Part 10

In severe cases the constitutional treatment is of more importance than the application of local remedies. If the patient is in shock wrap him in warm blankets, and give him stimulants. In superficial cases where the skin is not broken powder with bicarbonate of soda (baking soda). A ready domestic application is sweet oil. _Exclude the air at all times._ When vesicles have been produced they should be punctured with a sharp instrument, and the serum gently evacuated with absorbent cotton. Apply soothing ointments or wet dressings. IN CASE OF SEVERE BURNS OF THE BODY immerse the patient in a warm bath, keeping it at even temperature. Separating a layer of common white cotton wadding, and wrapping it about the injured part will allay the pain, and the cotton has the advantage of not adhering to the raw surface. Splints and bandages should be employed to prevent contractions.

BURNS OF THE EYE.

For burns resulting from molten lead, strong alkalies, lime, or acids, flush freely with warm water or boric-acid solution, and anoint with pure vaselin or a few drops of castor oil. Do not rub the injured tissues. The applications should be made quickly and very gently. Put on cold compresses until medical aid arrives.

INJURIES TO THE EYE.

For surface injuries a drop of castor oil may be applied, and the eye kept closed for the day with a pad of wadding and a bandage.

SYNCOPE (FAINTING OR SWOONING).

Place the patient in a recumbent position. Loosen all clothing, and dash cold water on the face and chest. Spirits of ammonia or smelling salts should be used with caution, and not brought too near the nostrils. The pulse and general appearance will indicate if condition is serious. Give whisky and strychnin sulphate (¹/₃₀ gr.) hypodermically if necessary.

HYSTERIA.

In hysteria the patient may be apparently unconscious; the body is normal to the touch, the pulse is full and regular, the color is natural, and if an attempt is made to raise the eyelid it will be met with resistance. Do not leave the patient alone, but do not disturb her until she recovers.

EPILEPSY.

The attack comes on very suddenly. The patient utters a sharp cry, and falls to the ground. The muscles are rigid, the eyes staring, and there may be frothing at the mouth. The muscles soon relax, and there are twitchings of the whole body. The attack may last only a few minutes. Place the patient on his back with the head slightly elevated, and loosen all clothing. Put a wedge between the teeth, give him plenty of fresh air, and do not attempt to stop the movements.

DROWNING.

_Begin artificial respiration at once_, then soon as possible remove or loosen all clothing about the back, chest, and abdomen. Free the throat and mouth from mucus and foreign substances. Secure the tongue with a dry cloth or handkerchief; keep it drawn forward and to one side, as this opens the windpipe. Then turn the patient face downward, allowing the abdomen to rest on a roll of goods. Make firm pressure on the back and on both sides of the thorax to evacuate the lungs. Envelop the body in warm blankets, apply heat to the feet, and stimulate with hypodermic of strychnin, whisky, and coffee.

SUSPENDED ANIMATION FROM NOXIOUS GASES.

Remove patient at once into the fresh air. Employ artificial respiration, apply heat, and stimulate hypodermically.

METHODS OF ARTIFICIAL RESPIRATION.

=Sylvester’s Method.=—Lay the patient upon his back; kneel above the head, take firm hold of the arms above the elbow, and move them horizontally—first away from the body, then over the head until the hands touch behind; pull them backward for a few seconds. This process expands the chest cavity, and the lungs are filled with air, inducing inspiration. Return the arms to the first position, and make strong pressure on the sides of the chest and epigastrium to expel the air and effect expiration. Movements should not be too rapid; they should be repeated about sixteen times a minute. In case of apparent want of success, persist in the treatment until it has been ascertained that the heart has ceased to beat.

=Marshall Hall’s Method.=—Roll the patient over on his breast, make gentle pressure on the back, then turn the body gently but completely on the side, and again make gentle pressure on the back. Repeat these movements fifteen times every minute.

Artificial respiration may be kept up for hours before the faintest symptoms of life are shown.

SUNSTROKE.

Two conditions result from exposure to excessive heat: thermic fever and heat exhaustion.

In =thermic fever=, after prodromal symptoms consisting of headache, nausea, and vomiting, there are stupor or coma, fever ranging from 105° to 110° F., flushing of the face, contraction of the pupils, a rapid, full pulse, and noisy respirations.

_Management._—Pack the patient in ice, and rub with ice. Ice-water enemas may also be given. Bleeding and the subcutaneous administration of normal salt solution are sometimes efficacious.

In =heat exhaustion= consciousness is not lost; the skin is cold and moist; the respirations are shallow and rapid, but not noisy; and the pulse is feeble.

_Management._—The patient should be covered with blankets and surrounded with hot bottles. Aromatic spirit of ammonia (30 minims), whisky, and black coffee are useful stimulants.

BATHS AND PACKS.

WARM PACK FOR PNEUMONIA PATIENTS.

Articles needed: 4 blankets. Foot-tub for hot water. 1 rubber and towel for head. Basin and ice. 1 long rubber sheet. 2 compresses for head.

Place under patient: First, blanket, then rubber sheet, covered with second blanket. Place small rubber piece, covered with the towel, under patient’s head. Third blanket put over patient. Leave patient on side while woolen blanket is wrung out of hot water. Place this blanket quickly under and about the patient, removing lower dry one at the same time. Leave feet out of wet blanket, wrapping them up dry, and use hot-water bottle if necessary. Cold compresses to head. Leave in pack 45 minutes. Wipe dry; give alcohol rub. Take temperature and pulse every half-hour after removing from pack.

COLD PACK TO REDUCE TEMPERATURE.

Articles needed: 1 long rubber sheet. Foot-tub. 3 blankets. Pitcher or sprinkler. Basin of ice. Rubber and towel for head. 2 compresses for head.

Place under patient: First, blanket, then rubber sheet, covered with second blanket. Have blanket over patient with patient on side. Wring a cotton blanket or sheet out of warm water to wrap about patient, leaving feet out, covering them with a dry blanket, using hot-water bottle if necessary. Compress on head. Sprinkle with tepid water. Use friction. Turn patient once in midst of pack and iron back with ice, and again just before he is removed. Leave in 30 minutes. Change compresses frequently. Give plenty of water to drink. Have sea sponge to take up water. Leave patient between blankets; give alcohol rub. Take temperature and pulse half an hour after removing the pack.

SPONGING TO REDUCE TEMPERATURE.

Articles needed: 2 blankets. Basin of ice. 3 towels. Basin of warm water. Rubber and towel for head. Compresses or ice-cap for head.

Place patient between blankets. Rubber and towel under head. Towel across loins. Wash face and apply cold compress to head. Sponge chest, arms, legs, and back with warm water. Cool water and sponge chest. Apply cold compress across chest. Turn patient on side. Sponge arms, leaving upper part of body exposed. Fold blanket up and sponge back. Change compresses frequently. Give plenty of water to drink. Continue sponging from 20 to 30 minutes. Rub with alcohol and put patient to bed. Take pulse and temperature half-hour after sponging.

HOT PACKS TO INDUCE PERSPIRATION.

Articles needed: 4 blankets. 1 sheet. 2 long rubber sheets. Basin of ice. 1 short “ sheet. Foot-tub of hot water. Rubber piece for head. Old woolen blanket. 2 towels. 2 compresses.

Place under patient: First, blanket, then rubber sheet, covered with the second blanket. Third blanket place over patient. Wrap feet up dry. Have patient on side. Wring fourth blanket out of hot water and place quickly about patient, bringing well up around neck and in between the arms. Wrap well about the legs. Bring under rubber sheet up about the neck well and place a long rubber sheet snugly over that. Wrap feet, then bring under blanket up over rubber sheet, and top blanket tucked over all, seeing that all folds of blankets are snug around the neck. Rubber and towel under head. Compress to head. Place sheet over patient not tucked in. Give hot drinks freely unless liquids are restricted. Take pulse before placing patient in pack and every 15 minutes while in. Leave patient in 45 minutes and then in dry blankets half an hour, Take out of pack, rub dry, and give alcohol rub.

TUBBING.

Articles needed:

1 long rubber sheet. 1 sea sponge. 2 blankets. 2 pails. 1 tubbing sheet. Basin of ice. 1 towel. Siphon. 2 compresses or ice-cap. Piece of rubber tubing. 1 bath towel.

Place under patient: One blanket covered with long rubber sheet, then with tubbing sheet, over which place muslin sheet widthwise. Place towel over loins. Bring sheet up around patient, tubbing sheet rolled in from sides and tied to the four corners of the bed. Use four pails of tepid water, gradually cool to 60° or 70° F. Apply friction most of the time. Compresses to head. Give water freely. Leave feet out of water. Turn patient and use friction on back once while in and before taking out. Take pulse frequently. Leave patient in pack 20 minutes. Turn patient and remove water with siphon and sea sponge. Lower patient, removing tubbing and wet sheet, leaving patient between blankets with hot-water can at feet. Take temperature half-hour after removal. Give alcohol rub and make bed.

ALCOHOL SWEAT.

Articles needed: 6 old blankets. 8 hot bricks in bags 1 piece of old blanket. (woolen preferred), 2 long rubber sheets. 12 × 12 inches. 1 short “ sheet. Basin of ice. 1 piece “ for head. 2 compresses. 1 towel. Alcohol. 1 sheet. Hot drink.

Place under patient blanket covered with a long rubber sheet and then second blanket. Wrap shoulders in a blanket. Place folded blanket and small rubber sheet around the feet. Cover patient with blanket, and over that place long rubber sheet. Fold back upper rubber sheet blanket over patient and then one under patient. Place covered bricks on folds of lower blanket. Pour one tablespoonful of alcohol on hot bricks covered with outer edge of blanket, on which bricks rest, then with blanket over patient, folding it in between bricks and patient. Bring under rubber sheet up and upper one down. Tuck each rubber sheet and blanket well in about the neck. Bring folded blanket and short rubber sheet over feet, under the long rubber sheet. Arrange opposite side in like manner. Place over all 2 blankets and tuck in. Cover these with clean sheet, not tucked in. Rubber and towel under head. Apply the cold compress to head and change frequently. Give a hot drink unless contraindicated. Take patient’s pulse before placing in sweat and every 10 minutes while in. More often as condition of patient indicates. Leave in one hour. Do not expose patient while removing bricks and blankets. Leave one blanket under and two over patient for half an hour. Tuck blanket about patient, sheet over all. When removing these blankets dry patient and give alcohol rub.

MASSAGE—MECHANO-THERAPY.

Massage (meaning to knead or manipulate) is one of the oldest therapeutic measures employed for the relief of disease. It is probable that the Chinese used this method of treatment several thousand years ago. The Japanese and the Greeks and Romans also were ancient users of massage. To-day it is recognized as one of our most useful adjuvants in the treatment of a great many disorders. Unfortunately, like some other therapeutic measures, it has been misused for personal gain by unscrupulous parties to the great detriment of this form of treatment; because of this many physicians have hesitated to adopt its use extensively for fear of being classed with the army of quacks and charlatans who endeavor to guile the public with a pretended knowledge of massage. It not being possible for all nurses to become proficient in the art of massage while doing general nursing (as it requires time, patience, and a great deal of experience to succeed), massage has become somewhat specialized, and we find many nurses who devote their time and attention exclusively to this work. Yet all nurses should have a general knowledge of the physiologic effects of massage and how to give it. The best results are obtained only when massage is given under the direct supervision of a physician, as massage may influence the function of almost every organ and tissue of the body.

Some general rules may be given as to the hour and duration of each treatment. A great deal depends upon the nature of the disorder in each individual case. In the treatment of neurasthenic patients where insomnia is often a troublesome symptom, massage given one or two hours before the patient quiets down for the night frequently results in improved sleep. Again, other patients will do better to have the treatment one or two hours after the morning meal. Individual peculiarities must be considered always in giving massage. The room should be of such temperature that the patient when exposed will not feel chilly. Absolute quiet should be maintained during the treatment, and after the treatment the patient should remain quiet in a recumbent posture for an hour or two as the condition may require. The oft-used expression “that a masseur or masseuse possesses a great deal of electricity which is transferred during the treatment to the patient,” should find no place in the intelligent mind in considering the effects of massage. It is true that one operator by his method of administering massage may please a patient and accomplish more than another, but this is due only to the fact that one understands how it should be given, and the other does not.

All the different movements in massage may be classed under the following: First, stroking; second, friction; third, kneading; fourth, vibration; fifth, percussion; sixth, joint movements.

=Stroking.=—This procedure may be given with two or three fingers or the palmar surface of one or both hands. The movement should be gentle, and the contact made as lightly as possible. Stroking should be done always in one direction, and, as a rule, in the direction of the blood currents in the arteries. The physiologic effects when properly applied should be sedative, as the purpose should be to diminish the blood-supply to the part. It produces a certain effect upon the cutaneous nerves which is very quieting. It is often found useful when applied about the forehead for sleeplessness. Nervous headache may be relieved by the same procedure. Neuralgic pains and the vague, but nevertheless uncomfortable, sensations complained of by neurasthenic patients are often relieved by this measure.

=Friction.=—In this procedure the whole or part of the palmar surface of the hand is moved over the surface of the body with considerable pressure. The principal effect of friction is upon the superficial blood-vessels and the lymphatics. In the lower extremities the movement should be from below upward in the direction of the venous flow. The same may be said of the upper extremities. The thumb may be made to follow the course of the larger veins, in this manner stimulating the venous circulation. Some patients object to friction applied by the dry hand, in which case some lubricant may be used; pure vaselin, cocoa-butter, and talcum powder are among the best for this purpose. Friction should always be used in the beginning of massage, especially if the surface of the body is cold.

It is not the intention here to give minute instruction as to the methods of procedure with all the different parts of the body; only general instructions can be here given, and those requiring further information should consult text-books upon this subject.

_Physiologic Effects of Friction._—First, reflex effects upon the vasomotor nerves producing dilatation of the peripheral blood-vessels with increased circulation, aiding the venous and lymphatic circulation. It is useful in all conditions accompanied by poor peripheral circulation. It not only stimulates the circulation, but aids materially in elimination and increased nutrition. It aids in the relief of general dropsy and hastens the absorption of inflammatory exudates resulting from sprains and various joint affections, etc.

=Kneading.=—Kneading is one of the most important procedures in massage. It consists in the alternate compression and relaxation of the tissues, the hand not being allowed to slip over the surface as in friction. It may be administered in various ways, such as rolling, wringing, and the use of the palm or fingers. Furthermore, it may be deep or superficial. Superficial kneading stimulates all the functions of the skin, increases superficial circulation in the blood-vessels and lymphatics. In deep kneading the object is to influence the deep-lying muscles, and care should be exercised in this procedure not to injure the large blood-vessels and nerves. Here a knowledge of anatomy is essential. In the beginning of deep kneading little pressure should be exercised until tolerance is established; then greater pressure may be exercised without discomfort to the patient. It is quite essential that each muscle group be gone over carefully and thoroughly, so that every muscle so far as possible shall be included in the treatment. The physiologic effect of deep kneading is a stimulation of the functions of the nerves, blood-vessels, lymphatics, and cellular metabolism of the muscles. It is of especial benefit to patients who are unable to take a sufficient amount of active exercise, such as those suffering from neurasthenia, rheumatism, chronic neuritis, locomotor ataxia, and from localized disturbances, such as fractures, sprains, etc.

=Vibration.=—This procedure consists of vibratory movements to the body of the patient through the hand of the operator. It may be given by using the palmar surfaces of the hand or the finger-tips. This procedure stimulates the superficial circulation and acts as a mild general stimulant. It may be used in conditions of poor circulation from any cause, but is contraindicated in conditions of hypersensitiveness.

=Percussion.=—This procedure consists of blows or taps with varying degrees of force. The tips of the fingers may be used, the two hands alternating, or the palmar or the ulnar surface of the hands may be used for the same purpose. In any case, the force should not be sufficient to bruise the tissues. The physiologic results of percussion are stimulation for functions of the skin and a marked effect upon the underlying structures, muscles, nerves, and blood-vessels. It is useful in such conditions as sciatica, inactivity of the liver, chronic constipation, poor circulation from various causes, and to produce reaction after a cold bath, etc.

=Joint Movements.=—Under this procedure we may mention flexion, extension, abduction, adduction, pronation, supination, circumduction, and stretching. The movements may be passive or resistive. In passive movements the exercise is almost entirely confined to the joint, the patient offering no muscular resistance. With the resistive movements a certain degree of muscular activity is enforced by the patient, thus not only exercising the joints, but the muscles connected with the joints. The physiologic effect of joint movements is to markedly stimulate all the parts about the joint, and is indicated in various joint disorders which may have resulted in the lessening of the normal movements of the part, as in rheumatism, gout, chronic synovitis, and the stiffness that follows immobilization of the joint in the treatment of sprains, fractures, etc. Care should be exercised in the beginning not to use too much force in the manipulation, otherwise the existing condition may be aggravated, and more harm result than good. Increased force may be exercised with each treatment, always bearing in mind the necessities of each case.

ELECTRICITY.

BY DR. JAMES C. GILL,

Rush Medical College, Chicago, Ill.

Electricity is a useful and important therapeutic agent, and an understanding of its effect when applied to the human body is as essential as a knowledge of any other therapeutic measure. Too often the therapeutic use of electricity is committed to those having very little knowledge of it, and consequently good results are not obtained.

It is a great mistake to allow or advise patients to use electricity themselves; no greater mistake would be made or more harmful results follow if they were advised to go to the drug store, and help themselves to any drugs they might choose. Electricity should be administered by a physician, or under the directions of a physician by a nurse who has been thoroughly taught its use.

In medicine we have usually considered three different forms of electricity: First, Galvanism or Chemical Electricity; Second, Faradism or Induced Electricity; Third, Franklinic or Static Electricity. Now, we add a fourth and a very important one—namely, _X_-ray. A nurse should have a general knowledge of these different manifestations of electricity and their effect when applied to the body.

In electricity we have units of measurements as we do in weights and measures. For instance, the force that drives the current of electricity along, as we might express it, is called the electromotive force, and its unit of measurement is a volt. The resistance which the current must overcome is measured in ohms, and the strength of the current is measured in amperes, or, as we measure it in medical electricity, the thousandth part of an ampere, a milliampere.

Galvanic or chemic electricity has certain properties not obtainable in the other forms. Comparatively speaking, it is a current of considerable quantity, but low electromotive force. The galvanic current passes always from the positive to the negative pole. It possesses the power to decompose various compounds, such as water, the tissues of the body, etc. This is called the electrolytic action, and may be used to destroy certain tumors, for the removal of superfluous hair, etc. Again this current has the power to convey certain substances in solution into the tissues. This is called cataphoresis, and is used to produce local anesthesia by the use of cocain applied to the positive pole. This is one of the best methods we possess of obtaining local anesthesia.

The effect of iodin may be obtained by the use of a solution of potassium iodid, and the negative pole may be used to affect local swellings, etc. Muscular tissue may be made to contract by the application of the current, either when applied to the motor nerve supplying the muscle or when applied directly to the muscle. Upon sensory nerves the positive pole is sedative, and may be used to relieve pain in cases of neuralgias, etc. The negative pole is stimulating, and may be used in conditions requiring increased nutrition, etc.