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In Diphtheria the expectoration, discharge from the nose and vomited matter should be received in paper napkins and burned at once in the room, or if this is impossible, boiled before being taken from the room.
Use the same treatment for the discharges in Scarlet fever. Two sets of cups should be kept and boiled in the soda solution before being used. All vessels, tubes or cups that are used for the mouth in diphtheria, syphilis, or cancer should be kept in a 1-40 solution of carbolic acid and boiled before being used by another patient.
Bed-pans used in cases of cancer, dysentery, typhoid fever and, in short, in all infectious diseases, are to be soaked in a 1-20 (five per cent) carbolic acid solution and boiled before again coming into general use.
Sheets and clothing stained with typhoid fever discharges must be washed out at once, or soaked in a disinfectant solution and steamed before being sent to the laundry. Also the bedding and clothing in any infectious or malignant disease should always be put to soak, at once, in a 1-20 (five per cent) carbolic acid solution, or else steamed or boiled before being brought again into general use.
The urine needs the same attention as the bowel discharges in typhoid fever.
Coughing in diphtheria, lung tuberculosis, scarlet fever, etc., sets free infectious germs. These may be received in the person of the attendant, or on the bedding and furniture. Care should be taken when attending such cases.
[628 MOTHERS' REMEDIES]
CARE OF THE MOUTH AND TEETH.--A weak solution of borax or listerine is very good. One-half ounce of listerine to a gla.s.s of water to be used by the patient as often as he desires to rinse his mouth. Lemon juice in solution is very good. For cracks in the mouth, vaselin or cold cream is good. A few drops of oil of peppermint can be added, or oil of wintergreen.
For spongy and sore gums.--A few drops of tincture of myrrh added to pure water may be used. Colorless golden seal in the same way is pleasant and successful.
Cloths for was.h.i.+ng the teeth and mouth are made in small squares of gauze or old linen. They are best to use since they can be burned immediately after being used. Wrap one of the squares around the first finger, dip it into the mouth-wash and insert in the mouth. Go over the whole cavity, the cloth being pa.s.sed along the gums and behind the wisdom teeth, thence over the roof of the mouth, inside the teeth and under the tongue. Use more than one piece for all this. This is very necessary in typhoid fever. If the tongue is badly coated, it can be soaked and gently sc.r.a.ped. A good mouth-wash for general use is the following:
Glycerin 1 dram Soda 10 grains 5% solution of Boric Acid 1 ounce
BED SORES. Prevention and care of.--Very fat flabby people or thin emaciated patients are liable to suffer from bed sores. They result from constant friction or pressure on a certain spot or spots and when the body is poorly nourished. Moisture, creases in the under sheets, night gown, crumbs in the bed and want of proper care and cleanliness also are causes.
Bed-sores due to pressure occur most frequently upon the hips and lower back, the shoulders and heels; those from friction, in the ankles, inner parts of the knees, or the elbows and back of the head. In patients suffering from dropsy, paralysis or spinal injuries, or when there is a continuous discharge from any part of the body, the utmost care must be taken to prevent bed sores.
Treatment. Preventive.--Cleanliness and relief from pressure. Bathe the back and shoulders with warm water and soap night and morning and afterwards rub with alcohol and water equal parts. Dust the parts with oxide of zinc or stearate of zinc powder, or bis.m.u.th mixed with borax; all are good. If there is much moisture due to sweating or involuntary stools or urine, castor oil should be well rubbed in addition. The sheets must be kept smooth and dry under the patient.
[ NURSING DEPARTMENT 629]
Redness of the skin may be the first symptom of this trouble. This may be followed by a dark color under the skin, and when the cuticle finally comes off the underlying tissues are found broken down and sloughing. Any skin sc.r.a.ped or worn off--abrasion--should be carefully washed and a small pad of cotton smeared with olive oil and stearate of zinc placed over it and kept there with collodion painted over it; or white of egg painted over the sore is sometimes very beneficial; also equal parts of castor oil and bis.m.u.th make an excellent dressing. Rubber rings or cotton rings over the part relieve the pressure. Changing the position is often beneficial.
Treatment of the Sore Proper.--Sponge with clean soft cloths, with a solution of boric acid or one per cent solution of carbolic acid and the cavity packed with iodoform gauze, or iodoform, or aristol ointment, over which apply a layer of borated cotton. Dress the sore daily. If it sloughs apply hot boric acid dressings every four hours and follow with an application of castor oil and balsam of Peru. When it is better treat as any other sore.
BATHS.
A hot bath temperature is from 100 to 112 degrees F. or higher.
A warm bath temperature is from 90 to 100 degrees F.
A tepid bath temperature is from 70 to 90 degrees F.
A cool bath temperature is from 65 to 70 degrees F.
A cold bath temperature is from 33 to 65 degrees F.
The entire bath should not last longer, when given in bed, than fifteen or twenty minutes. A few drops of water of ammonia or a little borax will help much in getting the patient clean and disguise the bad odor of the perspiration. A little alcohol or Eau de Cologne will be found refres.h.i.+ng.
Cold damp towels should never be employed here. The water should be pleasantly warm and changed a few times during the bath. A gla.s.s of hot milk can be taken after the bath is given, if the patient feels exhausted, and if the feet are cool a hot fruit can is applied.
Foot Baths in Bed.--The patient should lie on her back, with the knees bent and place her feet in the tub, which is placed lengthwise in the bed on a rubber sheet spread across the lower part of the bed for protection.
A mustard foot bath can be given the same way except that the knees and foot bath are enclosed in a blanket. These are often given for severe colds, with head symptoms (headaches), when it is desired to draw the blood from the head. Hot water alone will do this, but the mustard hastens the action. The mustard should be mixed with a small amount of water before being added to the bath. The amount will depend upon the sensitiveness of the patient. The feet may remain in the bath for fifteen to twenty minutes, the water kept at the same temperature or made warmer by adding more hot water from time to time. They are wiped gently afterward and tucked snugly in blankets.
[630 MOTHERS' REMEDIES]
Hot Bath, Hot Air, Vapor, and Steam Bath.--Given for sweating purposes.
Fill the tub half full of water at 100 degrees F. and draw it to the bedside if necessary. Lift the patient into the tub and gradually increase the temperature by the thermometer to 110 degrees and 112 degrees F.
Maintain it at this point for twelve or fifteen minutes. After this the patient is lifted out into a prepared bed on which a long rubber is spread with three or four hot blankets over it; these are wrapped all around the patient, tucked in closely about the neck and watched continually to see that no air enters. Give plenty of water to drink, as it promotes perspiration and helps in that way to cast off the impurities. Keep this up for an hour if possible, and then the patient is gradually uncovered, sponged under a blanket with alcohol and water and the wet blankets removed. Cloths wrung out of cold water are applied to the head during this bath. The pulse should be closely watched for any indication of faintness, when the patient should be put to bed, immediately. This bath should not be given during menstruation or pregnancy.
Warm Baths (90 degrees to 100 degrees F.) are frequently given to children for convulsions. They should be placed in the tub and cold applied to the head, while the body is washed and rubbed.
Local baths and packs.--For sprains, a foot bath. For menstrual pain, a sitz bath. The patient sits in the bath with only the thighs and part of the body immersed, while the upper part of the body and the feet are protected with blankets. Sitting on a cane-seated chair over a steaming pail with a blanket around the neck and body gives a good bath for pain during menstruation.
Salt-water bath. Tonic action.--Nine to fourteen pounds of sea salt to fifty gallons of water will redden the skin and give an exhilarating effect.
Dry Salt Bath sent us with Mothers' Remedies.--"To a basin of water put a big handful of salt, take a Turkish towel and soak it in the salt water, wring out and let dry. The salt will adhere to the towel. Use to rub the body. A tepid bath should be taken next day to remove the salt."
Starch bath.--Add eight ounces of laundry starch to each gallon of water.
This allays skin irritation.
Bran bath.--Put the bran in a bag and allow this to soak in warm water for an hour before being used; or it may be boiled for an hour and then the fluid drained and added to the bath water.
Sponge bath.--Water and soap should be ready. Clothes to be put on, well aired and at hand. Then remove the patient's clothes and wrap him in an old blanket, expose only the part being washed at a time, wash and dry this part. Begin with the face and neck, then the chest, abdomen, arms and back, and lastly the lower extremities. Warm the water at least twice.
Then put on his clean, well aired clothes and into a clean bed, and the patient will bless you.
[NURSING DEPARTMENT 631]
Alcohol sponge bath.--This is given the same way, only sixty per cent alcohol is used and the parts are allowed to dry themselves.
Tub bath (common).--Prepare everything as to heat, etc. Then carry the patient or a.s.sist him to the tub. Soap him all over and pour water over him from a large pitcher. The temperature of the water depends upon the disease. One person should continually rub the patient in typhoid fever to keep up the circulation while the water is being poured over him. A hot drink is given before and after these baths and the patient is wrapped immediately in warm flannel.
Patients are frequently put into a tub with a water temperature of 85 to 90 degrees, and then the water temperature decreased by adding cold water.
This bath must be carefully given.
The cold pack.--It is used to reduce fever, delirium and extreme nervousness and to induce sleep. Cover the bed with a rubber sheet or oilcloth, and over this a blanket. Wring a sheet out of cold water and place this over the blanket. Lay the patient on this sheet and wrap it around him so that every surface has the wet sheet next to it. Tuck the sheet in well at the neck and feet. Fold the outer blanket over the patient and tuck it in. Lay a wet towel over the head, or he can be enveloped loosely in blankets and allowed to remain twenty minutes to an hour, only ten to fifteen minutes by the tucked-in method and then dried and put to bed.
The hot pack.--This is given in the same manner except that the patient is wrapped first in a blanket wrung out of boiling water. More covering is put over the patient than in a cold pack, and something cold is applied to the head.
EXTERNAL APPLICATIONS.
General and Local.--For dry heat, for warmth alone, hot bags, bottles and cans are used. Hot flannels are sometimes used for inflamed joints. Make the flannel very hot, wrap in heated paper or cloth and apply quickly; cover all with a layer of cotton, wool and oiled muslin.
For neuralgia and earache, salt bags are used.
Fill flannel bags with salt, heat as hot as can be borne, and cover it so as to retain the heat after it is applied to the ear.
For moist heat.--This is more penetrating and has a more p.r.o.nounced effect than dry heat. It also hastens suppuration when it cannot be prevented in acute inflammation like quinsy, etc.
For local pains, fomentations, stupes and poultices are used. Poultices are best for deep-seated pain or continuous inflammation.