which cause dila- 
tion, of vessels. 

Nervous. Connected with the 
nerves; applied to low fevers and 
similar affections. 

Nettle-rash. (See Urticaria^ 

Neuralgia. Pains of a nerve or 
nerves; if of the sciatic nerve it is 
sciatica; or tic-douloureaux or hemi- 
crania if of the nerves of the face. Very 
often neuralgia of one part is a symp- 
tom of disease elsewhere, and, there- 
fore, neuralgia should always be 
watched and reported. 

Neurasthenia. Nervous exhaus- 
tion. No cases are more trying to a 
nurse than those where the nerves are 
disordered. The patient is weak and 
fanciful, and needs to be treated with 
sympathy, yet with firmness; the 
nurse must be cheerful but quiet, pa- 
tient and forbearing, yet strict in car- 
rying out the doctor's orders. 

Neuritis. Inflammation of a nerve. 

Neuroses. A class of diseases 
connected with the nervous system, 
which are functional instead of or- 
ganic. 

Neutral. Neither acid nor al- 
kaUne. 

Nevus. A birth-mark, a congenital 
blemish of the skin, often curable if 
the attention of the physician is 
called to it in time. 

New-born. A designation applied 
to the child for a short period after 
its birth. 

Nicotinism. Illness caused by 
overindulgence in tobacco. 

Nictitation. Involuntary winking 
of the eyelids. 

Nipple. The small eminence in 
the centre of each breast. 

Nipple-shields. Coverings of 
glass or India-rubber put on the 
nipples to protect them when they are 
sore. 

Nitrate of Silver. Lunar caustic; 
used in the form of a pencil to arrest 
bleeding from a leech-bite or other 
small wound by its styptic action. 
Also to check the growth of proud 
flesh. As an astringent lotion (i or 2 
per cent.) it is used to bathe the 
eyes in cases of ophthalmia. Salt 
and water is the antidote in case of 
poisoning. 

Nitric Acid. A corrosive fluid 
used in testing for albumin, etc. 



Minute doses, prescribed for indi- 
gestion, should be given after food, 
through a tube. If allowed to fall on 
the finger, it burns the skin. The 
antidotes for poisoning are alkalies, 
white of egg, and milk. 

Nitrite of Amyl. Useful as an 
inhalation in angina pectoris, and in 
some cases of poisoning. 

Nitrogen. A colorless gas enter- 
ing largely into the composition of 
the air we breathe. 

Nitroglycerin. An oily liquid, 
highly explosive, used as a heart 
stimulant, and for neuralgia, etc. 
Sometimes causes headache. Must 
never be teken near a light. Poi- 
son. 

Nitrous Oxid. Laughing gas; an 
anesthetic used for short operations, 
especially by dentists. 

Nodule. A little knob. 

Noli-me-tangere . A name given 
to bad ulcers, especially if on the 
face, and of syphilitic or cancerous 
origin. In dressing them the nurse 
must certainly be careful to "touch 
them not," and to use disinfectants. 

Non compos mentis. Not of 
sound mind. 

Normal. The ordinary and proper 
state. Thus the temperature of the 
body in health is 98.6°, and this is said 
to be normal. The normal respira- 
tion in an adult should be about 18 a 
minute; the pulse about 72 a minute. 

Nostalgia. Home sickness, or 
longing for home, so strongly devel- 
oped as to cause serious bodily ill- 
ness. 

Nostril. One of the external ori- 
fices of the nose. 

Nostrum. A quack medicine, or 
one of which the ingredients are kept 
secret. 

Nullipara. A woman who has 
never had children. 

Nutrient Enema. A substance 
that nourishes by rectal injection. 

Nux Vomica. The drug from 
which strychnine is derived. It is 
used as a nerve tonic and in cases 
of gastric affection, and also in paral- 
ysis. In large doses it is poisonous, 
and the antidotes are an emetic, tan- 
nin, chloroform or ether inhalation. 

Nsmaphse. Two folds of mucous 
membrane on either side of the vagina; 
the lesser or inner Hps which protect 
the orifice of the vagina. 



460 



APPENDIX. 



Oakum. The fibre obtained by 
picking old tarred rope into pieces. 
Used to some extent in surgical dress- 
ings. 

Oatmeal. The meal made from 
oats. 

Obesity. Excessive fatness. 

Obsession. An imperative idea. 

Obstetrician. One who practises 
obstetrics. 

Obstetrics . That part of medicine 
and nursing which is connected with 
midwifery, and with the operations 
and illness due to the bearing of 
children. 

Obstruction. Stoppage or block- 
ing up of a canal or opening of the body. 

Occipital. Relating to the back 
of the head. 

Occiput. The back of the head. 

Occlusion. Closure. 

Ocular. Relating to the e\^e. 

Oculist. An eye specialist. 

Odontalgia. Toothache. 

Odontoid. Tooth-like. 

Official. Term applied to medi- 
cines which are in the "Pharmaco- 
peia." 

Ohm. Unit of resistance in gal- 
vanism. 

Oidium. A parasitic fungus. 

O'idiiim albicans, the fungus causing 
thrush in children. 

Oiled Silk. Silk impregnated with 
boiled oil, semitransparent, and 
waterproof; used in the antiseptic 
dressings of wounds. Prepared in 

rolls about 5 yds. long, and in widths 
of 2%, 29, and 32 inches. 

Ointment. A soft application 
having healing virtues, usually con- 
sisting of lard impregnated with some 
drug. Ointment should be spread on 
lint with a palette-knife, and applied 
next the sore. 

Oleaginous. Oily. 

Olecranon. The bone composing 
the point of the elbow. 

Olfactory. Relating to the sense 
of smell. 

Olive Oil. An oil made from the 
fruit of the olive tree, and used as a food 
or as medicine, applied internally or 
externally. Mixed with lime-water in 
equal parts it forms carron oil, which is 
extensively used for bums. 

Omentum. A fold of fat in front 
of the intestines. 



Onychia. Inflammation of the 
matrix of a nail. 

Oophorectomy. Removal of the 
ovaries. 

Oophoritis. Inflammation of the 
ovaries. 

Opacity. Want of transparency, 
cloudiness. 

Operation. An act, especially a 
surgical act, upon the body. Opera- 
ting-table, the table on which a 
patient lies during a surgical opera- 
tion. 

Ophthalmia. Inflammation of the 
eye. Once contracted, the cure is 
chiefly in the hands of the nurse; 
for constant care is alone successful. 
Cloths used about the eyes must be 
promptly burnt, and the nurse must 
wash her hands in disinfecting fluid, 
for ophthalmia is contagious. Gran- 
ular ophthalmia is a chronic form 
with granulation of the Uds. 

Ophthalmia Neonatorum. 
Ophthalmia of the new-born. 

Ophthalmoscope. A small instru- 
ment fitted with a magnifying glass, 
and used to examine the eye. 

Opiate. A drug which causes 
sleep. 

Opisthotonos. A spasm which 
arches the back; seen in severe cases 
of tetanus. 

Opium. A preparation of poppy- 
juice, much used to induce sleep and 
to allay pain. It contracts the pupil. 
Children are specially susceptible to 
the influence of opium. In large 
doses it is a poison, the antidotes 
being external stimulation, cold water 
to the face, an emetic. 

Optic. Relating to the sight. 

Orbit. The bony cavity which 
holds the eye. 

Organ. A part constructed to ex- 
ercise a special function. Organs of 
generation, those that are functional 
in reproduction; the genitalia. Pel- 
vic organs, those situated in the pel- 
vis. Urinary organs, those concerned 
in the secretion and excretion of the 
urine — the kidneys, bladder, ureters, 
and urethra. 

Organic. Relating to the organs; 
thus, organic disease of the heart 
means that the structure itself is af- 
fected; whereas, if the evil is inor- 
ganic it may be the result of mischief 
elsewhere, causing functional de- 
rangement of the heart. 



GLOSSARY. 



461 



Orthopedic. Relating to the cure 
of deformities in children. 

Orthopnea. Breathlessness, the 
patient needing always to maintain 
an upright position. 

Os. A bone; also the mouth, as 
of the uterus. 

Os Calcis. The bone of the heel. 

Os Externum. Entrance to the 
uterus. 

Os Internum. The inner orifice 
of the uterus. 

Os Uteri. The mouth of the 
womb. 

Osseous. Like bone. 

Ossification. Hardening into 
bone. 

Ostalgia. Pain in a bone. 

Osteitis. Inflammation of a bone. 

Osteomalacia. Softening of the 
bones. Test urine. A lengthy and 
fatal illness. 

Osteomyelitis. Inflammation of 
the soft tissue of bone. Apt to oc- 
cur after fracture or bone injury. If 
there is a tendency to tuberculosis, it 
becomes tubercular. 

Osteotome. A surgical saw for 
sawing bones. 

Osteotomy. An operation on a 
bone; generally breaking and reset- 
ing it, as is done in the case of bow- 
legs. An anesthetic is used; the pa- 
tient has to be kept quiet, and is put 
in spUnts. 

Osteotribe. An instrument used 
for scraping bone. 

Otalgia. Ear-ache. 

Otitis Media. Inflammation of 
the middle ear, marked by rolling of 
the head and severe pain. 

Otorrhea. A purulent discharge 
from the ear. In all diseases of the 
middle ear there is fear of penetra- 
tion to brain and fatal termination. 

Ounce. In fluid measure about 
two tablespoonsful. 

Ovarian Tumor. A tumor of the 
ovary. May be cystic and grow to a 
tremendous size, and may contain 
hair, teeth, or sebaceous matter. 

Ovaries. Two small, oval bodies 
situated on either side of the uterus, 
the female organs in which ova are 
formed. 

Ovariotomy. Excision of an 
ovar\-; a serious operation, the nurs- 
ing treatment of which is ver>' im- 
portant. 

Ovaritis. Inflammation of an 



ovarj-, ver>' painful, and likely to de- 
press the patient. 

Overdistention. The state of 
being e.xcessively stretched or dilated. 

Oviduct. The Fallopian tube be- 
tween the ovar>' and the womb, con- 

\ veying the ova. 

1 Ovisac. Small vesicles found near 

! the surface of the ovarj-. 

j Ovum. The egg: the embryo from 

I which the fetus grows. Plural, ova. 

I Oxalic Acid. A poisonous acid 
obtained from wood sorrel. Antidotes: 
Chalk and magnesia. 

Oxygen. A colorless, odorless 
gas which is a necessarj^ element in the 
maintenance of life. Oxygenation of 
the blood purifies it and changes its 
color from blue to red. Inhalations 
of pure oxygen gas in heart and chest 
cases are often a great help in the 
treatment. 



Pack. A compress of a wet sheet 
or blanket which envelops the patient 
\ completely with the exception of the 
head. It may be hot or cold, according 
i to the effect desired. (See p. 99.) 
i Packing. Inserting gauze strips 
j into a cavity for the purpose of allay- 
ing hemorrhage or of draining a 
wound. 

Pads. Little pledgets of cotton 
enclosed in antiseptic gauze, and used 
instead of sponges. 

Paget 's Disease. A bright raw 
patch on the nipple that after some 
time develops into a cancer. 

Pain. Bodily or mental suffering. 
1 Griping pain, a spasmodic pain in the 
bowels. (See also Bearing-down pains 
and Labor-pains) 

Palate ._ The roof of the mouth. 

Palliative. A medicine which re- 
heves but does not cure. 

Palpation. Examination by the 
hand. 

Palpitation. Rapid throbbing of 
the heart. Should always be reported 
to the doctor. Keep the patient at 
rest during the attack. 

Palsy. The popular name for 
paralysis (which see). 

Panacea. A medicine alleged to 
cure all diseases. 

Pancreas. A long, flat gland be- 
*hind the stomach; it supplies a juice 
which aids digestion to the duode- 
num. 



4^3 



APPENDIX. 



Pancreatin. The active principle 
of pancreatic juice. 

Pancreatitis. Inflammation of the 
pancreas. 

Papilla. A small eminence; gen- 
erally applied to the nipple. 

Papule. A small, solid pimple. 

Paquelin's Cautery. A galvano- 
cautery on the syringe and ball sys- 
tem, in which the heat is obtained by 
benzoline vapor driven over plat- 
inum. 

Paracentesis. Tapping for dropsy; 
performed on the abdomen, chest, 
etc., to discharge the fluid secreted. 
(See Aspiration)) 

Paraldehyde. A swift soporific, 
having a pungent taste. As it is of an 
oily, unpleasant nature, it is usually 
given in stimulant (brandy) in the 
proportion of i to 3. It taints the 
breath. Poison. Antidotes: Friction, 
strong cofi'ee. 

Paralysis . Partial or complete loss 
of sensation and power due to structu- 
ral changes in the brain, spinal cord, or 
nerves. (See p. 289.) Infantile 

paralysis occurs in children usually im- 
der four years of age. The prognosis 
for complete recovery is not good. 
(See p. 315.) 

Paralytic Stroke . A sudden com- 
plete attack of hemiplegia. 

Paraphimosis. Retraction of the 
prepuce behind the glans penis. 

Paraplegia . Paralysis of the lower 
half of the body, including the bladder 
and rectum. 

Parasite. Any Kving thing which 
draws its nourishment from another 
living thing. 

Paregoric. Camphorated tincture 
of opimn used to relieve pain. 

Parenchyma . The spongy part of 
an organ. 

Paresis . A slight form of paralysis. 

Parietal. The two bones which 
form the vault and sides of the cra- 
nium. 

Parietes. The sides of any cavity 
of the body. 

Paronychia. Inflammation and 
abscess at the end of a finger near the 
nail. 

Parotid. Near the ear; applied to 
a conglomerate gland under the ear. 

Parotitis. Mumps (which see). 

Paroxysm. Periodical increase of 
disease. 

Parturient. Child-bearing. 



Parturition. The act of bringing 

forth young. 

Patella. The knee-cap. 

Pathogenesis. The origin and 
progress of disease. 

Pathological. Relatmg to pathol- 
ogy; morbid. 

Pathology. The study of the 
changes in structure and in function 
that occur in disease. 

Patulous. Open, wide. 

Peccant. Not healthy. 

Pectoral. Relating to the chest. 

Pedicle. The foot-stalk which 
forms the neck of a tumor. 

Pediculus. The louse, a parasite 
infesting the hair and skin. An oint- 
ment will be ordered. The head may 
have to be shaved. If the lice are on 
the body, see that all clothing is dis- 
infected. Great cleanliness neces- 
sary. 

Pellagra. An epidemic disease of 
Southern Europe which has recently 
appeared in the southern parts of the 
United States. It is said to be caused 
by eating diseased maize, but is also 
dependent on bad hygienic condi- 
tions. It is marked by a recurring 
eruption on the body, which is fol- 
lowed by scaling off of the epidermis. 
There is also weakness, debility, di- 
gestive disturbance, spinal pain, con- 
vulsions, melancholia, and idiocy. 

Pellicle. A thin skin or mem- 
brane. 

Pelvic. Relating to the pelvis. 

Pelvimeter. An instrument for 
measuring the size of the pelvis. 

Pelvis. The bony basin composed 
of the hips and the lower bones of 
the spine, and holding the bowels, 
bladder, and organs of generation. 

Pemphigus. A skin disease which 
is marked by eruptions of large bUsters. 

Pendulous. Hanging down. 

Peppermint. Carminative and 
stimulant. A household remedy for 
flatulence and stomach-ache. 

Pepsin. The ferment of gastric 
juice, which chiefly causes digestion 
of the food in the stomach. 

Peptonized Food. Food which 
has been partially digested by arti- 
ficial means. 

Percussion. Striking upon the 
chest, the sound heard being helpful 
in diagnosis. Place one finger of the 
left hand flat on the part to be exam- 
ined, and strike sharply with the ends 



GLOSSARY. 



463 



of the three fingers of the right hand, 
holding them at the same length. 
There is a certain degree of resonance 
in the sound emitted, but this is dulled 
when there is fluid in the lung, or the 
lung is soUd. Only a practised ear 
can detect and learn from the degrees 
of resonance, but the fact of dulness 
can be detected by a nurse, and may 
be useful to her. 

Perforation. A hole in an organ 
caused by disease. 

Perforator. An obstetrical in- 
strument for opening the cranium of 
the fetus. 

Pericarditis. Inflammation of the 
outer coat of the heart; apt to follow 
in cases of acute rheumatism or 
typhoid. Perfect rest, light diet, in- 
creasing watchfulness to anticipate 
all the patient's wants. The remedies 
ordered must be kept ready at hand. 
The patient will probably breathe 
better if propped up by plenty of 
pillows. On no account should the 
patient be permitted to make a sud- 
den movement. 

Pericardium. The outer mem- 
brane or sac which holds the heart. 

Perineorrhaphy. Operation for 
repairing a perineum ruptured during 
labor. ^ 

Perineum. The space between 
the anus and the genital organs. 

Periosteum. The membrane cov- 
ering a bone. 

Peripheral. Relating to the cir- 
cumference or outer surface. 

Peristaltic. The worm-like con- 
tractions and movements of the in- 
testines in forcing onward their con- 
tents. 

Peritoneum. The membrane or 
sac which holds the intestines and 
viscera generally. 

Peritonitis. Inflammation of the 
peritoneum. The symptoms are shal- 
low breathing, vomiting, pinched fea- 
tures, abdominal pain with knees 
drawn up, and rapid pulse. May 
follow any abdominal operation, 
therefore these symptoms must be 
watched for, and at once reported. 
Treatment differs with the doctor in 
charge. A cradle must be placed 
over abdomen. Collapse must be 
feared. In peritonitis with perfora- 
tion of the bowel, the operation of 
laparotomy may be performed. The 
convalescence is slow, and care is 



needed for a long time. Death may 
occur from exhaustion. 

Peroneal . Pertaining to the fibula. 
A branch of the posterior tibial artery. 

Peroxide . Oxide containing ■a. large 
preponderance of oxygen. 

Peroxide of Hydrogen. A power- 
ful antiseptic and germicide; used as 
a disinfectant in diphtheria, etc., and 
as an antispasmodic. 

Pertussis. Whooping-cough; a 
contagious spasmodic cough, com- 
mon in childhood. The first ten days 
the patient should be kept indoors; 
the disease runs its course in from 
two to three months. Watch for chest 
complications. 

Pessary. An instrument worn in 
the vagina to prevent or remedy pro- 
lapse of the uterus; generally in the 
shape of a ring or a ball, and made 
of gutta-percha or vulcanite. 

PetechioB. Small red spots on the 
skin. 

Petrissage. A massage move- 
ment, consisting in picking up and 
rolling the muscles between the 
thumb and fingers — it is slow and 
continuous. 

Petroleum. A mineral oil; anti- 
septic and expectorant. Used to ex- 
pel worms. 

Petrous. Stony; a term given to 
a hard part of the temporal bone. 
_ Peyer's Patches. Small glands 
situated on the surface of the intes- 
tines. 

Phagedena. Ulcers or wounds, 
which spread rapidly and slough. 

Phagocytes. Free cells of the 
body (leukocytes, endothelial cells, 
etc.) that counteract the action of dis- 
ease microbes. 

Phalanges. The small bones of the 
fingers and toes. 

Pharmacopeia. An authorized 
handbook of directions for com- 
pounding medicines. 

Pharmacy. The science of prepar- 
ing and mLxing medicines or drugs. 

Pharyngitis . Inflammation of the 
pharynx. 

Pharjrnx. The membranous sac 
at the back of the mouth and leading 
to the stomach. 

Phenacetin. An antipyretic in the 
form of a tasteless, reddish powder. 

Phlebitis. Inflammation of the 
veins. It often occurs following in- 
fectious diseases. The affected part 



464 



APPENDIX. 



must be kept quiet. The limb should 
be elevated and ice-bags applied. The 
part must never be rubbed, as this 
might dislodge the clot. 

Phlebotomy. Bleeding a patient 
b}' opening a vein in the arm. 

Phlegm, Thick expectoration 

coughed up in chest diseases. 

Phlegmasia Alba Dolens . Com- 
monly called ''milk leg," a form of ^ 
phlebitis occurring sometimes after | 
labor and ■ in other conditions. The 
leg becomes swollen, white, and 
tense, and is ver>' painful. Shghtly 
raise the hmb on a pillow, and ar- 
range it so as to give as much ease 
as possible. The danger is of the 
clot moving and going to the heart 
and causing sudden death. The 
swelling usually begins to go down 
after the ninth day. Gentle friction 
after the eighth week may be used. 

Phleginatic. Sluggish. 

Phobia. A morbid fear. 

Phonetic. Relating to the voice. 

Phosphate. A compound of phos- 
phoric acid and a base. Phosphates 
in urine appear as a dense, white de- 
posit; a few drops of nitric acid dis- 
solves them at once. 

Phosphorus. A non-metallic ele- 
ment, used as a tonic and stimulant. 
It must not be allowed to come in 
contact with water. Give after food. 

Phosphuria. Excess of phosphates 
in the urine. 

Photophobia. Dread of light, a 
symptom of inflammation of the ej'es. 

Phthisis. Consumption; tuber- 
cular disease of the lungs. The pa- 
tient must be weighed, the diet nour- 
ishing, chills avoided, temperature 
taken, and the sputa noted as to color 
and amount. The night-sweats are 
often a distressing symptom, leaving 
the patient weak and wretched, and 
necessitating much patience and care 
in providing warm, dry changes. In 
cases of pjnrexia, the temperature 
must be taken during the attack. 
The patient should wear wool only; 
see that the bed-clothes are light. 
Before washing or dressing the pa- 
tient, and immediately after, give 
some stimulating food. If hemor- 
rhage comes on, give ice to suck. 
Note if the urine is scanty. 

Physiology. The science which 
treats of living bodies, and the laws 
which govern them. 



Physostigmin. Another name 
for eserin, used to contract the pupil 
and diminish intra-ocular tension. 

Pia Mater. The fine membrane 
surrounding the brain and spinal cord. 

Piles. Enlarged veins about the 
rectum; hemorrhoids. Bleeding piles 
cause discharge of blood; blind piles 
do not. 

Pilocarpi!!. A drug which causes 
increased salivation and perspiration. 

Pipette. A small graduated tube 
for taking up hquids. 

Pityriasis. A scaly skin disease. 
The serious varietj^ rubra, is most 
common in men of middle age. Diet 
nourishing, no stimulants. Rosea, 
which is most common in children, 
is not so obstmate to cure. 

Placebo. Medicine given to please 
the patient, often only tincture of 
orange or bread pills. 

Placenta. The after-birth; a cir- 
cular, flesh-Uke substance surround- 
ing the fetus, and expelled from the 
womb after the birth of the child. 

Placenta Praevia. Presentation 
of the placenta before the fetus. In 
these cases hemorrhage must be 
feared. 

Plague. An extremely infectious 
disease caused by the Bacillus pestis, 
which invades the blood and organs 
of the patient. It is communicated 
by flies, fleas, rats, mice, and dogs. 
It occurs in three forms: the bubonic, 
the septicemic, and the pneumonic. 
There is headache, backache, and 
mental depression. There is a chill 
followed by fever. The tongue be- 
comes brown; the glands, especially 
those of the groin, swell, forming 
buboes, w^hich maj' soften and re- 
solve or else suppurate and break 
through the skin. An eruption of 
plague spots may appear over the 
body. Death occurs in three or four 
daj's, except in the septicemic and 
pneumonic forms, when it occurs in 
twenty-four hours. The first consid- 
eration in the nursing is to prevent 
the spread of the disease. The cloth- 
ing, urine, feces, sputum— in fact, 
everything that has been in contact 
with the patient — require immediate 
and rigorous sterilization. The bod- 
ies of the dead should be cremated. 
Convalescents should be kept isolated 
for a month after the disappearance 
of the fever. The buildings exposed 



GLOSSARY. 



465 



to contamination should be fumi- 
gated. The patient should be kept 
as comfortable as possible, the fever 
being combated in the usual way. 
The nurse must keep herself free 
from infection by the use of corro- 
sive sublimate, carbolic acid, and al- 
cohol solutions. 

Plantar. Relating to the sole of 
the foot. 

Plasma. The liquid in which the 
corpuscles of the blood float. 

Plaster of Paris. Used for pre- 
paring bandages for slight fractures. 
Rub the dry powder into a crinoline 
muslin bandage and pass it through 
a basin of water as it is used. For 
the ordinary bandage, mix the plaster 
of Paris with cold water into a cream 
(an assistant must stir the cream con- 
stantly or it will harden), place the 
bandage in plain water, and re-roll 
in the plaster of Paris. 

Plasters. Used for keeping 

wounds together, binding sores, and 
applying medicaments to different 
parts of the body. The spreading of 
plasters is sometimes left to the nurse. 
Take a piece of glazed muslin and 
stretch it on a board with drawing- 
pins, spread the plaster hot with the 
edge of a warm knife. To apply a 
surgical plaster cut it into convenient 
strips, and hold the wrong side against 
a tin filled with hot water; this is a 
cleaner method than dipping the 
plaster into hot water. In removing 
plasters, commence at the corners 
and work toward the centre; never 
pull away from the wound, or you 
may tear it open. The marks left 
by plasters can be removed wdth 
chloroform. 

Pledget. A small compress of 
lightly rolled lint. 

Plethora. Fulness; an excess of 
blood. 

Pleura. The membranous bag 
which holds the lung and lines the 
cavities of the thorax. 

Pleurisy. Inflammation of the 
pleura. This, like all chest cases, 
needs careful nursing; it is often 
found in conjunction with pneumonia 
or phthisis. Temperature every 4 
hours; poultices will probably be 
ordered; temperature of room 65°; 
fever diet. The sputa must be 
watched. In cases of effusion, aspi- 
ration may be performed. Great care 

30 



is necessary in convalescence, and 
woolen vests must be worn. 

Pleuro-pneumonia. Pleurisy 
combined with pneumonia. The term 
is usually applied to a certain cattle 
disease. 

Pleximeter. An ivory disk or 
other hard substance placed on the 
body to receive the stroke in mediate 
percussion. 

Plexus. A network of vessels or 
nerves. 

Pneumogastric . Relating to the 
lungs and the stomach, and applied 
to certain nerves, etc., connecting 
these two parts. 

Pneumonia. Inflammation of the 
lungs. Single pneumonia means one 
lung only is affected; double pneu- 
monia, that both lungs are diseased. 
Nearly every physician has a differ- 
ent method of treating pneumonia, 
but the most common nursing treat- 
ment is to keep the patient in bed, in 
a room with temperature of 65°; 
jacket poultices every four hours; 
temperature every four hours; keep 
a steam kettle going; liquid stimu- 
lating food frequently. Some physi- 
cians, instead of stimulating diet, ap- 
ply hot jacket poultices. Others, 
again, instead of poultices, apply ice- 
bags or Leiter tubes. The sputa 
must be kept for the inspection of the 
doctor. The crisis usually comes 
about the end of the first week, if 
delayed beyond the ninth day the 
case is critical; the convalescence 
takes three weeks. Relapse is al- 
ways to be feared, and flannel vests 
must be worn. 

Pneumothorax. Air in the pleu- 
ral cavity. Causes shock, which 
is usually met with stimulants and 
opiates. Light food frequently. As- 
piration may have to be performed. 

Pock-marks. The pits left by the 
small-pox pustules. 

Podophyllum. A drug used as a 
purge and as an alterative. 

Poison. A substance capable of 
producing noxious and even fatal 
effects when absorbed by the system. 
For a classification of poisons and 
their antidotes see p. 231. 

Polarization. The tendency to a 
reverse current in the battery cell. 

Politzer Bag. An India-rubber 
bag with long tube and nozzle. Used 
in ear cases, etc. 



466 



APPENDIX. 



Polyclinic. A large general hos- 
pital. 

Polyemia. Excess of blood. 

Polyuria. Excessive flow of urine 
of low specific gravity, and con- 
sequent thirst of patient. Measure 
urine. Nourishing food. Avoid chills 
and make the patient wear flannels. 

Popliteal. Behind the knee; a 
term given to a certain artery. The 
continuation of the femoral artery, etc. 

Pore. A small opening. 

Positive Pole. The pole of a gal- 
vanic batterj', by which electricity 
fiows out from the generator. 

Position. Posture or attitude of 
the body in obstetric, gj-necologic, 
or surgical examination and operation. 
The dorsal position is lying on the back; 
the knee-chest position is the patient 
on the knees; Sims' position is the 
patient l5dng on left side. (See pp. 
153-158-) 

Posthumous. After death; a 
posthumous child is one born after the 
father's death. 

Post-mortem. The opening and 
examining of a dead body. 

Post-partum. After labor. Posl- 
partum hemorrhage is bleeding after 
the child is born. 

Posture. Should be noted by the 
nurse; the knees are drawn up in ab- 
dominal pain; the body lies flat in 
fevers; shoulders raised in chest and 
heart complaint; arms overhead in 
heart complaint; lying on affected 
side in pneumonia; on stomach in 
colic. Slipping off the pillows is a 
sign of exhaustion. 

Potassiiun. A useful alkali; the 
bicarbonate is given in indigestion 
and rheumatic gout: the bromide, in 
nervous diseases, epilepsy, etc.; the 
iodide, in aneurysm, scrofula, etc., and 
to check milk secretion; and the per- 
manganate is a favorite disinfectant. 

Po tt ' S Disease . (See Spinal Cur- 
vature) 

Pott's Fracture. Fracture of 
the fibula close above the ankle, some- 
times also with dislocation of the ankle. 
Usually set in plaster splint. Twelve 
weeks' rest necessary. 

Poultices. One of the most im- 
portant items of nursing treatment 
(see p. 107.) 

Poupart's Ligament. A muscle 
of the abdomen, stretching between 
the ilium and the pubis. 



Precordial. The region in front 

of the heart. Precordial pain, spas- 
modic pain about the heart, not or- 
ganic. 

Predisposition. A state of body 
rendering it specially Uable to certain 
diseases. 

Pregnancy. The state of being 
with child. Usual period 280 days. 
Morning vomiting a marked symp- 
tom. Test urine monthly. Abdomi- 
nal pregnancy, fetation in the abdo- 
men (see also Extra-uterine). For 
signs of pregnancy see p. 129. 

Premature. Occurring before the 
proper time. 

Presentation. Position of the 
fetus at birth. 

Preventive. A medicine or agent 
which prevents the taking of disease; 
prophylactic. 

Primary. The early stage or 
symptom of disease. 

Primipara. A woman who has 
borne a child but once. 

Probang. A slender rod, some- 
times with sponge attached, used to 
remove foreign bodies from the esoph- 
agus. 

Probe. A slender rod, usually of 
silver, used for exploring wounds. 

Proctitis. Inflammation of the 
rectum. 

Prognathous. Forward promi- 
nence of the jaws. 

Prognosis. The art of foretelhng 
the course of a disease. 

Prolapsus Ani. The falHng of the 
membrane of the rectum through the 
anus. Not uncommon in children 
who are constipated, and therefore 
given to straining. Regulate the 
bowels, and when they are acting 
press the buttocks together. 

Prolapsus Uteri. The falling 
down of the uterus into the pelvic 
cavity. 

Promontory. A projection of the 
internal ear. 

Pronation. Downward turning of 
the palm of the hand. 

Prophylactic. A preventive of 
disease. 

Prostate. Heart-shaped gland at 
the neck of the male bladder. When 
enlarged, causes retention of urine. 

Prostration. Extreme exhaustion 
of nervous or muscular force; col- 
lapse. 

Protective . Thin green oiled silk 



GLOSSARY. 



467 



put between the first and second lay- 
ers of gauze in an aseptic dressing. 

Protein. Protoplasm; an artificial 
compound almost similar to white of 
egg. 

Proud Flesh. Too vigorous gran- 
ulation, growing up above the proper 
surface of the wound. May have to 
be touched with caustic. 

Prurigo. A skin disease marked 
by very irritable and lasting erup- 
tions. Tar, sulphur, and naphthol 
may be applied locally, or by means 
of vapor baths. 

Pruritus. Local skin irritation, 
generally of the genitals. Medicated 
baths and soothing ointments may be 
ordered. 

Prussic Acid. Violent poison 
found in bitter almonds, laurel 
leaves, etc. Antidotes: Alkalies, 

chlorkie, cold water dashed on face 
and neck. (See Hydrocyanic Acid) 

Psoas. Two muscles of the loin; 
a psoas abscess is a chronic abscess of 
the loins. These abscesses are most 
wearisome cases to nurse, and need 
the greatest care to avoid sepsis. If 
the dressing is left to the nurse, she 
must be most particular in every de- 
tail. Nourishing diet, cod-liver oil. 
The abscess is usually lanced, a drain- 
age-tube inserted, and an antiseptic 
dressing applied. 

Psoriasis. A scaly skin disease 
of a chronic character. Medicated 
baths, ointments, and arsenic subcu- 
taneously may be part of the treat- 
ment to be carried out by the nurse. 

Psychical. Relating to the mind. 

Ptomaines. Minute alkaloid bod- 
ies found in putrefying matter, and 
of a poisonous nature. 

Ptyalism. Excessive flow of sa- 
liva. Sometimes a symptom of mer- 
curiaHsm. 

Puberty. The period of develop- 
ment of the generative faculties or 
when reproduction first becomes pos- 
sible. 

Pubes. The hair-covered region 
about the genitals. 

Puerperal. Related to child-bear- 
ing. 

Puerperal Fever. Septicemia; 
fever following labor, and due to 
contagion. Note the temperature and 
pulse every four hours. Be extremely 
careful to use antiseptics freely. 
The fever is usually acute, reaching a 



crisis in a few days; then if the tem- 
perature, pulse, and respiration de- 
creases, recovery is possible. Death 
usually results from exhaustion. 

Puerperal Mania. Usually begins 
from 4th to loth day after childbirth, 
with pain in head, restlessness, and in- 
somnia. Never leave patient alone; 
keep the child and the family away. 

Puerperium. The period from 
childbirth to the time when the uterus 
or womb has regained its normal size; 
about six weeks. 

Pulmonary. Relating to the lungs. 

Pulsatilla. A drug used particu- 
larly in cases of arrested menstruation. 

Pulsation. Beating of the heart, 
or of the blood in the arteries. 

Pulse. The heart's beat felt in an 
artery near the surface, taken at the 
wrist in the radial artery, at the temple 
in the temporal artery, at the neck in 
the carotid, or at the ankle in the tibial 
artery. (See p. 40.) 

Pupil. The round opening in the 
center of the iris. 

Purgative. A medicine for caus- 
ing evacuation of the bowels. Should 
be given on an empty stomach. 

Purpura. A serious skin disease 
marked by purple patches, caused by 
the escape of blood from the vessels 
into the skin. Complete rest in hor- 
izontal position and nourishing diet. 

Purulent. Pus-like. 

Pus. The product of suppuration. 
Laudable or healthy pus is cream col- 
ored, not offensive, and not very thick. 
Unhealthy pus is brownish, offensive, 
and clotted. If stringy, it is a sign 
of scrofula. Pus in the urine shows 
as a white sediment, thick and ropy; 
it gelatinizes when liquor potassae is 
added. 

Pustule. A pimple containing 
pus. 

Putrefaction. The rotting away 
of animal matter. Decomposition ad- 
vanced to an offensive stage. 

Pyelitis. Inflammation of the 
pelvis of the kidney. 

Pyemia. Blood-poisoning caused 
by pus-producing microorganisms in 
the blood, and marked by the pres- 
ence of abscesses. It usually occurs 
about the second week after an injury 
or operation. Be very careful not to 
convey the contagion elsewhere. Diet 
nourishing. Take precaution against 
bed-sores. Use antiseptics freely. 



468 APPENDIX, 

Note the temperature and pulse both 
morning and evening. 

Pylorus. The opening of the stom- 
ach into the intestines. 

Pyrexia. A state of fever. 

Pyuria. Pus in the urine. 

Q. 

Quarantine. A period of separa- 
tion of infected persons from others, 
necessary to prevent the spread of 
disease. 

Quartan. A fever rising and fall- 
ing in periods of four days. If quinine 
is given, note if it arrests the parox- 
ysms. 

Quickening. The first movements 
of the fetus in the womb, usually felt 
by the mother at the end of the fourth 
month. 

Quicklime. Unslaked Ume. 

Quinine. An alkaloid obtained 
from_ cinchona. It has remarkable an- 
tiperiodic properties, and is particu- 
larly useful in intermittent fevers. It 
should be given before food. 

Quinsy. Inflammation and en- 
largement of the tonsils. (See Ton- 
sillitis) 

Quotidian. A fever having a pe- 
riod of twenty-four hours. If quinine 
is given, note if it arrests the parox- 
ysms. 

R. 

Rabies. Madness in animals; hy- 
drophobia. 

Racemose. Glands having numer- 
ous branched tubes. 

Rachitis. Rickets; a constitu- 
tional disease of childhood, marked 
by curving of the spine or long bones 
and enlargement of the joints. Light, 
air, good food, and soap and water are 
the best cures for rickets, but if the dis- 
ease is far advanced, splints may have 
to be appUed, and raw-meat juice and 
cod-liver oil be given. Rickety chil- 
dren are specially liable to colds, and 
must be warmly yet lightly clad. 

Radial. Relating to the radius. 
Radial artery is the smaller of the 
two terminal branches of the brachial. 
Begins at the bend of the elbow and ex- 
tends along the radial side of the fore- 
arm, passes around the outer side of the 
carpus, and forward to the palm. 

Radical. That which goes to the 
root; thus, radical treatment aims at 
an absolute cure, not a palliation. 



Radius. The smaller bone of the 
forearm, from the elbow to the wrist. 

Rale. Slight rattling sound heard 
in the air-passages upon auscultation. 

Rash.^ {See Eruption.) 

Reaction. The effect produced in 
response to treatment. 

Reagent. One substance used as 
a test for another. 

Reaumur. A temperature scale 
of 80 equal degrees, from freezing- (0°) 
to boiUng-pouit. 

Recrudescence. Return of bad 
symptorns, especially fever. 

Rectitis. Inflammation of the rec- 
tum. 

Rectocele. Prolapsus of the rec- 
tum through the vagina. 

Rectum. The lower end of the 
large intestine from the colon to the 
anus. 

Rectus. Straight; applied to cer- 
tain muscles. 

Recurrent. Returning again. 

Reducible. A term given to such 
hernias, dislocations, etc., as can be 
replaced. 

Reflex Action. Involuntary ac- 
tion caused by irritation of an afferent 
or sensory nerve. 

Regimen. A rule of diet. 

Regurgitation. A backward flow 
of blood through defective valves; an 
eructation. 

Relapse. A return of disease after 
convalescence has once begun. 

Relapsing Fever. A contagious 
fever due to starvation. Light nour- 
ishing diet given very frequently; 
fresh air, warmth, and cleanUness. 

Remittent. Returning at regular 
interv^als; apphed to agues and fevers 

Renal. Relating to the kidney. 

Rennet. A solution of the inner 
coat of the stomach of a calf, in water 
or wine, used for separating milk in the 
preparation of whey or junket. 

Repair. (See Healing.) 

Resistance. In electricity the 
non-conducting force of certain bodies 
to the current. 

Resorcin. Antiseptic and anti- 
pyretic, used chiefly in dermatology. 
May cause poisoning. 

Resorption. The absorption of a 
fluid or substance previously depos- 
ited. 

Respiration. Breathing. In 
counting a patient's respirations, hide 
the fact of what you are doing; for in- 



GLuSSARY. 



469 



stance, when taking the pulse, note ' 
the respirations. They should be 
in infants 50 to the minute, in chil- 
dren 36, in adults 16 to 18. Note 
whether the breathing is shallow or 
from low down, whether it is regular 
or intermittent. Note in which po- ; 
sition the breathing is easiest, and if 
accompanied by any noise, such as 
the crowing of croup or the snoring 
due to enlarged tonsils. 

Respirator. An instrument worn 
over the mouth to prevent direct con- 
tact with cold air. 

Rest-cure. The mode of treat- 
ment of patients suffering from hys- 
teria and neurasthenia, namely: (i) 
rest, (2) isolation, (3) systematic feed- 
ing, (4) massage and electricity. In- 
troduced into this country and ex- 
tensively used by Dr. S. Weir Mitchell. 

Restless. Deprived of repose or 
sleep; unable to sleep. 

Resuscitation. Reviving those 
who are apparently dead. The Mar- 
shall Hall method of restoring the 
apparently drowned is rolling the 
body over from the back to the side, 
and pressing the chest on the raised 
side. 

Retching. Ineffectual efforts to 
vomit. 

Retention. To hold back. In- 
ability to void urine. 

Retina. The inner membrane of 
the eye, upon which objects are re- 
flected; it is formed by an expansion 
of the optic nerve. 

Retractor. An instrument used 
to keep the edges of a wound apart, 
or to keep back muscles during an 
amputation. 

Retroversion. A morbid, back- 
ward inclination, as of the womb. 

Rheophores. The current-bearers 
of a battery: they are placed directlj^ 
on the organ or muscle to be galvan- 
ized. 

Rheum. Rhubarb: a favorite 
purge. 

Rheumatism. ^ A diseased condi- 
tion of the blood; if acute, it is com- 
monly called rheumatic fever; but it 
may be chronic or muscular. There 
is always great pain, and the nurse 
must so arrange the bed-clothes that 
no weight rests on the affected Hmbs. 
Put the patient between blankets. 
The temperature should be taken 
every four hours. Fever diet. Keep 



the temperature of the room not 
higher than 60°. The two chief causes 
of death in cases of acute rheumatism 
are heart complications and hyper- 
pyrexia. The patient must never be 
allowed to move suddenly, even dur- 
ing convalescence. Cold baths or 
cold packs will probably be ordered 
for hyperpyrexia. Test the urine for 
acid reaction (see p. 294). 

Rhinitis. Inflammation of the 
nose. 

Rhinoscope. Nasal speculum. 

Rhubarb. A favorite household 
medicine given as a purgati\-e. 

Ribs. Long lateral bones en- 

closing the chest, seven pairs of 
true ribs which join the breast bone, 
and five pairs of false ribs. Float- 
ing ribs are the two lower pairs of 
ribs. 

Rickets. (See Rachitis.) 

Rigor. A sudden attack of shiv- 
ering, usually the herald of a dis- 
ease. A nurse should note how 
long the rigor lasts, what the temper- 
ature of the patient was during the 
attack, and the hour of its occurrence. 
Rigors should be immediately reported 
to the nurse in charge. 

Rigor Mortis. The stiffening of 
the body after death. Articulo mortis 
is the moment of death. 

Ringworm. A circular skin erup- 
tion; contagious and very difficult to 
cure if occurring on the scalp. The 
hair should be shaved and a cap of 
oiled silk worn. The ointment ordered 
must be rubbed in daily after wash- 
ing the places with soap and water, 
and the nurse must see that the pa- 
tient's general health is maintained. 
A separate brush and comb and 
towel must be kept for the patient. 

Risus Sardonicus . A convulsive 
grin, symptomatic of lock-jaw. 

Rochelle Salt. An aperient con- 
taining potash and soda. 

Roseola. A rose-colored rash due 
to slight fever, and of no great im- 
portance. 

Rubefacients. Mild irritants 
which cause redness of the skin. 

Rubella. German measles. Keep 
the patient in bed three days, and in 
the house a week. 

Rubeola. Measles (which see). 

Rupture. Hernia (which see). 
Rupture of a blood-vessel means the 
bursting of the same. 



470 



APPENDIX. 



S. 

Sac. A small bag, such as a hernial 
sac. 

Saccharin. _ A substitute for sugar, 
used in diabetic cases; it is usually 
in the form of tabloids, two of which 
(I gr. in each) will sweeten a cup of 
tea. 

Sacculated. Bagged or pursed 
out. 

Sacrum. The lowest division of 
the back-bone, forming part of the 
pelvis. 

St. Anthony's Fire. Erysipelas. 

St. Vitus' Dance. Chorea. 

Salicylic Acid. An antiseptic and 
antipyretic. A favorite drug for allay- 
ing the joint-pains of acute rheuma- 
tism. Causes depression and singing 
in the ears. Steel instruments must 
not be put in this acid. 

Salicylic Wool. An antiseptic 
wool impregnated with the white 
crystals of the acid and a small quan- 
tity of glycerin. This wool must 
not be shaken, or the crystals fall out 
and cause sneezing. 

Saline . Partaking of the nature of 
a salt. 

Saliva. The watery fluid poured 
into the mouth by the salivary glands. 

Salivation. An excessive secre- 
tion of saliva. 

Salol. A white powder composed 
of salicylic and carbolic acids. Given 
internally in acute rheumatism, and 
also used locally as an antiseptic. 
Note any decrease of urine. One of 
the best intestinal antiseptics, used in 
the treatment of intestinal indigestion 
and fermentation. 

Saltpeter. Nitrate of potassium: 
diuretic and sedative. 

Salt Solution. Sodium chloride 
(common salt) dissolved in distilled 
water. In medicine it is employed to 
restore to the system the fluids lost 
by severe hemorrhage, etc. 

Salve. An ointment. 

Sanguineous. Relating to the 
blood. 

Santonin. A worm expeller. 

Usually given in cream. After a few 
doses the sight becomes disordered. 

Sapremia. Poisoning of puerperal 
women by retention of some decom- 
posing matter. The cause being re- 
moved, there is rapid recovery. 

Sarsaparilla. A mild laxative ob- 



tained from the root of a Central 
American vine. Given in strumous 
and skin cases. 

Sartorius. The long muscle of 
the thigh. 

Scab. An incrustation formed 
over a wound. 

Scabies. The itch; a contagious 
skin disease due to a parasitic insfect. 
A sulphur bath will probably be 
ordered (four ounces of sulphid of 
potassium to thirty gallons of water, 
in a porcelain bath), in which the pa- 
tient should be allowed to remain 
for twenty minutes. Disinfect (or 
bum) all the clothing. Vaselin will 
relieve the soreness caused by scratch- 
ing. 

Scalds. Cover up the scalded 
part with the dressing ordered (Unt 
soaked in carron oil probably), and 
expose the part to the air as little as 
possible. Guard against shock and 
exhaustion. 

Scalpel. A straight knife; chiefly 
used in dissecting. 

Scapula. The shoulder-blade. 

Scarification. Small incisions for 
blood-letting; used instead of cup- 
ping. 

Scarificator. A small box-like 
instrument fitted with many little 
blades, and used to perform scarifica- 
tion. 

Scarlet Fever. Scarlatina; an 
infectious fever accompanied by red- 
ness of the skin, and most common 
in children. Period of incubation, 
four to eight days; rash on second 
day. The rash shows chiefly on 
the chest and back, and lasts about a 
week. Then the fever subsides. Des- 
quamation lasts about five weeks, 
and this is the infectious period. 
Keep the room cool and well venti- 
lated, and a sheet soaked in carbolic 
solution hung over the door. Isola- 
tion is absolutely necessary, as is also 
disinfection and fumigation. (See 

Fumigation.) 

Schizomycetes. A general term 
for all classes of bacteria. 

Schneiderian Membrane . The 
lining membrane of the top of the 
nose. 

Sciatica. Neuralgia of the sciatic 
nerve — the large nerve of the leg. 
A very painful disease. Such local 
treatment as the injection of morphia, 
atropia, or thein, or the application 



GLOSSARY. 



47 



of blisters, or cupping, may be left to 
the nurse. Keep the patient warm. 

Scleroderma. A chronic disease 
of the skin causing hardness. Turk- 
ish baths and rubbing in of lanolin 
or other ointment. 

Scleroma. A hardening of the 
tissues. Scleroma neonatorum, infan- 
tile disease. Rare, very fatal. 

Scoliosis. Lateral cur\-ature of 
the spine. 

Scorbutus. Scur\-y; a skin dis- 
ease marked by dejection and ane- 
mia and caused by want of vegetable 
food. Plenty of green vegetables 
and lemons needed in the diet. Do 
not let the patient sit up or make any 
sudden movement, or syncope may 
be the result. 

Scrofula. Constitutional debility, 
with a tendency to tuberculosis. 
Characterized by swelling and sup- 
puration of the glands of the neck. 
Fresh air, nourishing diet, cod-liver 
oil, and attention to the general 
health are necessary. The glands 
may have to be removed. 

Scruple. A weight equal to 20 
grs. tro\-. 

Scurvy. Scorbutus (which see). 

Sebaceous. Fatty; secreting oily 
matter. 

Seborrhea. Excessive secretions 
of the sebaceous glands. 

Second Intention. The healing 
of a wound by means of granulation, 
or the growing of new skin. 

Secondary Disease. A disease 
consequent on another disease gone 
before. 

Secretion. Substance separated 
from the blood by a natural function 
of the body. 

Section. (See Cesarean.) 

Sedative. A soothing medicine. 

Seidlitz Powder. A popular aperi- 
ent in the form of two powders, 
which, when mixed, effer\-esce. 

Semicircular Canals. Three ca- 
nals of the internal ear. 

Senility. Dechne of power after 
passing the climacteric. 

Senna. A disagreeable rapid aperi- 
ent, usually given as a black draught. 
The syrup of senna is best disguised 
if given in coffee. 

Sepsis. The condition of putre- 
faction. 

Septic. Anything that causes pu- 
trefaction. 



Septicemia. Septic matter in the 
blood; blood-poisoning. Use disin- 
fectants freely. 

Septum. The division between 
two cavities; such as septum ven- 
triculorum, which separates the right 
ventricle from the left. 

Sequelae. Morbid conditions re- 
maining after, and consequent on, 
some former illness. 

Serum. The fluid of the blood in 
which the corpuscles float. 

Shingles. (See Herpes.) 

Shiver. A tremor or shaking of 
the body; often concomitant with or 
sj'mptomatie of fevers, especially those 
of an infectious nature. 

Shock. Sudden prostration due 
to painful impressions; a frequent 
cause of death after operations and 
accidents, especially after bums. It 
is best met by stimulants and warmth. 

Show. A popular name for the 
sanguineous mucous discharge from 
the vagina before labor. 

Sigmoid Flexure. The flexure of 
the descending colon, shaped like the 
letter S; ser\-es to remove the fecal 
matter from the body bj- muscles of 
its own, and ends in the rectum. 

Silkworm Gut . The thread drawn 
from a silkworm killed when ready to 
spin the cocoon. 

Sinapism. A mustard plaster. 

Sinciput. The upper forepart of 
the head. 

Sinew. A tendon uniting a muscle 
to a bone. 

Sinus. A passage leading from an 
abscess, or some diseased part, to an 
external opening. 

Sitz-bath. A hip-bath. (Seep. 89.) 

Sleeping Sickness. (See Trypan- 
osomiasis.) 

Sling. A bandage suspended from 
the neck for the support of a wounded 
arm or hand. 

Slough. Dead matter thrown off 
by gangrene or tilcers. 

Small-pox. (See Variola) 

Sneezing. Convulsive action of 
the respirator>' muscles from irrita- 
tion of the mucous membrane Hning 
the nasal cavity. 

Snoring. (See Stertor) 

Snuffles. The peculiar hard 

breathing noise made by infants af- 
fected with chronic cold in the head. 
I Sodium, The basis of common 
I salt. The bicarbonate is a favorite 



472 



APPENDIX. 



remedy for acidity of the stomach. 
The chloridt is an emetic. The sul- 
phate a cathartic. The nitrate, given 
in epilepsy, etc., may cause serious 
symptoms. Sodamint is a prepara- 
tion given for indigestion. 

Solubility. Capable of being 

dissolved. 

Solution. The product of a solid 
dissolved by a liquid. In therapeu- 
tics, the termination of a disease. 
Solution of continuity, the separation 
of united parts, or division of tissues, 
as from a wound. 

Somnambulism. Walkmg in the 
sleep. 

Sopor. An unnatural profound 
sleep. 

Soporific. An agent which in- 
duces sleep. 

Sordes. The secretions collected 
about the teeth and on the lips in 
fever. 

Souffle. Sound heard on auscul- 
tation. 

Sound. A probe-like instrument 
used for exploring. 

Spasm. Sudden involuntary 

movement. 

Spatula. A flat, flexible, blunt 
knife, used for spreading ointments 
and poultices. Also, in a smaller form, 
used to press down the tongue when 
the throat has to be examined. Every 
nurse should carry a spatula. 

Specific. Apphed to a medicine, 
it means infallible; applied to a dis- 
ease, it means of special character. 

Specific Gravity. The weight 
or density of a substance compared 
with some standard substance — usu- 
ally water in the case of liquids. 

Speculiun. A poHshed instru- 
ment for examining the interior cavi- 
ties of the body. 

Sphincter. A circular muscle 
which contracts the orifice of any 
organ. 

Sphygmograph. An instrument 
afiixed to the wrist, which moves 
with the beat of the pulse and regis- 
ters the rate and character of the 
beats, 

Spica. A spiral bandage done 
with a roller in a series of figure 
eights. Most used for the shoulder, 
groin, thumb, and great toe. 

Spina Bifida. A congenital mal- 
formation of the spine, forming a 
kind of tumor. Found in infants, and 



often terminating fatally. Usual treat- 
ment is tapping and subsequent dress- 
ing of absorbent wool, rather tightly 
strapped on. Watch for convulsions, 
signs of brain mischief, or paralysis. 

Spinal Cord. That part of the 
central nervous system occupying the 
spinal canal. 

Spinal Curvature. Constitutional 
cmving of the spine. When accom- 
panied by caries of the spine it is 
called Pott's disease. A Sayre 
jacket of plaster of Paris, applied 
during suspension, will probably be 
used. Long cases, needing good 
food and prevention of sores and the 
recumbent position. 

Spine. The back-bone or verte- 
bral column. 

Spirometer. An instrument for 
measuring the capacity of the lungs. 

Spissated. Thickened. 

Spleen. An oval body to the left 
of the stomach. Forms and purifies 
the blood. Hemorrhage is peculiarly 
liable to occur after any operation on 
the spleen. Such operations are 
always serious, and need careful 
nursing. 

Splints. Stiff pieces of board or 
material used to secure rest to some 
injured part. The most common are 
wooden splints, but iron, tin, felt, 
gutta-percha, etc., are used. An an- 
gular splint has one part at right 
angles to the other, and is used for 
the arm, the elbow occupying the 
angle. An interrupted splint has the 
part just over the wound removed to 
facilitate the dressing. The nurse's 
duty is to keep splints clean and pad 
them for use. The pads should be 
linen stuffed with antiseptic wool, 
made shghtly larger than the sphnt; 
the padding must be even. The pad 
can either be sown on by cross threads 
on the wTong side of the splint, or 
fastened on by three bands of strapping 
going right around the splint. When 
necessary, the pads near a discharg- 
ing wound should be covered with oiled 
silk. 

Sponge. A porous substance, 
varying in texture, derived from an 
aquatic organism of low order, and 
formerly much used in operations. 
Artificial sponges of absorbent w^ool 
or gauze are now used extensively in- 
stead of the natural sponge. 

Sporadic. A disease which is not 



GLOSSARY. 



473 



epidemic, but occurs in one or two 
isolated cases in a district. 

Sprain. Severe strain of a joint 
without dislocation. Cold-water ban- 
dages is the favorite mode of treat- 
ment, but severe sprains sometimes 
need splints, ice-bags, and all the time 
and trouble given a fracture. 

Sputum. Expectorated matter 
from the mouth. 

Squill. Drug used as an expector- 
ant and diuretic. Overdose poisons. 

Staff. A Uthotomy instrument 
used to guide the knife. 

Stapedius. A muscle of the in- 
ternal ear. 

Stapes. A stirrup-like bone of the 
internal ear. 

Staphyloma. Protrusion of the 
sclera or cornea of the eye. 

Stasis. Defective circulation of 
the blood. 

Stenosis. Contraction of an or- 
gan. 

Stercoraceous. Resembling the 
feces. 

Sterile. Barren; inability to have 
children. 

Sterilization. Rendered free from 
germs; generally by boiling. 

Sternum. The breast-bone. 

Stertor. The rasping, rattling 
sound produced when the larynx and 
the air-passages are obstructed with 
mucus. 

Stertorous. The snoring sound 
of breathing heard in apoplexy, 
etc. 

Stethoscope. A tube used for 
listening to the sounds of the chest 
and heart; one end is placed against 
the patient's chest, and the ear of 
the hstener at the other end. The 
binaural stethoscope has two flexible 
ends to apply to the ears of the listener. 

Sthenic. Strong, active. 

Stigmata. Marks on the skin. 

Stillborn. Bom after the seventh 
month, but without having made a 
complete breath. 

Stillingia. Drug used as a ca- 
thartic; also in cases of syphiUs. 

Stimulant. That which causes 
temporary increase of the vital en- 
ergy'. 

Stomach-pump. An instrument 
used for emptying the stomach by the 
mouth: also to feed refractory pa- 
tients. 

Stomatitis. Inflammation of the 



mouth, and ulceration; most com- 
mon in infants. Attend to the diet, 
give a mild purgative; wash the 
mouth out frequently with a little 
borax. 

Stools. Discharge from the anus. 
(See Motions.) 

Strabismus. Squinting; divergent 
when the eye turns out; convergent 
when it turns in. 

Stramonium. A drug used as a 
sedative. Overdose poisons. 

Strangulated. A hernia which 
cannot be reduced by taxis, but needs 
operation. 

Strangulation. Choking; con- 
striction. 

Strangury. Painful passing of 
urine in drops. Hot sponge to part, 
hot baths, etc., may be ordered. 

Strawberry Tongue . Applied to 
a characteristic clear-red appearance 
of the tongue in scarlet fever after a 
thick white fur has disappeared. 

Stricture. Contraction. Usually 
applied to the urethra, and conse- 
quent inability to pass urine. 

Stridulous. A creaking sound in 
breathing. 

Stroma. The tissue which forms 
the foundation of an organ. 

Strophanthus. A poison, used in 
small doses as a heart stimulant. 

Struma. Scrofula; or a scrofulous 
swelling. 

Strychnine. A poison, used as a 
nerve and spinal stimulant. Anti- 
dotes: An emetic, strong tea, ether 
inhalation. 

Stump. The part of a limb re- 
maining after an amputation. 

Stupe. A fomentation (see p. 105.) 

Stupor. State of unconsciousness, 

Styptic. Agent to arrest bleed- 
ing; astringent. 

Subclavian. Under the collar- 
bone. 

Subcutaneous. Under the skin. 

Subinvolution. A condition of 
imperfect restoration of the uterus to 
its original size after delivery in child- 
birth. 

Subluxation. Sprain and partial 
dislocation. 

Subnormal. Below the normal. 

Subsultus. Involuntary twitch- 
ing. 

Sudor. Perspiration. 

Sudorific. An agent causing per- 
spiration. 



474 



APPENDIX. 



Suffocation. Stoppage of respi- 
ration. Asphyxia. 

Suffusion. Fluid poured out of 
its natural organ into the surrounding 
parts. 

Sugar. A carbohydrate. Levidosc, 
fruit sugar; glucose, grape sugar; lac- 
tose, milk sugar. Sugar found in the 
urine is a symptom of diabetes. 

Suggillation. Livid spots on the 
body. 

Sulphonal. Crystalline tasteless 
substance, used as an hypnotic. Give 
2 hours before bed-time. Note any 
headache next day. 

Sulphur. Use<i as a laxative. The 
ointment is used for skin diseases, 
particularly scabies. 

Sulphuric Acid. Vitriol. A poi- 
son; the antidotes are lime-water, 
potash- water, oil, and milk. 

Sumbul. Antispasmodic and stim- 
ulant. Given chiefly for neuralgia 
and hysteria. 

Sunstroke . Brain mischief caused 
by heat. Symptoms: Headache, sick- 
ness, confusion of ideas, refusal of 
food. Put patient in darkened room 
and keep quiet. Ice to head. 

Superfetation. Supposed con- 
ception by a woman already preg- 
nant. 

Supination. Turning the palm of 
the hand upward. 

Suppository. A soHd medicine 
introduced into the rectum or vagina. 

Suppression. Failure of the kid- 
neys to secrete urine. 

Suppuration. Gathering of pus 
under the skin. 

Sutures. Silk, silver thread, or 
catgut used to sew a wound or tie an 
artery (see p. 187). Also the union of 
flat bones by their margins. 

Swelling. Morbid enlargement of 
a part. 

Symphysis. Growing together of 
bones. Symphysis pubis, the line of 
union of the two pubic bones. 

Symptom. ^ A sign by which dis- 
eases are recognized. 

Syncope . Suspension of the heart's 
action and consequent state of swoon. 
Stimulation, warmth, and artificial 
respiration may have to be tried. Put 
the patient flat on his back and open 
the windows. 

Sjniovial Fluid. The liquid se- 
creted m the ligaments that lubricates 
the joints. 



Synovitis. Infla.mmation of the 
synovial membrane of a joint. 

S3rphilis. Venereal disease, spe- 
cific and contagious. There are three 
stages, the one marked by primary 
symptoms, the second a period of 
outbreak, and the third certain vis- 
ceral and nervous symptoms. In 
dressing all sores in these cases the 
nurse must be most careful to use 
forceps, and to bum soiled dressings. 
Infantile syphilis is inherited; the in- 
fant looks old, head large. (See p. 
262.) 

Syringe. An instrument for in- 
jecting fluids. 

Systole. The contraction of the 
heart in its beat. 



Tabes. Gradual, progressive wast- 
ing; Tabes dorsalis, a progressive dis- 
ease of the spinal cord, marked by 
loss of power over voluntary muscles, 
unsteady gait, and many other symp- 
toms. Locomotor ataxia. Tabes mes- 
enterica,_ tuberculosis of the mesenteric 
glands in infants. 

Tactile . Relating to the touch. 

Talcum. Silicate of magnesia; a 
white, unctuous powder. 

Talipes. Club-foot. Talipes val- 
gus, the foot turned outward; varus, 
the foot turned inward; equinus, the 
heel lifted from the ground; calca- 
neus, heel projecting downward. 

Tampons. Plugs of antiseptic 
wool enclosed in gauze, and used for 
introducing into the vagina, etc. A 
string is usually attached to the plug 
to aid in its withdrawal. 

Tansy. A favorite household 

remedy derived from a common 
plant. Promotes menses, and is a 
diuretic. Poisonous. 

Tape -worm. Tenia (g. v.). 

Tapotement. A massage move- 
ment; the hand is lightly clinched 
and held hammer-Uke, used to beat 
the muscles with swift, short strokes. 
All beating movements are sometimes 
included imder this term. 

Tapping. (See Aspiration.) 

Tar. A thick, black, resinous 

substance obtained from the wood 
of the pine or fir tree. 

Tarsus. The seven small bones 
across the instep. 

Tartar. Incrustation on the teeth 
if they are not kept clean. 



1 



GLOSSARY. 



475 



Tartar Emetic . Potassio-tartrate 
of antimony; an emetic; or in small 
doses a sedative. 

Taxis. Hand manipulation for 
restoring a part to its natural posi- 
tion, such as reducing a hernia. 

Tears. The fluid secreted by the 
lachrymal gland. 

Teeth. The principal organs of 
mastication. There are four kinds 
of teeth — incisors, canine, bicuspids, 
and molars. The first set of teeth in 
childhood are called "milk-teeth," 
which are only temporary teeth. 
They number 20, 10 in each jaw, 
namely, 4 incisors, 2 canine, and 4 
molars. The two middle teeth of 
the lower jaw should appear about 
the seventh month. In the adult the 
permanent teeth consist of 32 teeth, 
16 in each jaw, viz.: 4 incisors (front 
teeth); 2 canines; 5 bicuspids, and 6 
molars. (See Dentition.) 

Temperature. Degree of heat. 
The average temperature of the body 
in health is 98.6° F., but it rises 
slightly at night and falls in the 
early morning. A temperature of 
99 1° 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 
subfebrile temperature is slightly fever- 
ish; subnormal temperature is below 
the normal; an algid body tempera- 
ture is seen in pernicious intermittent 
fevers in which there is great coldness 
of the surface of the body. The tem- 
perature of a sick-room should be 68° 
as a rule, rather lower for surgical 
cases, rather higher for chest cases. 

Temples. The part of the fore- 
head between the outer corner of each 
eye and the hair. 

Temporal. Two bones at the 
side of the skull containing the organs 
of hearing. 

Tenaculum. Small surgical hook 
to secure arteries, etc., and used by 
anatomists in dissection. 

Tendon. White fibrous tissue, the 
continuation of the muscle sheath which 
affords attachment of the muscle to the 
bone. Cord, sinew. 

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 are expelled, 
the worm will grow again. 

Tenotomy. Cutting a tendon 
under the skin by means of a small 
knife especially devised for the pur- 
pose. As a rule, no anesthetic is used. 

Tension. Stretching. 

Tensor. A muscle which stretches. 

Terebene. A preparation of oil of 
turpentine. From 5 to 10 drops on a 
lump of sugar acts as an expectorant. 
A teaspoonful to a pint of water for 
an inhalation. 

Terminals. The extremities of a 
conductor of a battery. 

Tertian. An intermittent fever 
with attacks every third day. 

Testicles. The two glands of the 
scrotum, which secrete the semen. 

Testing. Finding the constituents 
of the urine by means of chemicals. 
The common tests include acid or 
alkali reaction, deposits of urates, 
phosphates or oxalate of Hme; pus, 
blood, chlorides, bile-pigment, albu- 
min and sugar. 

Tetanus. Lock-jaw. Severe 
spasms occur at intervals, during 
which try to prevent the patient 
biting the tongue, or in any way in- 
juring himself. Perfect quiet and 
darkness, as the least irritation re- 
news the spasms. Death may occur 
about the third or fifth day. Food 
and medicine can seldom be taken 
by the mouth in cases of tetanus. 

Therapeutics. That branch of 
medicine which treats of the appli- 
cation of remedies and all forms of 
cure. 

Thermometer. An instrument 
used to measure the degree of heat. 
There are several thermometric scales, 
the one in popular use in America 
being that of Fahrenheit. The dia- 
gram on page 476 presents to the 
eye the difference between the mark- 
ings of the centrigrade and the Fah- 
renheit scales. Clinical thermometer 
is a slender glass instrument used to 
discover the temperature of the body. 
(See Temperature) (See Fig. 6, p. 
45.) 

Thoracentesis. Puncture of the 
thorax, as the tapping for pleurisy. 
Paracentesis. 

Thoracic. Pertaining to the chest 
or thorax. 



476 



APPENDIX. 



Centigrade. Fahrenheit. 



Boiling-point 
of water. 



lOO^ 



go —\ 
80 

70 — I 
60 

50 
40 

30 
20 



Freezing-point ) c 



of water. 



212^ 

194 
— 176 

158 
140 
122 
104 

—S6 
-68 
—50 

■T4 



O 



k 4 



Crimparative thermometric scale. 

Thorax. The chest; the cavity 
which holds the heart and lungs. 

Thread-worm. Small parasitic 
worm in the rectum; common only 
in children. Injections of salt water 
or quassia may be ordered. Oxyiiris 
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) 

Thsrmol. An antiseptic, used as a 
solution or spray, also as an ointment. 

Thymus. A gland at the root of 
the tongue. 

Thyroid. The name of the largest 
cartilage of the larynx, and of a gland 
in the front of the neck. 

Tibia. The shm-bone; the larger 
bone of the lower leg. 



Tibial. Pertaining to the tibia; 
the tibial arteries are the posterior and 
anterior, and pass from the knee to the 
ankle. 

Tic-douloureaux. Neuralgia of 
the face. 

Tincture. An alcoholic solution 
of a drug. 

Tinnitus Aurium. A ringing in 
the ears. 

Tissue. The texture of a part. 
Areolar tissue is the filmy connective 
tissue of the body. Connective tissue, 
the white fibrous tissue which sur- 
rounds and connects the muscles, fat, 
etc., of the body. Elastic tissue, the 
yellow fibrous tissue of the elastic 
ligaments and membranes. 

Tolerance. Capacity to take a 
certain drug. 

Tongue-tie. Immobility of the 
tongue from a short frenum, the fold 
of mucous membrane in the middle 
of the under surface of the tongue. 

Tonic. A medicine which braces 
up the general health chiefly by in- 
creasing the appetite. 

Tonsillitis. Quinsy. Inflamma- 
tion of tonsils. Generally caused by 
cold or weakness. Difficulty in swal- 
lowing, hence give bread and milk 
and soft food. Swelling often dis- 
appears suddenly on fourth day, but 
it may go on to suppuration. (See 
p. 272.) _ 

Tonsils. Two oval bodies, one on 
either side of the throat at the open- 
ing of the pharynx. When these 
glands are removed, rest from talking 
and eating, and ice to suck will be 
the nursing treatment. 

Torpor. Lethargy and want of 
feeling. 

Torsion. Twisting an artery to 
arrest bleeding. 

Torticollis. Wry-neck. Very 

often the least touch about the head in 
these cases wall cause painful spasms, 
so the nurse must be careful. Rest 
and counter-irritation are usually 
tried or, in obstinate cases, an opera- 
tion is performed, and the contracted 
nerve is stretched. 

Tourniquet. An instrument used 
to exert pressure on an artery. 

Toxemia. A poisoned state of 
the blood. 

Toxic. Poisonous. 

Toxicology. Science of poisons. 

Trachea. The windpipe; the 



GLOSSARY. 



477 



air-passage from the larynx to the 
bronchi. 

Tracheotomy. The operation of 
making an opening into the wind- 
pipe, and inserting a tube so that the 
patient breathes through the tube 
instead of through the mouth. This 
is performed in cases such as diph- 
theria, where the membrane is caus- 
ing suffocation; or scalded throat, 
where the swelling is closing the 
laryn.x. The nursing is most im- 
portant. The nurse must remem- 
ber that the tube must be kept clear 
or death will result. Sometimes a 
small piece of flannel wrung out in hot 
water and changed every few minutes 
is kept over the opening of the tube. 

Trachoma. Granular lids. 

Trance. State of unnatural sleep; 
catalepsy. 

Transfusion. The transfer of the 
blood from one person into the blood- 
vessles of another. 

Trapezius. A large muscle be- 
tween the shoulders. 

Trauma. A wound or injury. 
Thus traumatic gangrene is gangrene 
arising from a wound. 

Tremor. Involuntary trembling. 

Trepan. A circular saw used for 
trephining. Old term for trephine. 

Trephining. Removing a circular 
piece of bone from the skull. 

Trichiasis . Turning in of the eye- 
lashes. 

Trichinosis. A disease caused by 
a spiral worm found in swine's flesh, 
and called trichina. 

Tricuspid Valve. The valve of 
the heart between the right auricle and 
ventricle. 

Trismus. Lock-jaw. Trismus nas- 
centium, an infantile disease, very 
fatal. (See Tetanus.) 

Trocar. The perforating instru- 
ment used to draw off fluids from 
the body. 

Trochanter . Two processes at the 
juncture of the neck and shaft of 
femur. 

Troche. A medicinal lozenge. 

Trunk. All the body except the 
head and limbs; also the main stem 
of a nerve or vessel. 

Truss. A bandage or belt for re- 
taining a hernia in place. 

Trypanosomiasis. A tropical dis- 
ease due to the presence in the blood 
of a parasite called Trypanosoma. It 



is marked by irregular fever, emacia- 
tion, swelling of the spleen and lymph 
glands. In Africa it is termed sleep- 
ing sickness, and in this form is also 
attended by apathy, difiiculty in walk- 
ing, drowsiness, and sleep. 

Tuberculosis. Disease caused by 
a bacillus to which there is, as a rule, 
an inherited tendency. Tuberculosis 
of the lungs is called "phthisis." 

Tumefaction. A swelHng. 

Tumor. An enlargement due to a 
permanent morbid growth. Tumors 
may be benign or malignant; in the 
first case, they are not dangerous in 
themselves; in the second case, they 
are. They may also be solid or cystic. 
Phantom tumor is a false tumor of 
the abdomen, due to distention, pecu- 
liar to hysterical women. 

Turgescence. Swelling caused by 
fulness of the blood-vessels. 

Turpentine . Used in washing the 
skin, if it is necessary, to remove all 
grease. Also used to sprinkle on a 
fomentation where counter-irritation 
is required; it must not be left on the 
patient too long. Styptic and anti- 
septic. Relieves flatulence and ex- 
pels worms. Give small dose on 
sugar, large dose suspended in yolk 
of egg. (See Terebene.) 

Tussis. A cough. 

Twitching. Irregular spasmodic 
contractions of the tendons. 

Tympanites . Wind-dropsy ; a dis- 
tended state of the abdomen caused 
by gas in the intestines or peritoneal 
cavity. 

Tympanum. Cavity of the middle 
ear, commonly called the ""drum." 

Tjrphoid Fever. A continued 
fever, usually attended with ulcera- 
tion of the bowels and a rose-colored 
eruption on the abdomen appearing 
on the seventh day. (See p. 239.) 

Typhus Fever. A highly infec- 
tious fever. Rash comes out on sev- 
enth day, crisis about twelfth day. 
(See p. 250.) 



Ulcer. A sore, attended by dis- 
charge. Ulcers are local when con- 
fined to one spot; constitutional when 
liable to appear on different parts of 
the body. They are usually dressed 
with stimulating lotions or powdered 
oxid of zinc, the dressing firmly ban- 
daged on to support the part. 



478 



APPENDIX. 



Ulna. The larger bone of the fore- 
arm from the elbow to the wrist. 

Ulnar. The name of an artery 
and a vein running beside the ulna. 
Ulnar artery is one of the two ter- 
minal branches of the brachial artery. 
Begins just below the bend of the 
elbow, passes to the ulnar side of the 
forearm, thence to the wrist, and crosses 
the palm. 

Umbilical Cord. The funis; the 
cord connecting the fetus with the 
placenta. 

Umbilicus. The navel, the scar 
m the centre of the abdomen where 
the funis was attached. 

Unconscious. The state of being 
without sensibility. 
Unctuous. Greasy. 
Unguentum. An ointment. 
Union. (See First and Second In- 
tention) 

Uniparous. Bearing one at a 
birth. 

Urea. The chief soUd constituent 
of urine. To test for an excess of 
urea, take two drachms of urine, 
concentrate by evaporation to one 
drachm, add equal parts of nitric 
acid, and, if there be an excess, the 
nitrate of urea will crystallize out in 
abundance. 

Uremia. The symptoms due to 
retention in the blood of waste mat- 
ters ordinarily eliminated by the 
kidneys; a manifestation of Bright's 
disease or other disease of the kid- 
neys. Cupping or poulticing over 
the kidneys may be ordered. Meas- 
ure and test lurine. Watch for con- 
vulsions. 

Uremic Convulsion. Bears some 
resemblance to an epileptic seizure. 
Prevent the patient from injuring him- 
self. 

Ureter. The canal between the 
kidney and the bladder, down which 
canal the urine passes. 

Urethane. An odorless, agreeable 
hypnotic. It is the ethyl salt of car- 
bonic acid. 

Urethra. The canal through which 
the urine is discharged. 

Urethritis. Inflammation of the 
urethra. 

Uric Acid._ Lithic acid; its pres- 
ence in urine is discovered by its re- 
semblance in color to Cayenne pep- 
per. Liquor potassae dissolves this 
red deposit. 



Urine. The fluid secreted by the 
kidneys. The normal amount se- 
creted in the 24 hours varies from 30 
to 50 ounces in an adult, 10 to 15 in 
a child, 8 to 10 in an infant. The 
normal color is pale amber and clear, 
the specific gravity is from 1.018 to 
1.025. The reaction should be slightly 
acid, save after meals, when it is 
slightly alkahne. There should be 
no appreciable sediment. The fol- 
lowing may be present in urine and 
discovered by chemical tests: sugar, 
albumin, bile-pigment, chlorides, blood, 
pus, urates, uric acid, phosphates, and 
oxalate of hme. 

Urinometer . A small glass instru- 
ment with a graduated stem, used for 
measuring the specific gravity of 
urine. 

Urticaria. Nettle-rash; a skin dis- 
ease with eruptions causing great ir- 
ritation, generally the result of eating 
some unwholesome food. A soothing 
lotion (lime-water and zinc), dabbed 
on with a sponge, or a hot bath, if 
very severe, will relieve the irrita- 
tion. 

Uterine. Relating to the uterus. 

Utero-gestation. Gestation in 
the uterus. 

Uterus. The womb; a fleshy body 
in the pelvic cavity about 3 inches 
long, and shaped like a pear; here 
the ovum grows during the period of 
pregnancy and the womb enlarges to 
hold it. All operations involving the 
uterus are serious, and must be nursed 
by strict gynecologic rules, especially 
with regard to the use of antiseptics. 

Uvula. A small fleshy body hang- 
ing down at the back of the soft pal- 
ate. When too long it often irritates 
the throat and has to have a piece cut 
off. This is a simple operation in- 
volving no anesthetic, and merely re- 
quiring that the patient suck ice after- 
ward, and take only fluid food for a 
short time. 

V. 

Vaccination. Inoculation of cow- 
pox lymph into the arm as a protec- 
tion from small-pox. Infants should 
be vaccinated before they are three 
months old, unless they have a skin 
eruption or are in bad health. 

Vagina. The passage leading from 
the vulva to the uterus. 

Valerian. A nerve sedative that 



GLOSSARY. 



479 



increases the heart's action, and is I 
often prescribed in nervous and hys- I 
terical complaints. 

Valgus. A bow-legged person. 

Vapor. An inhalation. 

Varicella. Chicken-pox. 

Varicocele. A swollen and dis- 
eased state of the veins of the scro- 
tum. 

Varicose. (See Vein) 

Variola. Small-pox. An infec- 
tious fever marked by an eruption of 
red pimples on the third day. (See p. 

251-) 

Varix. A venous dilatation. 

Varus. Knock-knee. 

Vas. A vessel or duct of the body. 

Vascular. Relating to vessels. 

Vascular System. The system of \ 
blood-vessels. 

Vaselin. A bland ointment pre- 
pared from petroleum, and useful for 
dressings, greasing suppositories, etc. 

Vaso-motor. Regulating the ten- 
sion of blood-vessels. 

Vein. A vessel carrying the blood 
from the extremities to the heart. 
Veins, non-pulsating vessels, which 
convey blood toward the heart. Jug- 
tUar veins, two large veins of the 
neck. Varicose veins, a swollen state 
of the veins due to lack of action of the 
valves. Common in the veins of the 
leg. An elastic stocking and rest on 
a sofa may do good. The danger is 
of the veins bursting, in which case 
pressure must be appUed over the 
bleeding-point, and also rather nearer 
the extremity. 

Venesection. Bleeding; opening 
a vein to let out blood. Provide a 
measuring-glass, into which to receive 
the blood, and a compress and roller- 
bandage for the dressing. 

Venous. Relating to the veins. 

Ventilation. It is part of the 
nurse's duty to see that her ward 
or sick-room is properly ventilated. 
There are very few diseases in which 
it is not permissible to have the win- 
dow open for an inch at the top, 
taking care that the draft does not 
blow straight across the bed. Always 
have a small fire, except in very hot 
weather. 

Ventral. Relating to the belly. 

Ventricles. The two lower cham- 
bers of the heart are known as the 
right and left ventricles. 
Veratruzn Viride. A drug ob- 



tained from the hellebore, and used 
as a depressant. It lessens the circu- 
lation. Overdose poisons. 

Vermicide. A drug used to expel 
worms. Also called vermifuge. 

Vermiform Appendix. A curved 
tube, closed at one end, and opening 
at the other into the cecum. 

Vernix Caseosa. Cheesy stuflf 
covering the fetus. 

Verrucas . Warts. 

Vertebrae. The small substantial 
bones which form the back-bone, or 
vertebral column. There are 24 

vertebrae — 7 cervical (neck); 12 dor- 
sal (back); 5 lumbar (loin). 

Vertex. The crown of the head. 

Vertigo. Giddiness. Any move- 
ment or sense of movement, either 
in the individual himself or in ex- 
ternal objects, that involves a real 
or seeming defect in the equilibrium 
of the body and is associated with 
more or less disturbance of con- 
sciousness. This condition may be 
due to pathologic conditions of the 
ears, the eyes, the brain, the stomach, 
the blood, etc. 

Vesica. The bladder. 

Vesical. Relating to the bladder. 

Vesicant. A blistering fluid. 

Vesicle. A blister. 

Vessels. Canals by which fluid 
is conveyed from one part of the body 
to another. 

Vestibule. A small cavity of the 
ear; also the angle between the 
nymphse. 

Vicarious. When one organ per- 
forms the work of another. For in- 
stance, when bleeding of the nose 
takes place in suppressed menstru- 
ation. 

Villi. Fine soft hairs. 

Vinum. Wine. 

Virulent. Violent, malignant. 

Virus. Contagious matter capable 
of spreading disease if introduced 
into the system. 

Viscera. ' The contents of the 
body cavities. 

Viscid. Sticky and thick. 

Vitreous Humor. The glass-Hke 
fluid in the eyeball, behind the lens. 

Vivisection. Scientific examina- 
tion of a living animal. 

Volatile. That which evaporates 
' quickly. 

Volt. A unit of electric force. 
I Vomit. Involuntary ejection of 



48o 



APPENDIX. 



the contents of the stomach through 
the mouth. 

Vulva. The external organs of 
generation of a female. 

Vulvitis. Inflammation of the 
vulva. 



Water-beds. (See p. 34.) 

Water-brash. Heartburn, with 
flow of bitter water to the mouth 
caused by indigestion. 

Watt. Unit of electrical energy. 

Weaning. The termination of 
suckling. 

Wen. A sebaceous cyst. 

Wharton's Jelly. The gelatin- 
like connective tissue of the umbilical 
cord. 

Whisky. An alcohoUc liquid dis- 
tilled from fermented grain; a stimu- 
lant. 

Whitlow. (See Fe/ow.) 

Whooping-cough. (See Pertus- 
sis?! 

Wine. The alcoholic fermented 
juice of the grape. Port wine, a 
heavy wine from Oporto, Portugal. 
Sherry, a brownish colored wine, 
comes from Spain; the so-called 
"sherry" wines seldom contain any 
wine, being an artificial product. 

Wolffian Bodies. Two fetal ab- 
dominal bodies, forerunners of the 
kidneys. 

Womb. The uterus. 

Wood-wool. An absorbent wool 
used for dressings. 

Wounds. A healthy wound, not 



uniting by first intention, should fill 
up from the bottom, the edges should 
not be red or unequal. An abscess 
wound should pucker and the centre 
sink. 

Y. 
Yellow Fever. An epidemic fever 
marked by a yellow state of the skin, 
black vomit, etc. The fever is in- 
fectious, but the nurse is no more 
liable to catch it than others not in 
attendance on the sick. The first 
feelings are of languor and dyspep- 
sia, followed by twenty-four hours 
of high fever; if, after these twenty- 
four hours, the fever declines, there 
are hopes of recovery. Death may 
result from violent convulsion or 
from exhaustion. A mustard plaster 
to the stomach or hot mustard bath 
allays the sickness and convulsions. 
Beef-tea decreases the exhaustion. 
Mild purgatives are good, and any 
treatment which produces perspira- 
tion. The recovery is slow, and food 
must be given in very small quanti- 
ties, and be very light. Deafness and 
blindness may result. It is now an 
established fact that the mosquito is 
the carrier of the germ of yellow fever. 



Zinc. The chlorid is used as a 
caustic and disinfectant, the sulphate 
as an emetic in cases of poisoning by 
atropin, opium, etc. The ointment 
is used for dressing sores, particularly 
burns and scalds. 



INDEX. 



A. C. E. mixture, 421 
Abbreviations, 400 
Abdomen, 359, 421 

condition of, symptomatic, 53 

flushing of, 65 

pregnant, rate of enlargement, 

131 

Aboulia, 327, 421 

Abscess, 421 
psoas, 467 

Abscesses, cause of, following hy- 
podermatic injections, 85 

Absorption of medicines, rapidity 
of, 78 

Accidents and emergencies, 188 
surgical, 188 

Acetabulum, 421 

Acetic acid, antidotes, 232 

Acid steam-bath, 96 

Acids, 421 

administering, method of, 82 

Acne, 296, 421 

Aconite, 421 
antidotes, 234 

Action of medicines, 78 

Acupressure, 421 

Acupuncture, 421 

Adenitis, 421 

Adenoids, 421 

Adhesive-plaster strapping, 205 
for sprains, 193 
of chest, 206 
of joints, 205 
of ribs, 206 

Adolescence, 422 

Adolescent mental cases, feeding in, 

337 
management of, 336 
Aerobia, 422 
Affusion, 98 

31 



After-birth, 422 

management of, 143 
After-pains, 146, 422 
Ague, 422 
Air, composition of, 346 

night, purity of, 39 

of sick-room, 38 
Air-bed, 34, 422 
Air-cushions, 422 
Alalia, 422 
Albumen and milk, 391 

water, 393 
Albumin, nitric-acid test for, 294 
Albuminuria, 422 
Alcohol, absolute, as antiseptic, 187 

poisoning, antidotes, 234 
Alcoholism, 422, 452 
Aleukemia, 422 
Alienist, 422 

AUmentary canal, 347, 422 
Alkali, 422 
Alkaline waters, 394 
Alopecia areata, 297 
Alum, 422 
Amblyopia, 422 
Amenorrhea, 422 
Ammonia, 422 

antidotes, 233 

use of, in fainting, 222 
Amniotic fluid, 132, 422 
Amputations, 422 

after-treatment in, 197 
Amputation-stump, hemorrhage 

from, treatment, 216 
Amyl nitrite, antidotes, 235 
Amyloid degeneration, 437 
Anatomy, descriptive, 350 

of blood-vessels, 354 

of bones of body, 35c 

of brain, 355 

481 



482 



INDEX, 



Anatomy of cord, 355 

of digestive organs, 359 

of female organs of generation, 
362 

of heart, 354 

of lymphatics, 354 

of muscles, 353 

of nerves, 355 

of organs of sense, 355 

of respiratory organs, 359 

of skin, 350 

of urinary organs, 350, 359 
Anemia, 423 
Anesthesia, 423 

chloroform, 171 

ether, 168 

during labor, 139 

surgical, 168 
Aneurysm, 423 
Angina pectoris, 423 
Animals, rabid, bites of, 235 
Ankylosis, 423 
Anthrax, 423 
Antidotes, 231-235 
Antifebrin, 423 
Antipyrine, 423 
Antisepsis, 183, 423 
Antiseptic douches, 72 

poultices. III 

spray, 424 
Antiseptics, 183, 423 

absolute alcohol, 187 

boric acid, 185 

carboHc acid, 184 

Condy's fluid, 186 

corrosive sublimate, 184 

creolin, 185 

iodoform, 186 

lysol, 185 

permanganate of potash, 185 

peroxid of hydrogen, 186 
Antitoxin, 424 
Anus, 362, 424 

artificial, 424 
Aorta, 342, 354, 424 
Aphthae, 424 
Apnea, 424 
Apoplexy, 424 

cerebral, 286 

consciousness of patient, 288 
diagnosis of, differential, 288 
symptoms of, 287 



Apoplexy, cerebral, treatment of, 

287 
Appendicitis, 282, 361 

catarrhal, 280 
perforation in, symptoms, 280 

causes of, 279 

nursing in, 282 

symptoms of, 282 

treatment of, 282 
operative, 282 
Appendix vermiformis, 281, 361, 

424 
Apples, baked, 384 
Apple-water, 393 
Aqua fortis, 424 
Ann, fracture of, 192 
Arnica, 424 
Arrowroot, 372 

pudding, 378 
Arsenic, 424 

antidotes, 233 
Arteries, 342, 354, 424 

aorta, 354 

axillary, 355 

brachial, 355 

carotid, 354 

femoral, 355 

functions of, 342 

ihac, external, 355 
internal, 355 

peroneal, 355 

popliteal, 355 

puhnonary, 344, 345 

radial, 355 

subclavian, 355 

tibial, 355 

uhiar, 355 
Articulation of bones, 35i> 425 

of extremities, 352, 353 
Artificial anus, 424 

feeding, 444 

respiration in the apparently 
drowned, 224 
in newborn, 141 
in shock, 176 

teeth, care of, 57 
Ascaris, 425 
Asepsis, 183 
Asiatic cholera, 432 
Asphyxia, 425 
Aspiration, 425 
Aspirator, 425 



INDEX. 



483 



Asthma, 276, 425 

position of patient in, 48 
Astigmatism, 425 
Astragalus, 353 
Astringent enema, 66 
Atrophy, 425 
Atropine, 425 

antidotes, 234 
Audiphone, 425 
Auditory canal, 358, 426 

nerve, 359 
Aura epileptica, 290, 426 
Auricle, ear, 358, 426 
Auricles, heart, 344 
Auscultation, 426 
Auto-intoxication, 452 

in nervous and mental diseases, 

325 
Axilla, 353 
Axillary artery, 355 



Back-bone, 352 
Bacteria, 368 
Bag, ice-, 115 

of waters, 132, 426 
Baked apples, 384 

custard, 385 
Baking soda, 418 
Ballottement, 426 
Balneum, 426 
Bandage, breast, 147 

scissors, 194 
Bandages, 195, 426 

chalk-and-gum, 205 

Desault, 198 

divided, 199 

figure-of-eight, 198 

four-tailed, 199 

handkerchief, 200 

m.any-tailed, 199 

piaster-of-Paris, 201 

roller-, 196 

rubber, 195 

Scultetus, 199 

sihcate-of-soda, 204 

spiral, 197 

starch, 205 

T-, 200 
Bandaging, gangrene from, 196 
Barley-water, 393 

enema, 66 



Baths, 58 
action of, 88 

of acid-steam bath, 96 

of cold baths, 89 

of hot baths, 91 
foot-baths, 89 
vapor-bath, 94 

of hot-air bath, 96 

of sheet-bath, 97 

of sitz-bath, 89 

of tepid baths, 89 

of vapor-baths, 88, 94 

of warm bath, 88 
bed-, 91 
bran, 97 
Brand, 90 
Carlsbad, 97 
continuous, 93 
ear, 128 
effervescent, 97 
foot-, 58 

hot foot-baths, 92 
in treatment of scarlet fever, 

248 
medicated, 97 
Nauheim, 97 
neutral, 89, 92 

in typhoid cases, 243 
of infant, 302 
of newborn, 300 
salt-water, 97 
Schott, 97 
shower-bath, 96 
sitz-, 92 
soda, 97 
sponge-, 58, 90 
starch, 97 
sulphur, 97 
surgical, 165 
temperature of, 88 
tepid, 89, 92 

in typhoid cases, 243 
thermometer, 88, 426 
time for gi\ang, 88 
tub-, 59, 89, 90 
Bavarian cream, 384 
Bearing-down pains, 426 
Bed, air-, 34, 422 
for different -cases, 2>2i 
gynecologic, 156 
obstetric^ preparation of, 135 

temporary, 34 



484 



INDEX, 



Bed of rheumatic patient, 295 

preparation of, in case of burns 
or scalds, 221 

sick-, changing clothing of, 32 
preparation of, 30. See also 
Bed-making. 

water-, 34 
Bed-bath, 91 

Bed-clothing, arrangement of, for 
patient, 32 

catching fire, 105 
Bed-cradle, 35, 426 
Bed-cushion, 36 
Bed-making, 33 

cross-bed, 34 

medical bed, 33 

obstetric bed, 34 

surgical bed, 2>2> 
Bed-pads, 36 

Bed-pan, method of using, 59 
Bed-patients, appliances for relief 

of, 35 
Bed-rest, ^d 
Bed-screen, 36 
Bed-sores, 57, 426 

complicating typhoid fever, 245 
Beef, preparations of, for invalids, 

373 
Beef-essence, 374 
Beef-extracts, 374 
Beef-juice, 374 
Beef-tea, 373, 374 

peptonized, 374 

with oatmeal, 375 
Belladonna, antidotes, 234 
Beri-beri, 427 
Beverages, invalid, 389 

permitted sick, 368 
Bichlorid of mercury, 414 
Bile, 361, 427 

digestive action of, 349 
Binder, obstetric, 143, 427 

umbilical, of newborn, 301 
Birth, 427 

normal management after, 142 
management during, 140 
Birth-marks, 427, 459 
Bites, insect, 228 

of rabid animals, 235 
Black draught, 418 
Black-heads, 296, 434 
Bladder, 361, 427 



Bladder, emptying of, 54. See also 
Catheterization. 

washing out, 75 
Blanc-mange, 385 

of rice, 385 
Bland enemas, 66 
Bleeding, 102 
Blisters, 116, 120, 427 

cantharis, 119 

chloroform, 120 

dressing of, 1 20 

perpetual, 120, 427 
Blood, 427 

arterial, 344 

capillary, 214 

composition of, loi 

venous, 344 
Blood-changes, 344, 345 
Blood-circulation, mechanism and 
course, 344 

physiology of, 342 
Blood-poisoning, 181, 211, 427, 471 

from diphtheritic discharges, 255 
Blood-serum, 427 
Blood-supply, fetal, 132 
Blood-vessels, 354 
Blue mass, 414 

pill, 414 

vitriol, 409 
Boas' test-breakfast, 77 
Body-temperature, 42 

taking of, 45 
BoU, 213 

blind, 213 
Boiled-flour gruel, 372 
Bone-repair, 189 
Bones of body, 350 

of extremities, 353 

of skull, 351 

of trunk, 351 
Borax, 418, 428 
Boric acid as antiseptic, 18.5 

poultice, 112 
Bougie, 428 

Bowel obstruction of infancy, symp- 
toms and treatment, 310 _ 
Bowels of patient, condition of, 

protrusion of, m mfancy, 313 
Brachial artery, 355 
Brain, 355 

compression of, 227 



INDEX. 



485 



Brain, concussion of, 226, 434 

congestion of, 435 

nerves of, 355 
Bran bath, 97 

jacket-poultice, 109 
Brand bath, 90 
Bread poultices, 109 

toasted, 383 
Breast, care of, during puerperium, 
146 

fomentations to, 107 

massage of, 146 
Breast-bandage, 147 
Breast-bone, 352 
Breast-pump, 147 
Breath of patient, odor of, 50 
Breathing, 47 

of patient, character of, 5 1 
Bright's disease, 428 
Brimstone, 419 
Broad ligaments, 364 
Bromides, 428 
Bronchi, 359 
Bronchial tubes, 359 
Bronchitis, 274 

treatment, 275 
Broths, 376 
Bruises and cuts, 227 
Bruit, 428 

B runner's glands, 446 
Bubo, 428 

Bubonic plague, 464 
Burnett's fluid, 428 
Burns, 428 

alkali, of eye, treatment, 229 

and scalds, 218 

complications of, 221 
treatment of, 220 

death from, causes, 219 

degrees of, 219 
first degree, 219 
second degree, 219 
third degree, 219 

of acids, 229 

of alkalies, 229 

of eye, 229 
Button suture, 187 



Cacao butter, 429 
Cafe noir, 389 
Caffeine, 429 



Calabar bean, 429 
Calculus, 429 
Calf's-foot jeUy, 385 
Callus, 189 
Calomel, 414, 429 
Cancer, 429 

Cantharis, blistering, 1 19 
Capillaries, 342, 355 
Capsules, gelatin, 82 

medicine, 82 
CarboHc acid, 429 
antidotes, 232 
as disinfectant, 184 
poisoning from absorption, 

185 
poultice, 112 
Carbonic-acid waters, 394 
Carbimcle, 213 
Cardiac dilatation, 311 
Caries, 430 
Carlsbad bath, 97 
Carotid arteries, 355 
Caruncle, 430 
Case-taking, 430 
Castor-oU, 430 

enema, 65 
Casts, 430 
Catalepsy, 430 
Cataract, 430 
Catarrh, 430 

Catarrhal appendicitis, 282 
Catatonia, 337 

feeding in, 337^ 
Catgut, sterilization of, 187 
Catheter, 430 
Catheterization, 54 

after abdominal operations, 180 

in puerperium, 144 

operation of, 74 

precautions in, 73 
Catheters, 73 
Caul, 141 
Caustic, 431 

potash, antidotes', 233 

soda, antidotes, 233 
Cauterization, 121 
Cautery, 431, 462 
Cecum, 361, 431 
Celery soup, 379 
Cerate, 431 

cantharidal, 119 
Cerebellum, 355 



486 



INDEX, 



Cerebral apoplexy, 286 

consciousness of patient in, 288 
diagnosis, differential, 288 
symptoms of, 287 
treatment of, 287 
Cerebrospinal meningitis, 286 

treatment of, 286 
Cerebrimi, 355 
Cervical vertebra, 352 
Cervix uteri, 363 
Cesarean section, 152, 431 
Chalk-and-gimi bandage, 205 
Chalybeate waters, 395 
Chancre, 262 
Charcoal poultice, no 
Charts, sick-room, 29 
Cheyne-Stokes respiration, 47, 432 
Chicken broth, 376 

panada, 381 

soup, 379 
Chicken-pox, 253, 432 
Chilblains, 230, 432 
Childhood, diseases of, 316 
Children, etherization of, 171 

management of, nurse's, 320 

sick, nursing of, 300 
Chills, 432 

reporting of, 51 
Chloral, antidotes, 234 
Chloroform, 432 

administration of, 171 

anesthesia, 171 

symptoms to be watched for, 
171 

blistering, 120 
Chlorosis, 432 
Chocolate, 389 
Cholera, 432 

infantum, 311, 433 

morbus, 284, 433 
Chorea, 318, 433 

complications, 319 

treatment, 319 
Chyle, 349 
Chyme, 349 

Circulation, mechanism and course 
of, 344 

physiology of, 342 

portal, 345 

pulmonary, 345 

systematic, 346 
Circumcision, 433 



Cirrhosis, 433 
Clam broth, 376 
Clavicle, 352, 433 
Cleanhness, antiseptic, 136, 282 
Cleft palate, 433 
Climacteric, 433 
Clonic convulsions, 435 
Clothing, bed-, catching fire, 105 
changing of, 32 
body-, catching fire, what to do, 
225 
changmg of, 55 
of newborn, 301 
Club-foot, 433 
Coal-tar camphor, 415 
Coated tongue in fevers, 49 
Cocain, 434 
Coccyx, 352 
Cochlea, ear, 359 
Cocoa, 389 
Cod-Uver oil, 434 
Coffee, 389 
crust, 389 
French, 389 
nutritious, 390 
percolated, 389 
rice, 390 
Cold, apphcation of, 113 
baths, action of, 89 
douche, 98 

exposure to, death from, 230 
pack, action of, 99 
sponge-bath, 90 
CoUc, infant, 309 
Colitis, 434 
CoUapse, 434 

after surgical operation, 177 
Collar-bone, 352 

fracture, treatment, 102 
Colles' fracture, 445 
CoUodion, 434 
Colon, 361 

ascending, 348, 362 
descending, 348, 362 
flushing, 65 
transverse, 348, 362 
Colostrum, 146, 434 
Colotomy, 434 
Coma \dgil, 240 
Comedones, 296, 434 
Compression of brain, 227 
Concussion of brain, 226, 434 



INDEX. 



487 



Condy's fluid, 434 
Confinement, date of, how to esti- 
mate, 130 
table for computing, 399 

nurse's preparations for, 134 
Congestion, 435 
Conium, 435 
Constipation, 435 

of pregnancy, 133 
Contagion, spread of, prevention, 

239 
Contagious diseases, 236 

fumigation of sick room after, 
263 
Continuous bath, 93 

enteroclysis, 178 

suture, 187 
Convalescence, 435 

diet in, 369 

in nervous and mental diseases, 

337 
of scarlet-fever patient, 249 
of typhoid patie.nt, 246 
Convulsions, 435 
clonic, 435 

in cerebral apoplexy, 287 
infant, treatment, 312 
of pregnancy, 134 
of whooping-cough, treatment, 

271 
puerperal, 151 
tonic, 435 

uremic, 249, 285, 435 
Cord, spinal, 352 

composition of, 356 
nerves of, 356, 357 ^ 
imibilical, compUcating labor, 
141 
dressing of, 301 
tying of, 143 
Corn-flour pudding, 378 
Corrosive sublimate, 435 
antidotes, 233 
as disinfectant, 184 
poultice, III 
Cotton sponges, 193 
Cough of patient, nature of, 50 
Counter-extension, 208 
Counter-irritants, 116 
Cowper's glands, 446 
Coxalgia, 319 
Cracked nipple, 146 



Cradle, bed-, 35 
Craniotomy, 436 
Cream, Bavarian, 384 

of tartar, 416 

of tomato soup, 379 

toast, 383 

tapioca, 386 

whipped, 388 
frozen, 388 
Creamed potatoes, 380 
Creolin^s antiseptic, 185 

poultice, 112 
Creosote, 436 
Crepitation, 436 
Cretinism, 436 
Crisis, 46 
Cross-bed, 34 

Croton oil as counter-irritant, 119 
Croup, 436 

membranous, 268 

simple, 268 

tent, 269 
Croupous pneumonia, 273 

diet in, 274 
Crust •coffee, 389 

Cry of infant, significance of, 316 
Cupping, dry, 104, 436 

wet, 104, 436 
Cups, feeding, 366 
Cushion, bed-, 36 
Custard, baked, 385 

pudding, 378 

sauce, 378 

soft, 385 
Cutis, 350 

Cuts and bruises, 227 
Cyanid of potassium, antidotes, 233 
Cyanosis, causes of, 50 
Cystitis, 75, 437 



Dead, caring for, 298, 437 
Deadly nightshadp, 405 
Decussation of nerv^e-fibers, 289, 

356 
Def-ecation of infant, 303 
Deformity from burns or scalds, 

221 
Degeneration, 437 
Deglutition, 348 
Dehrium, 437 

character of, 51 



488 



INDEX. 



Delirium of scarlet fever, 249 

of small-pox, 252 

of typhoid fever, 240 

tremens, 437 
Delusion, 326 
Dementia, senile, untidiness and 

vulgarity in, 330 
Dengue, 437 
Dentition, 438, 475 
Deodorizers, 438 
Depression, 329 
Derma, 350 
Desault bandage, 198 
Desserts, recipes for, 384 
Diabetes, 291 

insipidus, 291, 438 

mellitus, 291, 438 

treatment, 291 
Diaphragm, 354 
Diarrhea, 438 

acute, treatment of, 285 

infant, 310 

treatment of , 3 1 1 

of pregnancy, 133 
Diastole, 354 
Diet, 438 

after gynecologic operation, 159 

before surgical operation, 166 

during puerperimn, 145 

following appendicitis, 283 
peritonitis, 281 
surgical operation, 180 

in bronchitis, 275 

in cerebral apoplexy, 287 

in cerebrospinal meningitis, 286 

in cholera morbus, 285 

in convalescence, 369 
of typhoid patient, 246 
selection of, 369 

in croupous pneumonia, 274 

in deficient milk-secretion, 147 

in diabetes, 291 

in diarrhea, 284 

in diphtheria, 257 

in dysentery, 285 

in epilepsy, 291 

in gastritis, 280 

in heart diseases, 278 

in measles, 254 

in rheumatism, 295 

in small-pox, 253 

in tuberculosis, 267 



Diet in typhoid fever, 242 
in whooping-cough, 271 
raw-meat, 375 
Dietary of feeble patients, 60 
Diet-kitchen outfit, 369 
Digestion, 347 
intestinal, 349 
stomach, 349 
Digestive organs, 347, 359 
DigitaHs, 439 
antidotes, 234 
poultice. III 
Dilatation of heart, 279 
Diphtheria, 255, 439 
intubation in, 261 
nourishment and stimulants in, 

257 
nursing in, 256 
symptoms, 256 
tracheotomy in, 257 
Dipsomania, 439 

Diseases, contagious, defined, 236 
fumigation after, 263 
spread of, media for, 239 
prevention of, 239 
infectious, cause of, 236 

defined, 236 
miasmatic, 239 
of childhood, 316 
chorea, 318 
incontinence, 318 
meningitis, 317 
mumps, 318 
surgical, 319 
typhoid fever, 316 
of infancy, 309 

bowel obstruction, 310 
cholera infantum, 311 
colic, 309 
convulsions, 312 
diarrhea, 310 
from teething, 313 
ophthalmia neonatorum, 314 
paralysis, 315 
protrusion of bowel, 313 
rickets, 312 
snuflfles, 315 
thrush, 309 
tongue-tie, 315 
vomiting, 311 
worms, 313 
of skin, 296 



INDEX. 



489 



Disinfectants, 183 
Disinfection following diphtheria, 
257 
measles, 254 
small-pox, 253 

formaldehyd, 264 

heat, 187 

in scarlet fever cases, 248 

in typhoid fever, 214 

in typhus fever, 251 

of excreta of consumptives, 266 
of typhoid fever, 241 

surgical, and materials, 183 
Dislocations, iq2, 439 

compound, treatment, 192 

of jaw, treatment, 192 
Disorders of pregnancy, 133 
Divided bandages, 199 
Donovan's solution, 439 
Dont's for nurses, 25 
Dorsal vertebrae, 352 
Dose-list, 402 
Douche, 69 

antiseptic, 72 

cold, 98 

during puerperium, 145 

ear-, 128 

genital, 72 

head-, method of giving, 96 

perineal, 72 

rectal, 72 

Scotch, 99 

spinal, 98 

vaginal, 69 

apparatus for, 69 
for vaginitis in children, 69 
Dover's powder, 439 
Drainage after surgical operations, 

180 
Drainage-tubes, 439 
Drains, 194 
Dress of nurse and personal habits, 

in contagious diseases, 265 
of patient for surgical operation. 

Dressing, infant, 301 
of bums or scalds, 220 
surgical, 193 
dry, 194 
emergency, 193 
instruments for, 194 



Dressing, surgical, moist, 194 
sterilization of, 194 

umbilical cord, 301 
Dressings, 440 

surgical, 193, 440 
management of, 194 

vaginal, 159 
Drip-sheet, 97 
Drops, administering, 81 

and minims, 398 
Dropsy, 291, 440 

complicating scarlet fever, 249 

of glottis from scalds, 2 20 
Drowning, 223 
Drug habit, 79 
Drugs, absorption of, rapidity of, 

Dry surgical dressings, 194 

toast, 383 
Duodenum, 361 
Dura mater, 356 
Dysentery, 283, 440 

symptoms of, 284 

treatment of, 284 
Dysmenorrhea, 228, 440 
Dyspepsia, 440 
Dyspnea of bronchitis, relief of, 275 



Ear, 358 

external, 358 

foreign body in, 227 

internal, 359 

middle, 359 _ 
inflammation of, causes and 
treatm.ent, 248 

syringing of, 127 
Ear-bath, 128 
Ear-douche, 128 
Eclampsia, 134, 151, 440 
Eczema, 296, 440 
Edema, 440 

of glottis from scalds, 220 
Effervescent bath.. 97 
Effleurage, 440, 456 
Egg broth, 376 

flip, 390 

lemonade, 391 

toast, 383 
Egg-nog, 390 
Eggs, 381 

poached, 381 



490 



INDEX. 



Eggs, scrambled, 381 

snow-, 388 

soft-boiled, 381 
Electricity, accidents from, 2 26 
Elephantiasis, 441 
Embolism, 152, 441 
Emergencies and accidents, 188 

common, 214 

duties of nurse in, 166 
Emergency surgical dressings, 193 
Emetics, 441 

in poisoning, 232 
Emprostho tonus, 212 
Empyema, 276 

treatment of, 277 
Endocarditis, 279 
Enemata, 63, 441 

astringent, 66 

bland, 66 

evacuant, 63 

high, 64 

in surgical operation, 165 

method of administering, 63 

purgative, 65 

stimulating, 66, 67 
in septicemia, 183 
Enterectomy, 441 
Enteritis, 441 

Enteroclysis, continuous, 178 
Enterotomy, 441 
Epidermis, 350 
Epilepsy, 289, 442 

treatment of, 290 
Epistaxis, 218, 442 
Epsom salt, enema of, 65 
Ergot, 442 

antidotes, 233 

in hemorrhage of puerperium, 149 
Erysipelas, 211, 442 
Erythema, 297, 442 
Eserin salicylate, 416 

sulphate, 416 
Esophagus, 347 
Ether, 442 

administration of, method of, 168 
to children, 171 

anesthesia, 168 

cone, impro\dsed, 168 

during labor, 139 

obstruction to breathing in, 
method of preventing, 169 
Etiquette, hospital, 23 



Etiquette in private nursing, 24 

Eucalyptus, 442 
Eustachian tube, 359 
Evacuant enema, 63 
Ewald's test breakfast, 77 
Exaltation, 329 

Examination, gynecologic, positions 
for, 153 
preparation of patient for, 152 
Exanthemata, 239 
Excretions, 349 
Exophthalmos, 324 
Expectoration, 443 

character of, 50 
Expiation, 346 
Expulsion, mechanism of, 138 

regulation of, 140 
Extension, 208 

Eye-drops, application of, 125 
Eyes, 357 

bums of, 229 

foreign body in, 228 

inflammation of, in infant, 314 

inserting drops in, method of, 125 

of newborn, care of, 300 

ointment in, method of, 1 26 

syringing of, 126 
of infant, 3 14 



Face, expression of, in sickness, 

SO 
Fainting, 222, 443 
Faintness following discharge of 

amniotic fluid, 139 
Fallopian tubes, 364, 443 
False ribs, 351 

sense-perception, 326 
Farinaceous foods, 372 
Fascia, 354 
Fatty degeneration, 437 

heart, 279 
Favus, 297, 443 
Fears, morbid, 327 
Fecal movements, 458 
Feeding, artificial, of newborn, 304 

by stomach-tube, 77 

cups, 366 

feeble patients, 60 

in adolescent mental cases, 337 

in catatonia, 337 

in hysteria, 338 



INDEX. 



49] 



Feeding in nervous and mental dis- 
eases, zzz 

in neurasthenia, 338 

infant, rules for, 306 

nasal, 77 

of sick, 59 

general rules for, 365 

patient, 59 

rectal, of unconscious patient, 60 
Femoral artery, 355 
Femur, 351, 353 
Fetus, 132 

movements of, 132 
Fevers, coated tongue in, 49 

cold tub-baths in, method of giv- 
ing, 88 
Fibrin, blood-, loi 
Fibula, 353 

Fig\ire-of -eight bandage, 198 
Finger-nails of patient, condition of, 

.52 
Fire, accidents from, 225 

sick-room, management of, 37 
Fish berries, 408 
Fistula, 214 
Fits, epileptic, 289, 444 

treatment of, 290 
Flatulence, 228 
Flaxseed enema, 66 

poultices, 107 

tea, 392_ 
Floating ribs, 352, 469 
Flush, hectic, 448 
Flushing, abdominal, 65 

colonic, 65 
Follicular tonsilHtis, 272 
Fomentations, 105, 444 

action of, 102 

hot- water, 105 

laudanum, 106 

mustard, 106 

to breast, 107 

turpentine, 106 
Fontanel, anterior, closing of, 307 
Food-changes in stomach, 349 
Foods, administration of, before 
surgical operation, 166 

artificial, for newborn, 304 

invalid, recipes for, 372 

beef-teas and extracts, 373 
broths, 376 
desserts, 384 



Foods, invalid, recipes for, farina- 
ceous, 372 
miscellaneous, 380 
oysters, 377 
prepared milk, 382 
puddings, 378 
soups, 379 
toasts, 383 
Meigs', 306 

infant, 306 
record of, taken by patient, 49 
serving of, proper method, 59, 365 
Foot-bath, 58 
hot, 92 

action of, 89 
Forceps, 444 
Forearm, 355 
Foreign bodies, obstruction due to, 

227 
Formalin with potassium perman- 
ganate fumigation, 264 
Fountain syringe, 127 
Four-tailed bandage, 199 
Fowler's solution, 404 
Fractures, 188, 445 
management of, 189 
moving of patient in, 33 
nurse's preparation for surgeon 

in, 191 
removal of patient's clothing in, 

. 55, 190 

signs of, 189 

splints in, application of, 207 

varieties of, 188 
French coffee, 389 
Friar's balsam, 405 
Fricasseed oysters, 377 
Frost-bite, 230 
Frozen whipped cream, 388 
Fuller's earth, 445 
Fumigation, 445 

after contagious diseases, 263, 445 

formaldehyd, 264 

formahn with ' potassium per- 
manganate, 264 

sulphur fumes, 263 
Furuncle, 213 



Gall-bladder, 361 
Gall-stones, 445 
Galvanism, 445 



492 



INDEX, 



Galvanocautery, 431 
Gangrene, 212,445 

dry, 213 ^ . 

from improper bandaging, 196 

moist, 212 
Gargles, 123 
Gastric juice, 349 

digestive action of, 349 
Gastritis, acute, treatment, 279 

symptoms, 279 

treatment, 280 
Gauze, 193 
Gavage, 77 
Gelatin capsules, 82 
Gelsemium, 446 
German measles, 254, 456 
Germs, disease, conditions neces- 
sary for development of, 236 
Glanders, 446 
Glass syringe, care of, 85 
Glauber's salt, 418, 446 
Glonoin, 446 
Glossary, 421 

Glottis, edema of, from scalds, 220 
Glucose, 474 
Glycerin, 446 

enema, 65 
Glycosuria, 446 
Goiter, 446 
Golden seal, 412 
Gonorrhea, 261, 446 
Gout, 294, 447 
Grafting, 447 
Granular ophthalmia, 460 
Gruels, 372 

Guaiacol as counter-irritant, 121 
Gullet, 347 

Gum-arabic water, 393 
Gummata, 262 

Gums of patient, condition of, 49 
Gurgling sounds, 447 



Hair, patient's, dressing of, 56 

washing of, 56 
Hallucination, 326 
Hand, palm of, bleeding from, 

checking, 217 
Handkerchief bandages, 200 
Hands of nurse, care of, 25 
Harehp, 447 
Hartshorn, 403 



Hay-fever, 447 

Head-accidents, 226 

Headache, 447 

Head-douche, 96 

Healing by first intention, 209, 444 

by second intention, 209 

of wounds, 209 

under blood-clot, 210 
Heart, 354, 447 

dilatation of, 279 

diseases of, 277 

fatty, 279 

hypertrophy of, 279 

structure and valves of, 343 
Heart-failure, unconsciousness from, 

treatment, 223 
Heat as disinfectant, 187 

dry, application of, 112 

moist, 105 

of inflammation, cause of, 102 
Heat-exhaustion, 222 
Hectic flush, 448 
Heel-pad, 36 
Hematemesis, 218, 448 
Hematuria, 448 
Hemiplegia, 289 
Hemoptysis, 218, 448 
Hemorrhage, 214 

body-temperature in, 175 

cerebral, 286 

checking, fainting in, 216 
with ice, 216 

during pregnancy, 134 

flexion in checking, 216 

foflowing surgical operation, 177 

from lungs, treatment of, 218 

from nose, treatment of, 218 

from palm, checking of, 217 

from stomach, treatment of, 218 

in surgical operation,''i77 

of amputation stump, checking, 
216 

of pregnancy, treatment, 134 

of typhoid fever, 244 

post-partum, 149 
treatment, 149 

primary, 215 

puerperal, 147 

recurrent, 215 

secondary, 215 

stimulus in, 177 

symptoms of, 215 



INDEX. 



493 



Hemorrhage, thirst yi, 217 

tourniquet in checking, 217 

treatment of, 215 

venous, checking of, 216 
Hemorrhoids^ 448, 464 
Henbane, 412 
Hepatic veins, 346 
Hernia, 448 
Herniotomy, 448 
Herpes circinatus, 448 

zoster, 297, 448 
Hiccough, 54, 448 
High enema, 64 
Hinge- jomt, 353 
Hip-joint disease, 348, 448 
Hives, 297 

Hoffmann's anodyne, 410 
Hookworm disease, 449 
Hop poultice. III 
Hot baths, action of, 91 

foot baths, action of, 92 

pack, 90 

vapor-bath, 88, 94 
Hot-air bath, 96 
Hot-water bag, 449 

fomentation, 105 
Humerus, 353 
Hydrastis, 449 
Hydrocephalus, 449 
Hydrochloric acid, antidotes, 233 
Hydrocyanic acid, antidotes, 233 
Hydrophobia, 235, 449 
Hygiene of children, 320 

of sick-room, 30, 37, 347 
Hyoscyamus, 449 
Hyperpyrexia, 449 
Hypertrophy, 449 

of heart, 279 
Hypnotics, action of, 80 
Hypochondriasis, 450 
Hypodermatic administration of 

medicines, 83 
Hypodermic syringe, 84 
Hypodermics, 450 
Hypodermoclysis, 178, 450 
Hysterectomy, 450 

after-care of, 181 
Hysteria, 338, 450 

rest cure in, 338 

temperature and pulse in, 3 24 

vomiting in, 325 
Hysterotomy, 450 



Ice, action ci, in inflammatory 
process, 103 

in checking hemorrhage, 216 

in treatment of sunstroke, 221 

ser\dng of, to sick, 60 
Ice-bags, 115, 45© 

in heart diseases, 277 
Ice-caps, 116 
Ice-poultice, 112 
Icterus, 361, 450 
Idiocy, 450 

Idiosyncrasy defined, 78 
Ileocecal valve, 361 
Ileimi, 361 
Iliac artery, external, 355, 450 

internal, 355, 450 
Illusion, 327 
Immunity, 237, 450 
Impetigo, 451 
Impulse, 329 

Incontinence of urine, 53, 318, 451 
in children, 318 
in pregnancy, cause of, 133 
Incubator, 451 

improvised, 308 
Indian-meal enema, 66 
Indigestion, 451 

infant, treatment, 310 
Indulgence in nervous and mental 

diseases,_33i, 332 
Infancy, diseases of, 309 
Infant, 451 

artificial feeding of, 304 

bathing of, 302 

cry of, significance of, 316 

defecation of, 303 

development of, 307 

dressing of, 301 

feeding of, care of utensils, 304 
periods of, 306 
rules for, 306 

food, 306, 382 

newborn, care of, 300 

nursing of, 303 

paralysis of, 315, 462 

premature, care of, 308 

pulse of, at birth, 307 
how to take, 316 

pulse-rate of, 307, 316 

respiration of, 47, 316 
artificial, 141 

syphilis of, 474 



494 



INDEX. 



Infant, syringing eyes of, 314 

urination of, 303 

weaning, time for, 307 
Infection, 451 
Infectious diseases, 236 
Inflammation, loi, 451 

from frost-bite, treatrnent, 230 

symptoms of, loi 

treatment of, 102 
Influenza, 271 
Inguinal hernia, 448 
Inhalation, 451 

of medicines, 87 
dry, 87 
moist, 87 
Injection, 451 

intravenous, defined, 85 

of medicines, hypodermatic, 83 
Inoculation, 452 
Insanity, 452 

puerperal, 151 
Insect bites and stings, 228 

in ear, removal of, 227 
Insomnia, 229, 452 
Inspiration, 346 
Instruments for surgical dressings, 

194 
Insufflation, 452 
Intermittent fever, 255 
Interrupted suture, 187 
Intestine, large, 361, 452 

secretions of, 349 

small, 361, 452 
Intoxication, 229, 452 

auto-, 452 

differentiation from apoplexy, 288 
Intravenous injection defined, 85 
Intubation, 452 

in diphtheria, 261 

in scalds of glottis, 220 
Intussusception, 452 
Inunction, 452 

mercurial, 85 

of medicines, 85 
Invagination, 452 
Invalid's lunch, 384 
Inversio uteri, 452 
Involution, 140, 452 
Iodine, 452 

antidotes, 234 

tincture of, as counter-irritant, 
n8 



Iodoform, i86,«4.52 
lodol, 452 
Ipecac, 412, 452 
Irish moss, 387 

blanc-mange, 388 
Iron, 452 

Ironing as counter-irritant, 121 
Isolation, 453 
Itch, 297, 470 
Ivy-poisoning, 234 

Jaborandi, 453 

Jacket-poultice, preparation of, 108 
James' powder, 404 
Jaundice, 361 

Jaw, lower, dislocation of, treat- 
ment, 192 
Jaw-fracture, treatment, 192 
Jellies, recipes for, 385, 387 
Jugular vein, 354 
Junket, 387 



Kidneys, 362, 453 

Kitchen as an operating-room, 161, 

167 
Knee-cap, 353 

fracture of, 190 
Koumyss, 383, 453 



Labia majora, 453 

minora, 453 
Labor, 137, 453 

duration of, 140 

normal, birth in, 137 
conduct of, 140 
first sign of, 137 
stages of, 137 

premature, 453 

preparation for, nurse's, 134 
Labor-pains, 137, 138, 453 

false or true, differential diagno- 
sis, 134 
Labyrinth, ear, 359 
Lachrymal glands, 446 - 
Lactation, 146 

during puerperium, 146 
Lactose, 474 
La grippe, 271 
Laparotomy, 453 
Laryngismus stridulus, 454 



INDEX. 



495 



Laryngitis, 454 
Laudanum, 415, 454 

antidotes, 234 

stupes, 106 
Lavage, 75 

in gastritis, 280 
Laxatives, administering, 82 
Lead, 454 

Lead-poisoning, 454 
Leeches, 102, 103, 454 
Leeching, 102 

Leg-fracture, treatment, 190, 191 
Leiter coil, 113, 454 
Lemon jelly, 386 

sherbet, 390 
Lemonade, 390 

egg, 391 

Leprosy, 454 

Leube and Riegel's test dinner, 77 

Leukorrhea, 55, 454 

Levulose, 474 

Licorice-root, 411 

Ligation, 187 

Ligatures, 454 

Lightning-stroke, 222 

Limbs, swelling of, in pregnancy, 
cause of, 133 

Linie- water, 393, 454 

Liniments, 123 

Lint, 454 

Lithotrity, 455 

Liver, 360, 455 

Lochia, 145, 455 

Lockjaw, 211, 475. See also Tet- 
anus. 

Logwood, 411 

Lotions, 123, 455 

Lugol's solution, 412 

Lumbago, 455 

Lumbar vertebrae, 352 

Lunch, invalid's, 384 

Lungs, 359, 455 
congestion of, 435 
function of, 344 

gangrene of, expectoration in, 50 
hemorrhage from, treatment of, 
218 

Lupus,^ 297, 455 

Lying-in, period of, 144 

Lymphatics, 354, 355 

Lysis, 46 

Lysol as antiseptic, 185 



Macaroni, 380 

Mad dog, bites by, treatment, 235 

Magnesia, calcined, 414 

husband's, 414 
Malaria, 255, 455 
Malignant pustule, 455 
Malta fever, 456 
Mammitis, 456 
Manganese, 456 
Mania, puerperal, 467 
Mania-a-potu, 456 
Marasmus, 456 
Massage, 121, 456 

breast, 146 

in infant paralysis, 315 

in paralysis, 289 
Mastication, 348 
Mastoid process, 359 
Mastoiditis, 456 
Measles, 253, 456 

complications of, 254 

diet in, 254 

German, 254, 456 

nursing in, 254 

symptoms of, 253 
Meat cure, 375 

raw-, diet, 375 
Meat-cake, Salisbury, 381 
Meatus urinarius, 362 
Meconimn, 456 
Medicated bath, 97 
Medicine, absorption of, rapidity 
of, 78 

action of, 78 

administration of, 77 
by inhalation, 87 
by inunction, 85 
by mouth, 81 
by rectum, 83 
hjTDodermatic, 83 

precautions in handling and ad- 
ministering, 80 
Medicine-glasses, care of, 81 
Medicine-spoons, care of, 81 
Medulla oblongata, 355 
Melancholia, 332, 456 

puerperal, 151 
Membranous croup, 268 
Meningitis, 457 

cerebral, 317 

symptoms of, 317 
treatment of, 318 



49^ 



INDEX. 



Meningitis, cerebrospinal, 286 
Menopause, 457 
Menorrhagia, 457 
Menstruation, 54, 457 
painful, treatment, 228 
retarded, relief of, 89 
Mental diseases, 323 

adolescent, feeding in, 337 

management of, 336 

auto-intoxication in, 325 

convalescence in, 337 

feeding in, 333 

indulgence in, 331, 332 

pulse in, 324 

qualifications of nurse, 323 

respiration in, 324 

suggestions for nursing care in, 

330 
suicide in, ZZZ 
symptoms of, objective, 323 

physical, 323 

subjective, 323, 325 
temperature in, 324 
untidiness in, 329 
vigilance in, 332 
vomiting in, 325 
weight in, 325 
symptoms and characteristics, 

325 
Mercury, 457 

inunction of, 85 
method of, 85, 86 
Milk and albumen, 391 

mother's, first appearance of, 146 

peptonized, 382 

prepared, 382 

sago, 383 

sterilization of, 305 

sterilized, 391 

toast, 384 
peptonized, 384 

use of, in typhoid fever, 243 
Mesmerism, 457 
Metal syringe, care of, 85 
Metrorrhagia, 457 
MiHaria, 457 
Milk of asafetida, 405 
Milk-leg, 151 
Milk-punch, 391 
Milk-secretion, scanty, 147 
Milk-shake, 392 
Mineral waters, 394 



Minim-glass, 80 
Mitral valve, 344 
Moist surgical dressings, 194 
Molasses enema, 65 
Monarticular rheimiatism, 296 
Monoplegia, 289 
Morbid fears, 327 
Morning sickness, 457 
Morphine, 457 

antidotes, 234 

justification of nurse in giving, 
283 
Mosquito bites, 228 
Motor nerve, 458 

Mouth, administration of medicines 
by, 81 

baby's, care of, before nursing, 

304 
of newborn, care of, 300 
patient's, cleansing of, 56 

state of, 49 
secretions of, 349 
Mouth-wash, 56 
Movements, bowel, 458 
after labor, 145 
character of, 52 
color of, 52 
composition of , 53 
disinfection of, in contagious 
diseases, 239 
in typhoid fever, 241 
disposition of, from contagious 

cases, 239 
in infant bowel obstruction, 
310 
colic, 309 
diarrhea, 310 
in typhoid fever, 241, 317 
of newborn, 303 
Mulled wine, 392 
Mumps, 318, 458 
Muriatic acid, 402 
Murphy's continuous enteroclysis, 

178 
Muscles of body, 353, 458 
involuntary, 353 
longest, 353 
smallest, 353 
sternocleidomastoid, 354 
voluntary, 353 
Mushrooms, poisonous, antidotes, 
235 



INDEX. 



49; 



Mustard fomentation, 106 

plaster, 118 

poultices, 109 
Mutton broth, 376 

soup, 379 
Myocarditis, 458 



Napkins during puerperium, 145 
Narcotics, action of, 80 
Nasal feeding, 77 
Nauheim bath, 97 
Nausea and vomiting, 48 

follo\ving etherization, 170 
of pregnancy, 133 
Neck, vertebrae of, 352 
Necrosis, 458 
Negativism, 328 
Nephritis, 458 

digitahs poultice in, 1 1 1 
in scarlet fever, 249 
Nerve-fibers, decussation of, 289, 
356 
motor, 356 . 
sensory, 356 
Nerves, 356,^458 

action of, impulsive, 356, 357 

reflex, 357 
auditory, 359 
of brain, 355 
of spinal cord, 356, 357 
vasomotor, 357 
Nervous diseases, 323 

auto-intoxication in, 325 
convalescence in, 337 
feedmg in, 333 
indulgence in, 331, 332 
pulse in, 324 

qualifications of nurse, 3 23 
respiration in, 324 
suggestions for nursing care in, 

330 
suicide in, 333 
symptoms of, objective, 323 

physical, 323 

subjective, 323, 325 
temperature in, 324 
vigilance in, 2)Z 2 
vomiting in, 325 
weight m, 325 
system, 356 
Neuralgia, 459 

32 



Neurasthenia, 338, 459 

rest-cure in, 338 
Neurosis, 459 
Neutral bath, 89, 92 

in typhoid fever, 243 
Nevus, 427, 459 ^ 

Newborn, artificial respiration in, 
141 
bathing of, 300 
care of, 300 
dressing cord of, 301 
eyes of, care of, 300 
mouth of, care of, 300 
nose of, care of, 300 
skin of, care of, 301 
Nightshade, deadly, 405 
Nipple, cracked, 146 
Nipples, care of, before nursing, 304 
Nipple-shields, 459 
Nitrate of silver, 459 

for eyes of newborn, 300 
Nitric acid, 459 

antidotes, 233 
Nitroglycerin, 459 
Nitromuriatic acid, 402 
Noli-me-tangere, 459 
Nose, 358 

foreign body in, 227 
of newborn, care of, 300 
spraying of, 1 24 
Nosebleed, 218, 442 
Nostalgia, 459 
Nurse, 17 

appearance of, 18 
aseptic cleanliness of, in obstetric 
cases, 136 
in surgical operations, 136, 
282 
compensation of, 19 
conduct of, in emergencies, 236 
dont's for, 25 

dress and personal habits, 25 
in contagious diseases, 265 
in operating-room, 171 
duties of, 20 

in circumstances of environ- 
ment, 21 
in conversing with patients, 21, 

22 
in dissensions, 22 
in emergency cases, 166, 236 
in general surgical cases, 160 



49^ 



INDEX. 



Nurse, duties of, in operating-room, 
i6o, 171 

in preparations for night, 21 

to doctor, 22 

to family, 20 

to patient, 20 

to superiors, 23 
equipment of, 26 

for obstetric case, 135 
hands of, care of, 25 

sterilization of, 246 
management of children, 320 
meals, 21, 22 

night duty of, responsibility, 19 
personal bearing, 18 

care, 18 
in contagious diseases, 257 
hygiene of, 25 
preparation for confinement, 134 
qualifications, 20 

for nervous and mental dis- 
eases, 323 
record of, 26 
respect for, 18 
responsibilities, 17 
suggestions for, in nervous and 

mental diseases, 330 
sympathy and kindness of, to- 
ward patient, 321 
Nursing, hospital, etiquette in, 23 
in accidents and emergencies, 

188 
in common emergency cases, 214 
in general surgical cases, 160 
in gjTiecologic cases, 152 
in nervous and mental diseases, 

323 
suggestions for nursing 
care, 330 
in obstetric cases, 1 29 
in special medical diseases, 236 
of adolescent mental cases, 336 
of infant by mother, 303 
of old people, 335 
of sick children, 300 
private, etiquette in, 24 
Nutritive enema, 68 
formulae for, 68 
stimulating formula for, 67 
Nux vomica, 459 
antidotes, 234 
Nymphae, 459 



Oakum, 460 
Oatmeal, 373 

beef-tea wdth, 375 

enema, 66 

gruels, 373 
Observations in medical cases, 40 

of symptoms, 48 
Obsession, 328 
Oil of vitriol, 403 
Oiled silk, 460 
Oils, administering, 82 
Ointment, 460 

mercurial, inunction of, 85 
Old people, care of, 335 
Olive-oil, 460 

enema, 65 
Omelet, 380 
Omentum, 362 

Operating-room, duties of nurse in, 
171 

kitchen as, 161, 167 

preparation of, 160 

selection of, 160 
Operating-table, improvised, 161 
Operation, abdominal, after-treat- 
ment in, 179 
of patient, 179 
catheterization after, 180 

gynecologic, after-care of patient, 

examination for, preparation 

of patient, 152 
positions for, 156 
preparation for, 156 
surgical, 160 

after-care of patient in, 174 
antiseptic cleanliness of nurse 

in, 136, 282 
arranging patient for, 1 73 
cleansing part for, 165 
collapse after, 177 
diet before, 164 

following, 179 
disinfection and materials, 183 
drainage after, 180 
dressing patient for, 165 
emergency, duties of nurses in, 

166 
food before, gi\ang, 166 
hemorrhage in, 177 
preparation for, 161 

articles required, 161, 162 



INDEX. 



499 



Operation, surgical, preparation of 
patient, 163 
sequels of, 1 74 
shock after, 174 
treatment, 176 
Ophthalmia, 460 

neonatorum, 314, 460 
Opisthotonos, 212 
Opium, 460 

antidotes, 234 
Opium-poisoning, diagnosis of, 

from apoplexy, 288 
Optic nerve, 458 
Orangeade, 392 
Orange- jelly, 386 

sherbet, 392 
Orbit of eye, 358 
Organs, circulatory, 342, 354 

digestive, 347, 359 

of generation, female, 362 

respiratory, 359 

sensory, 355 

urinary, 350, 362 
function of, 350 
Os uteri, 363 
Osteotomy, 461 
Otitis media, 461 
Otorrhea, 461 
Ovaries, 461 
Ovariotomy, 461 
Oxalic acid, 461 
antidotes, 232 

for removal of permanganate 
stain, 185 
Oyster broth, 377 

soup, 379 

stew, 377 
Oysters, 377 

fricasseed, 377 

peptonized, 377 



Pack, 461 
cold, 99 
hot, 99 
partial, loi 
shower, 99 
Packed feces, 53 
Packing, 461 
Pads, bed-, 36 
cotton, 193 
gauze, 193 



Pads, obstetric, antiseptic, 135 
Paget's disease, 461 
Pain from burns, 220 

inflammatory, cause of, 102 
of patient, reporting, 49 
Palpitation, 461 
Panada, chicken, 381 
Pancreas, 361 
Pancreatic juice, 349 

digestive action of, 349 
Paquelin cautery, 121, 462 
Paracentesis, 276, 462 

in pleurisy, 276 
Paraldehyde, 462 
Paralysis, 289, 462 

changing patient's clothing in, 55 
infant, 315 
treatment, 289 
Paraplegia, 289, 462 
Paregoric, 415 
Paresis, 289 

Paris green, antidotes, 233 
Parotid glands, anatomy of, 348 
Partial packs, loi 
Patella, 353 

fracture of, 190 
Patient, 40 
administration of medicines to, by 
inhalation, 87 
by inimction, 85 
by mouth, 81 
by rectum, 83 
h3^odermatic, 83 
after-care of, in gynecologic oper- 
ations, 158 
in surgical operations, 174 
after-treatment of, in abdominal 
operations, 179 
in amputations, 179 
in surgical operations, 1 79 
arranging of, for surgical opera- 
tion, 173 
bathing of, 58 

bed-, apphances for relief of, 35 
bodily care of, 55 
body-temperature of, 42 
bowels of, condition of, 52 
breath of, character of, 50 
breathing of, character of, 51 
catheterization of, 73, 74 
changing bed-clothing of, 32 
chills of, reporting of, 51 



500 



INDEX. 



Patient, clothing of, changing of, 55 
cough of, 50 
deUrious, caution observed with, 

5.1. 
delirium of, character of, 51 
dressing of, for surgical operation, 

165 
expectoration of, 50 
external applications to, general 

and local, 88 
facial expression of, 50 
feeding of , 59 

food taken by, record of, 49 
functional disturbances of, relief 
of, 63^ 
catheterization, 73, 74 
douches, 69 
enemata, 63 
lavage, 75 
rectal feeding, 67 
washing out bladder, 75 
stomach, 75 
gynecologic, 152 
after-care of, 158 
of diet, 159 
vaginal dressing, 159 
tampons, 159 
positions of, for examination, 

preparation of, for examina- 
tion, 152 
for operation, 156 
hair of, dressing, 56 

washing, 56 
helpless, carr>dng of, 62 

lifting of, 61 
hiccough of, character of, 54 
menstruation of, 54 
mouth of, cleansing of, 56 

state of, 49 
mo\'ing of, 61 

with fractured limb, 33 
nausea and vomiting of, 48 
obser\'ation of symptoms in, 48 
obstetric, preparation of, 135 
pain of, reporting, 49 
position of, for introduction of 
stomach-tube, 75, 76 

in giving vaginal douche, 70 

in peritonitis, 281 

symptoms in, 48 
pulse of, 40 



Patient, rectal feeding of, 67 

respiration of, 47 

serving food to, 365 
beverages, 368 
liquids, 366 

necessity for cleanliness, 368 
preparation of patient, 368 
taking the meal, 367 
varying bill of fare, 366, 

367 

skin of, condition of, 52 

sleep of, character of, 50 

surgical, preparation of, 163 

s>T3ipathy and kindness of nurse 
toward, 321 

symptoms in observation of, 48 

teeth of, care, 56 

toilet of, 56 

tongue of, condition of, 49 

unconscious, administering medi- 
cine to, 81 

urine of, condition of, 53 

\dtal powers of, lowest ebb, 37 

washiiig of hair of, 56 
out bladder of, 75 
stomach of, 75 
Peach foam, 386 
Pearson's solution, 418 
Pediculus, 462 
Pellagra, 462 
Pehds, 352, 462 

female, contents of, 352 
Pepper, cayenne, 407 
Peppermint, camphor, 414 
Peptonized beef-tea, 374 

milk, 382 
jelly, 387 

milk-toast, 384 

oysters, 377 
Percussion, 462 
Perforation in typhoid fever, 245, 

317 
Pericarditis, 279, 463 
Pericardium, 354 
Periosteum, 351 
Peritoneum, 361 
Peritonitis, 280, 463 

causes of, 280 

position of patient in, 48, 281 

septic, 181 

symptoms, 280 

treatment, 281 



INDEX, 



501 



Permanganate of potash as disin- 
fectant, 185 
stain, oxalic acid for removal of, 

185 
Peroneal artery, 355 
Peroxid of hydrogen as antiseptic, 

186, 463 
Pertussis, 269, 463 
Peruvian bark, 408 
Pessary, 463 
P6trissage, 456, 463 _ 
Phenacetin, danger in use of, 271 
Phenic acid, 402 
Phenol, 402 
Phenozone, 404 
Phlebias,463 

Phlegmasia alba dolens, 151, 464 
Phlegmonous tonsillitis, 272 
Phobias, 327 

Phosphoric acid, antidotes, 233 
Phosphorus, antidotes, 234 
Phthisis, 266, 464, 477 

acute, symptoms, 266 

chronic, 266 

danger of contagion by contact 
with patient, 266 

diet in, 267 

forms of, 266 

nursing of patients with, 266 
Physiology, 342 

of blood-circulation, 342 

of digestion, 347 

of respiration, 346 
Pia mater, 356 
Piles, 448, 464 
Pillows, bed, changing of, 33 
Pills, administering, 82 
Pinna, 358 
Pityriasis, 464 

Placenta, fetal and maternal, 132, 
464 

praivia, 464 
Plague, 464 

Plants in sick-room, removal of, 347 
Plasma, blood-, loi 
Plaster, 465 

cantharidal, 119 

mustard-, 118 

removing, method of, 195 
Plaster-of-Paris, 406, 465 

bandages, 201 

splint, 207 



Pleurisy, 276, 465 
position of patient in, 48 
symptoms of, 276 
treatment of, 276 
Pleuropneumonia, 465 
Pneumonia, 465 
croupous, 273 
diet in, 274 
double, 273 

symptoms, favorable and un- 
favorable, 273, 274 
treatment, 273 
Pneumothorax, 465 
Poached eggs, 381 
Poisoning, accidental, 231 

by tainted meat, fish, cheese, ice- 
cream, mushrooms, antidotes, 

carbolic-acid, from absorption, 

185. 
from ivy, treatment, 234 
induction of vomiting in, 232 
iodoform-, from absorption, 

symptoms, 186 
lead, 454 

mercurial, by inunction, symp- 
toms of, 86, 185 
ptomain, antidotes, 235 
septic, from catheterization, 73 
what to do in, 231 
Poisons, 231, 465 

classification and action of, 231 
irritant, 232 

action of, 231 
narcotic, 234 
action of, 231 
Polyarthritis, 296 
Polyuria, 466 
Popliteal artery, 355 
Position, 466 

change of, by patient, favorable 

sign, 48 
for gynecologic examination, 153 
dorsal, 153 
knee-chest, 155 
Sims, 154 
for surgical operation, 163 
Trendelenburg, 163 
Posture, 466. See also Position. 
Potash, antidotes, 233 
Potassium, 466 
cyanid of, antidotes, 233 



502 



INDEX. 



Potato soup, 379 
Potatoes, creamed, 380 
Potential cautery, 431 
Pott's fracture, 466 
Poultices, 107 

action of, 102 

antiseptic, in 

boric-acid, 112 

bran- jacket, 109 

bread, 109 

carbolic-acid, 112 

charcoal, no 

corrosive-sublimate, in 

creolin, 112 

digitalis, in 

flaxseed, 107 

green-soap, 112 

hop, III 

ice, 112 

jacket, 109 

in surgical operations, 165 

method of applying, proper, 107 

mustard, 109 

renewal of, frequency, 108 
on sleeping patient, 109 

slippery-elm, in 

spice, no 

starch, no 

yeast, in 
Powder, administering, 82 

applying to throat, method of, 
124 
Pregnancy, 129, 466 

abdominal enlargement, rate of, 

131 

conception, 130 

date of confinement, 130 

disorders of, 133 

duration of, 130 

extra-uterine, 152 

fetal movements, 132 

fetus, 132 

nurse's preparations for confine- 
ment, 134 

signs and symptoms of, 1 29 

termination of, 134 
Premature infant, care of, 308 
Presentations in labor, 137 
Prolapsus ani, 466 
Protrusion of bowel in infancy, 313 
Proud flesh, 209 
Prurigo, 467 



Pruritus, 467 
Prussic acid, 402, 467 

antidotes, 233 
Psoas abscess, 467 

muscles, 467 
Psoriasis, 297, 467 
Psychasthenics, 328 
Ptomain poisoning, antidotes, 235 
Puddings, recipes for, 378 
Puerperal fever, 467 

mania, 467 
Puerperium, 467 
management of, 144 
after-pains, 146 
breast-bandage, 147 
care of breasts in, 146 
catheterization, 144 
diet in, 145 
douches in, 145 
lactation in, 146 
lochia in, 145 
napkins in, 145 
phlegmasia dolens, 151 
temperature and pulse in, 145 
thrombosis, 151 
pathology of, 148 
eclampsia, 151 
hemorrhages, 148 
insanity, 151 
septicemia, 150 
Pulmonary artery, 344, 345 
tuberculosis. See Phthisis. 
vems, 344 
Pulse, 40, 467 
at birth, 307 
at puberty, 42 
compressible, 41 
conditions influencing, 40 
dicrotic, 41 

during puerperium, 145 
frequency of, 41 
full, 41 

high-tension, 41 
in children, 42 
in croupous pneumonia, 273 
in hemorrhage following surgical 

operation, 177 
in infancy, 42, 307, 316 
in nervous and mental diseases, 

. 324 . 

in septicemia, 182 

in shock, 175 



INDEX. 



503 



Pulse in small-pox, 251 

in typhoid fever, 240 

in uremia, 285 

incompressible, 41 

influence of body temperature 
on, 42 

intermittent, 41 

irregular, 41 

low-tension, 41 

normal, 42 

of aged, 42 

rapid, 41 

regular, 41 

running, 41 

taking of, 42 

varieties of, 41 
Pump, breast-, 147 
Purgative waters, 395 
Purgatives, administering, 82 

enema, 65 

formula for, 65 
Purpura, 467 
Pus, 467 
Pustulants, 117 
Pyemia, 211, 467 



Quicksilver, 414 
Quinsy, 272, 468 



Rabid animals, bites of, 235 
Rabies, 235, 468 
Rachitis, 312, 468 
Radial artery, 355, 468 
Radius, 353 
Raw-meat diet, 375 
Reamur thermometer, 468 
Recipes, 372 
beef -essence, 374 
beef -extract, 373 
beef -juice, 374 
beef- tea, 3 73 > 374 
peptonized, 374 
with oatmeal, 375 
beverages, 389 
chocolate, 389 
cocoa, 389 
coffee, 389 
crust, 389 
nutritious, 390 
rice, 390 



Recipes, beverages, egg-flip, 390 
egg-nog, 390 
lemonade, 391 

egg, 391 
milk and albumen, 391 

sterilized, 391 
milk-punch, 391 
milk-shake, 392 
orangeade, 392 
sherbet, lemon, 390 

orange, 392 
tea, 392 

flaxseed, 392 
water, albumen-, 393 

apple-, 393 

barley-, 393 

gum-arabic, 393 

rice-, 393 

tamarind-, 393 

toast-, 394 
wine, mulled, 392 
whey, 394 
broths, 376 
chicken, 376 
clam, 376 
egg, 376 
mutton, 376 
oyster, 377 
desserts, 384 

apples, baked, 384 
baked custard, 385 
blanc-mange, 385 

Irish-moss, 387 

rice, 385 
cream, Bavarian, 384 

tapioca, 386 

whipped, 388 
custard, baked, 385 
Irish moss, 387 

blanc-mange, 388 
jelly, calf's-foot, 385 

lemon, 386 

orange, 386 

peptonized-milk, 387 

wine, 387 
junket, 387 
peaclvioam, 386 
rice blanc-mange, 385 
snow-eggs, 388 
soft custard, 385 
whey, wine, 388 
farinaceous foods, 372 



504 



INDEX. 



Recipes, farinaceous foods, arrow- 
root, 372 
corn-starch, 372 
gruel, boiled-flour. 372 
oatmeal, 373 
rice-flour, 372 
oatmeal, 373 
milk, 382 

koumyss, 383 
peptonized, 382 
sago, 383 
miscellaneous, 380 
chicken panada, 381 
eggs, poached, 381 
scrambled, 381 
soft-boiled, 381 
infant's food, 382 
macaroni, 380 
omelet, 380 
potatoes, creamed, 380 
Salisbury meat-cake, 381 
oysters, 377 
broth, 377 
fricasseed, 377 
peptonized, 377 
stewed, 377 
puddings, 378 
arrowroot, 378 
corn-flour, 378 
custard, 378 
rice, 378 
sago, 378 
snow, 378 
Salisbury meat-cake, 381 
soups, 379 
chicken, 379 
cream of tomato, 379 
mutton, 379 
oyster, 379 
potato, 379 
white-celery, 379 
sweetbreads, 375 
toasts, 383 

cream-toast, 383 
dry toast, 383 
egg-toast, 383 
milk-toast, 384 
peptonized, 384 
Record, nurse's, keeping of, 26 
of food taken by patient, 49 
of pulse, temperature, and 
respiration, 48 



Record, nurse's, of symptoms, 48 
Rectal douche, 72 

feeding, 67 
Rectmn, 361 

administration of medicines by, 

83 
gas, passage of, 53 
medicines administered by, 83 
temperature in, 45 
Reflex action, 357 
Regurgitation, 279 
Relapsing fever, 468 
Remittent fever, 255 
Reports, nurse's, 40 

method of making, 27, 28 
Respiration, 47, 346, 428, 468 
artificial, in apparently drowned, 
224, 469 
in shock, 176 
of newborn, 141 
Che>Tie-Stokes, 47 
in nervous and mental diseases, 

324 
mechanism of, 346 
of infancy, 47, 316 
of infant at birth, 307 
taking of, 47 
Respiratory organs, 359 
Rest-cure, 338, 469 
Resuscitation, 224, 469 
Retention of urine, 226 
in newborn, 303 
treatment of, 226 
Rheumatism, 295, 469 
acute articular, 295 

muscular, 296 
complications of, 295, 296 
monoarticular, 296 
treatment of, 295 
medicinal, 295 
Ribs, 351, 469 
false, 351 
floating, 352 
true, 351 
Rice, blanc mange of, 385 
coffee, 390 
pudding, 378 
Rice-water, 393 
Rickets, 312, 469 

Riegel and Leube's test-dinner, 77 
Rigor, 469 
mortis, 469 



INDEX. 



505 



Ringworm, 297, 448, 469 
Rochelle salt, 416 
enema of, 65 
Roller-bandages, 196 
Room in scarlet fever, 247 

temperature for rheumatic pa- 
tients, 295 
regulation of, 38 
ventilation, 38 
Rub, wet-sheet, 97 
Rubber bandages, 195 
Rubefacients, 116 
Rubella, 254, 469 
Rupture, 469 



Sacrum, 352 
Sago milk, 383 
pudding, 378 
St. Vitus' dance, 318, 433 
Salicylic acid, 470 

wool, 470 
Saline waters, 395 
Salisbury meat cakes, 381 
Saliva, digestive action of, 349 
Salivary glands, 446 
Salol, 416, 470 
Salt enema, 66 

solution, 178, 470 
Salt-water bath, 97 
Sand-bags, how made, 191 
Sapremia, 470 
Sartorius, 353 
Scabies, 297, 470 
Scalds, 218, 428, 470. See also 

Burns and scalds. 
and bums, 218, 428, 470 
Scapula, 352 
Scarlet fever, 246, 470 

complications of, 249 
dropsy, 249 
nephritis, 249 
uremia, 249 

convalescence of, 249 

deUrium of, 249 

depression in, 249 

disinfection in, 248 

malignant, 247 

room ventilation in, 247 

symptoms of, 246 

tongue, 49, 247 

treatment of, 247 



Scarlet fever, uremic convulsions 
of, treatment, 249 

Schott bath, 97 

Schultze's method of artificial res- 
piration, 142 

Sciatica, 470 

Scissors, bandage, 194 

Scleroderma, 471 

Scleroma, 471 

Scorbutus, 471 

Scotch douche, 99 

Scrambled eggs, 381 

Screen, bed-, 36 

Scrofula, 471 

Scrotal hernia, 448 

Scultetus bandage, 199 

Sea-bathing, 89 

Second intention, 471 

Secretions, body, 349 

Sedatives, action of, 79 

Self-control in children, 331, 332 

Semilunar valves, 344 

Senile dementia, untidiness and vul- 
garity in, 330 

Senna, 471 

Sense-perception, false, 326 

Sepsis after childbirth, symptoms, 
146 
death from, responsibility for, 182 

Septic wounds, 209 

Septicemia, 181, 467, 471 
puerperal, 150 
symptoms, 182 
treatment, 182 

Septum, 471 

Serpent-bites, treatment, 235 

Serum, blood-, loi 

Sheet-bath, 97 

Sheets, bed-, changing of, without 
remo\dng patient, 32, 33 

Sherbet, lemon, 390 
orange, 392 

Shingles, 297, 471 > 

Shock, 471 
after surgical operation, 174 

treatment, 176 
body-temperature in, 175 
conditions influencing, 176 
enemata in, 176 
from burns, 220 
from surgical operation, 174 
respiration in, artificial, 176 



So6 



INDEX. 



Shock, s>Tnptoms, 175 

treatment, 176 
Shoulder-blade, 352 
Show, 138 
Shower-bath, 96 
Shower-pack, 99 
Sick, feeding of, general rules for, 

365 
ser\dng food in, 365 
Sick-room, 30 
air of, 38 

cooling, 38 
bearing of nurse in, 18 
bed, preparation of, 30 
care of, 37 
dress of nurse in, 25 
etiquette of, 24 
fumigation of, after contagious 

diseases, 263 
hygiene of, 37 

keeping records, methods of, 26 
plants in, removal of, 347 
preparation of , 30 

removal of excreta from, 39 
selection of, 30 
temperature of, 37 
regulation of, 38 
ventilation of, 38 

protection of patient during, 39 
Sigmoid flexure, 362, 471 
Sign of labor, first, 137 
Signs of pregnancy, positive, 130 
probable, 129 
vital, 40 
Silicate-of-soda bandage, 204 
Silk, oiled, 460 
Silkworm gut, 471 
Silver nitrate, 459 

for eyes of newborn, 300 
Sinus, 214 
Sitz-bath, 92 

action of, 89 
Skin, anatomy of, 350 
color of, cause of, 350 
diseases of, 296 
of newborn, care of, 301 
of patient, color of, 52 

condition of, 52 
redness of, inflammatory, cause 

of, 102 
tuberculosis of, 297 
Skull, bones of, 351 



Sleep of patient, character of, 50 

taking of, by nurse, 21 
Sleeping sickness, 477 
Sleeplessness, 229 
SKpper}^-elm poultice, 1 1 1 
Small-pox, 251, 479 

confluent, 252 

malignant, 252 

nursing in, 252 

pitting of, prevention, 252 

syrnptoms of, 251 

varieties of, 251 
Smoke, preventing suffocation in, 

225 
Snow pudding, 378 
Snow-eggs, 388 
Snuffles of infancy, 315 
Soda bath, 97 
Sodium, 471 
Soft custard, 385 
Soft-boiled eggs, 381 
Solutions, 472 

antiseptic, 398 
Soups, recipes for, 379 
Spanish-flies, 407 
Spanish-fly blister, 1 19 
Spatula, 472 
Sphygmograph, 472 
Spica, 472 
Spice poultice, no 
Spina bifida, 472 
Spinal column, 352 

cord, 352,^355 

composition of, 356 
ner\'es of, 356 

curvature, 472 

douche, 98 
Spiral bandage, 197 
Spleen, 361,472 
SpHnts, 472 

coaptation, 207 

impro\'ised, in fracture, 189 

plaster-of-Paris, 207 
removal of, 208 
Sponge-bath, 58 
Sponges, 472 

cotton, 193 

gauze, 162 

sterilizing of , 188 

nurse's handling of, 172 
Sprains, 193, 473 
Sprays, 123 



INDEX. 



507 



Sputum, disposition of, in infectious 

diseases, 50 
Sputum-cup, 50, 266, 275 
Stapedius, 353 
Stapes, 351 
Starch bandages, 205 

bath, 97 

poultice, no 
Starch-and-laudanum enema, 66 
Steam-bath, acid, 96 
Sterilization by boiling water, 168 

for surgical operations, 163 

milk, 305 

of gauze sponges, 188 

of nurse's hands, 171, 246 

of surgical dressings, 194 

of sutures, 187 

of utensils for surgical operations, 
173, 186, 188 

personal, of nurse, for surgical 
operation, 171, 173 
Sterilized milk, 391 
Sterihzer, Arnold, 305 
Sternocleidomastoid muscle, 354 
Sternum, 352 
Stethoscope, 473 
Stimulants, action of, 79 

alcohoUc, in treatment of hemor- 
rhage, 216 

per rectum, effect of, 67 
Stimulating enemata, 66 
Stings, insect, 228 
Stomach, 360 

bleeding from, 218 

food-changes in, 349 

hemorrhage from, treatment of, 
218 

lavage of, 75 

secretions of, 349 

washing out, 75 
Stomach- tube, use of, 75, 76 
Stomatitis, 473 
Strabismus, 473 
Strangulated hernia, 448 
Strapping, adhesive-plaster, 205 
for sprains, 193 
of chest, 206 
of joints, 205 
of ribs, 206 
Strawberry tongue, 49, 247, 473 
Stretcher, improvised bed-room, 62 
Strychnine, 473 



Strychnine, antidotes, 234 
as heart-stimulant, 176 

Stupes, 105. See also Fomenta- 
tions. 

Subclavian arteries, 355 

Subinvolution, 140 

Suffocation from drowning, treat- 
ment, 224 

Sugar, 474 

in urine, Trommer's test for, 294 

Suicide in nervous and mental dis- 
eases, 333 

Sulphonal, 419, 474 

Sulphur bath, 97 

Sulphuretted waters, 396 

Sulphuric acid, antidotes, 233 

Sunburn, 229 

Sunstroke, 222, 474 

body-temperature in, 44 
treatment, 221 

Suppositories, introduction of, 83 

Suppuration, 210 

Surgical dressings, 193 
dry, 194 
emergency, 193 
instruments for, 194 
moist, 194 
sterilization of, 194 

Sutures, 474 
button, 187 
continuous, 187 
interrupted, 187 
materials for, 187 
sterilization of, 187 

Suturing, 187 

Swallowing, involuntary, how to in- 
duce, 261 

Sweeping and dusting sick-room, 37 

Sweetbreads, cooking of, 375 

Sweet oil, 415 
spirits of nitre, 410 

Swelling, inflammatory, cause of, 
102 > 

Sylvester's method of artificial res- 
piration, 141, 142 

Sympathetic nerve, 458 

Symptoms, observation of, 48 

Syncope, 474 

Synovial fluid, 351 

Syphilides, 262 

Syphilis, 262, 474 

Syringe, fountain, 127 



5o8 



INDEX. 



Syringe, fountain, uses of, 26 
glass, care of, 85 
hard-rubber, preventing leakage 

of, 63 
hypodermic, 84 
care of, 85 
method of using, 84 
metal, care of, 85 
Syringing eyes, 1 26 

of infant, 3 14 
Systole, 354 



Tabes, 474 

dorsalis, 474 

mesenterica, 474 
Table, gynecologic, 157 

salt, 418 
Talipes, 474 
Tamarind-water, 393 
Tampons, 474 

kite-tail, 159 

vaginal, 159 
Tannin, 403 

in tea, 392 
Tapioca cream, 386 
Tapotement, 456, 474 
Tartar emetic, 404 
Tartaric acid, antidotes, 232 
T-bandage, 200 
Tea, 392 

beef-, 373, 374 

flaxseed-, 392 
Tears, age when infant first sheds, 

307 
Tear-secretion, 125 
Teeth, 475 

age when growth begins, 307 

artificial, care of, 57 

care of, 56 

development of, 307 
Teething, 313 
Temperature, body-, 42, 475 

after childbirth, rise of, 145 

conditions influencing increase, 

43 
during puerperium, 145 
in bronchitis, 275 
in cerebrospinal meningitis, 286 
in croupous pneumonia, 273 
in diphtheria, 256 
in hemorrhage, 175 



Temperature in measles, 253 

in nervous and mental diseases, 
324. 

in peritonitis, 281 

in rheumatism, 295 

in scarlet fever, 247 

in septicemia, 182 

in shock, 175 

in small-pox, 251 

in sunstroke, 44, 221 

in tetanus, 44 

in typhoid fever, 250 

in typhus fever, 250 
taking of, 45 

of infant at birth, 307 
method of taking, 315 

of sick-room, 38 

subnormal, causes of, 44 
Tendo AchiUis, 354 
Tendons, 354 
Tenia, 475 
Tepid baths, 92 
action of, 89 
in typhoid cases, 243 
Terebene, 475 
Test-meals, 77 
Tetanus, 211,475 

body-temperature in, 44 

symptoms, 211 

treatment, 212 
Thermocautery, 431 
Thermometer, 475 

bath, 88 

clinical, 45, 475 
Thirst after operation, 180 

bathing for, 89 

in hemorrhage, 217 

in typhoid fever, 243 
Thorax, 35 1 
Thread-worm, 476 
Throat, foreign body in, 227 

gargling of, 123 

painting of, 1 24 

spraying of, 1 24 
Thrombosis, 151, 476 
Thrush, 309 

treatment of, 309 
tibia, 353 
Tibial artery, 355 
Tissue, 476 

Toasts, recipes for, 383 
Toast-water, 394 



INDEX. 



509 



Toilet of patient, 56 
Tomato soup, cream of, 379 
Tongue of patient, condition of, 49 

strawberry, 49, 247 
Tongue-tie, 316, 476 
Tongue, trembling, 49 
Tonic convulsions, 435 
Tonics, action of, 79 
Tonsillitis, 272, 435 

follicular, 272 

phlegmonous, 272 
Tonsils, 476 
Torticollis, 476 
Toothache, 229 

Tourniquet in checking hemor- 
rhage, 217 
Towels, 193 
Trachea, 359 
Tracheotomy, 477 

after-care in, 257 

in diphtheria, 257 

in scalds of glottis, 220 

position for, 258 
Tracheotomy- tube, care of, 259 
Transfusion, 178, 477 
Trendelenburg position, 163 
Tricuspid valve, 344 
Trional, 419 
True ribs, 351 
Trypanosomiasis, 477 
Tub-baths, 59 
Tuberculosis, 477 

of lungs, 266, 477. See also 
Phthisis. 

of skin, 297 
Tully's powder, 415 
Tumors, 477 
Turpentine, 477 

enema, 65 

stupes, 106 
Tympanites, 477 

in typhoid fever, 235 
Tympanum, 358 
Typhoid fever, 239,477 

bed-sores in, prevention of, 245 
complications of, 244 
convalescence in, management 

of, 246 
diet in, 242 
nursing in, 241 
of children, 316 
treatment, 317 



Typhoid fever, symptoms of, 240 

thirst in, rehef of, 243 

treatment of, 242 

walking, 246 
Typhus fever, 250, 477 

complications of, 251 

symptoms, 250 

treatment, 251 



Ulcer, 214, 477 
Ulna, 353 

Ulnar artery, 355, 478 
Umbilical cord, 478 

hernia, 448 
Union of broken bones, process of, 

189 
Untidiness in mental diseases, 3 29 
Urea, 478 
Uremia, 285, 478 

complicating scarlet fever, 249 

treatment of, 285 
Uremic convulsions, 435, 478 
Ureter, 362 
Urethra, 362 
Uric acid, 478 
Urinalysis, 294 
Urinary organs, 359 
anatomy of, 350 
Urination of infant, 303 
Urine, 294, 478 

abnormalities of, 53 

albumin in, 294 
test for, 294 

amount of, conditions affecting, 
292 

color of, 292, 293 

composition of, 292 

excretion of, in pleurisy, 276 

in children, 318 

in diabetes, 291, 292 

incontinence of, 53,133 

odor of, 292, 293 

of patient, condition of, 53 

of pregnancy, attention to, 133 

passage of, 53 

quantity of, normal, 292 

reaction of, 293 

method of determining, 293 

retention of, 226 
by newborn, relief of, 303 
danger of, 242 



510 



INDEX, 



Urine, retention of, in typhoid 
fever, 242 
treatment, 226 
specific gravity of, 292 

method of ascertaining, 

.293 
sugar in, test for, 294 

or urea in, 292 
suppression of, from cantharid- 

ism, 120 
tests of, 294 
Urinometer, 292, 478 
Urotropin, 411 
Urticaria, 297, 478 
Uterus, 362, 478 
Uvula, 478 



Vaccination, 478 
Vaginal douche, administration of, 
69 
apparatus for, 69 

dressings, 159 

tampons, 159, 474 
Vaginitis in children, douches for, 

69 
Valves, ileocecal, 361 

mitral, 344 

of heart, 343 
disease of, 279 

semilunar, 343 

tricuspid, 344 
Valvular disease, 279 
Vapor-baths, action of, 88 
Varicella, 253, 432 
Variola, 479 
Varioloid, 252 
Varix, 479 

Vasomotor nerves, 357, 458 
Veins, 343,479 

hepatic, 346 

jugular, 354 

pulmonary, 344 
Vena cava, inferior, 343 
superior, 343 

portae, 345 
Venesection, 479 
Ventilation of sick-room, 38, 479 
Ventilator, window-, 39 
Ventricles, heart, 344 
Vermiform appendix, 362 



Vermin, head, extermination of, 56 
Vernix caseosa, 300 
Vertebrae, 352, 479 

cervical, 352 

dorsal, 352 

lumbar, 352 
Vertigo, 479 
Vesicants, 116 

Vigilance in nervous and mental dis- 
eases, 332 
Vomiting, 228 

in ether anesthesia, 170 

in hysteria, 325 

in nervous and mental diseases, 

325 
in septicemia, 182 
induction of, in poisoning, 23 2 
of infancy, 311 
of patient, symptoms of, 48 
repetition of dose after, 82 
treatment of, 228 



Walking typhoid fever, 246 

Warm bath, action of, 88 

Water, giving of, to babies, 304 

Water-bed, 34 

Waters, mineral, 394 

Weaning infant, time for, 307 

Weight in nervous and mental dis- 
eases, 325 

Weights and measures, 397 

Weir Mitchell rest-cure, 338 

Wet-sheet rub, 97 

Wharton's jelly, 132 

Whey, 394 
wine, 388 

Whipped cream, 388 
frozen, 388 

White celery-soup, 379 

Whites, 454 

Whitlow, 480 

Whooping-cough, 269, 463 
treatment, 271 

Wine jelly, 387 
mulled, 392 
whey, 388 

Witch-hazel, 411 

Womb, 362 

involution and subinvolution of, 
140 



INDEX. 



511 



Wood-oil, 405 
Worms, 312 

of infancy, 312 
Wounds, 209, 480 

healing of, 209 

septic, 209 

suppuration of, 210 

treatment, 210 



Wounds, varieties of, 209 
Wry-neck, 476 



Yellow fever, 480 
Zinc chloride, 466 



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