Part 76

For olive oil, six ounces may be given in a hard rubber syringe; this is seldom successful unless followed by a soap suds enema in one-half hour.

Glycerin enema, one-half ounce with equal quantity of warm water 95 degrees F., and give with a hard rubber syringe. This generally proves successful, without an additional soap suds enema.

For infants and children the contents of a straight medicine dropper will be sufficient.

Glycerin irritates the mucous membrane, and it is best that we add an equal amount of olive oil.

If these enemata fail it will be necessary to use purgative enemata. These are made by adding drugs, such as turpentine, rochelle or epsom salts or castor oil in certain proportions to the simple enema. In giving castor oil and water it is necessary first to mix the oil with the yolk of an egg and then add the warm soap suds.

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1. Formula.--

Castor Oil 2 ounces Turpentine 1/2 ounce

Mix thoroughly and inject with hard rubber syringe, followed in one-half hour by a quart of soap-suds.

2. Formula.--

Turpentine 1/2 ounce Rochelle Salts 1 ounce

Mix with warm soap-suds, one pint.

The buttocks and anus should be washed off with warm water after turpentine has been used in the enema.

3. Molasses and Laxative Enema.--Mix from two to ten ounces, according to age, with one pint of soap suds and inject slowly.

Nutritive Enemata.--Food is given by the bowel when the stomach cannot retain it. It is then called Nutritive Enemata. They should be given only from four to six times in twenty-four hours and the quantity given at one time should not exceed four ounces. It must be introduced high up in the bowel, about ten inches, and therefore they should be given through a rectal tube made of heavy rubber one-quarter inch in diameter and at least eight inches of it should be inserted in the bowel. After it has been oiled the tube is gently inserted in a backward, upward, direction and a glass funnel is attached to the outer end. The enema has been already mixed in a small pitcher and gently poured (very slowly) into the funnel, which is then raised so that the contents will go slowly through the tube into the bowel. The patient is protected from drops by a folded towel underneath him. Then the tube is slowly withdrawn. The tube should then be cleansed by allowing warm water to run through it, and then kept in a one per cent solution of boric acid. Food given by enemata should be very nourishing and concentrated. The following are excellent formulas:

Formula 1.--

One whole Egg Table Salt 15 grains Peptonized Milk 3 ounces or 3/8 of a cup Brandy 1/2 ounce

Formula 2.--

White of two Eggs Peptonized Milk 2 ounces or 1/4 of a cup

The whole amount should never exceed four ounces. The addition of salt aids the absorption of the egg. Brandy, and whisky are very irritating and should be given only every other time.

The fresh raw milk can be used, if it is impossible to have it peptonized.

After a nutritive enemata the patient should lie quietly on his back for twenty or thirty minutes.

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Turpentine enemata for distention may be given according to the following formula:

Mucilage of Acacia 1/2 ounce Spirits of Turpentine 10 drops

This should be administered high up in the bowel.

Astringent Enemata. To check diarrhea.--They should be given slowly and injected high up, and they should be retained as long as possible.

Starch and Laudanum.--Boil the starch as if to be used in the laundry and dilute with luke-warm water, until it is thin enough to pass through a tube. Take of this three ounces. This can be given alone in mild cases; but if there is much pain and straining add ten to fifteen drops of laudanum to the starch water or thirty to forty drops of paregoric. This dose is for an adult.

Stimulating Enemata. 1. Black coffee.--One-half to one pint of strong coffee, injected as hot as possible. It should be strained before using. This is frequently given in poison cases.

2. Salt Enemata.--Two teaspoonfuls to one quart of hot water is mildly stimulating; one-half to one ounce of brandy or whisky may be added.

DOUCHES.--By this term is generally meant a jet of fluid directed with a certain amount of force upon a limited external or internal surface, for cleansing, stimulating purposes and to relieve inflammation. Three common douches are the ear (aural), the vaginal and the rectal.

The Vaginal Douche. For cleansing.--A one per cent solution of carbolic acid is often used in one to three quarts of water.

To allay inflammation.--A hot solution of the temperature of 105 degrees to 115 degrees is given, and three or six quarts may be used. Allow the stream to flow before the nozzle is inserted so as to have the warm temperature instead of cold at the start, and the nozzle should be introduced up towards the posterior vaginal wall. The fountain syringe bag should not be raised more than six to twelve inches above the patient who is lying down with her hips raised on pillows and her knees drawn up. Medicines can be used in all the douches.

Rectal douche.--This is to relieve piles and reduce inflammation. Hot or cold as needed. A rectal tube or fountain syringe is used.

Ear (aural) douche.--This is used for earache and inflammation. Salt or boric acid is generally used in the warm water. It should be allowed to flow in slowly and gently.

How to use a bed pan.--When you are placing the pan, you should slip one hand under the buttocks and then place the flat end of the pan under the buttocks. It should always be warm. Raise the patient in the same way before attempting to remove it. Do not pull it out.

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TEMPERATURE (Fever).--A thermometer is necessary in taking the temperature. They can be bought for from fifty cents up. The temperature is taken by putting the thermometer under the tongue, in the arm-pit and in the rectum. For children it should be placed in the rectum or in the arm-pit or groin. Allow it to remain from two to five minutes. This depends upon the time limit of the thermometer. The normal temperature is 98-6/10 degrees F. This varies, some people are normal at times at 99 or 98 degrees. The temperature in the arm-pit is lower by 3/10 of a degree, but that in the rectum is 1/2 degree higher than that taken in the mouth. The normal point on the thermometer is marked by an arrow. The mercury in the tube must always be down to that at its highest point, before the thermometer is placed and the highest point the mercury goes indicates the height of the temperature (fever). If you take it in the rectum, that should be free from feces. Oil the thermometer and gently insert it into the bowel for one and one-half inches and hold the stem.

Under the Tongue.--Place the point under the tongue and instruct the patient to close his lips over the thermometer. He can also hold the stem with his fingers, It should never be taken here right after a cold drink. Unconscious patients may bite through the instrument, so care must be taken with them.

Arm-pit.--Wipe the part thoroughly dry and place the point directly in the arm-pit. Then place the elbow against the body and the hand on the chest pointing to the opposite shoulder. When ready to take it out move the arm away from the body and take the thermometer away gently for it sticks sometimes and you will cause pain if you draw it away quickly. The instrument should be cleansed in tepid mild salt solution.

PULSE.--Average in men, sixty to seventy. In women, sixty-five to eighty. Children ninety to one hundred to one hundred and twenty. Different authors vary. In men it is generally seventy to seventy-two. In women seventy-two to seventy-five.

It is better taken sitting. It is faster when walking, slower when lying down. I always take the pulse in the left arm unless there is a deformity there. I use my right hand with the third finger toward the elbow. By using the first three fingers you can find out different things about the pulse. Some people are very nervous and such an one will make your arm ache when feeling the pulse. The pulse should be regular, even beats, in health. Sometimes you can feel it best on the temple or on the neck.

RESPIRATION (Breathing).--In an adult the average is eighteen per minute. In a child the average is twenty to twenty-four. Respiration is the act of taking in (inspiration), and giving out (expiration) air by the lungs.

THE TONGUE.--This is coated in dyspepsia and fevers,--some healthy persons always have a coated tongue.

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In Ulcers of the stomach there is no coating.

In high fevers, the tongue may also be red and cracked as well as coated in some parts.

A dark brown or blackish coating indicates a serious condition in acute diseases.

Strawberry tongue is seen in Scarlet Fever.

Cankered tongue and month may be due to local conditions, or to stomach, liver and bowel disorders.

In Peritonitis the tongue is generally dry and red (beefy).

Cholera Infantum.--At first coated, then dry and reddish.

Constipation.--Tongue is generally coated.

Biliousness.--Yellowish dirty coating.

DIET

FOODS AND DRINKS FOR THE SICK ROOM.

DIET.--The importance of diet and its relation to the needs of the system in disease can hardly be overrated. One should not only know what kind of food to give, but how much and how often it should be given to get the best result. Food should be given in small quantities in acute diseases and at regular intervals. It will digest better. The food should never be left in the sick room after a patient has finished with it. This applies to all kinds of food, but especially to milk, for it absorbs impurities from the air more readily than any other kind of food. How often do we see milk standing in a sick room and uncovered; how often is it placed in an ice box uncovered. I have often wondered how such people could eat some foods I have seen prepared for them in such a careless way and with no attempt to make it appear tempting to their poor appetite. Foods should be given just as regularly as medicines, when so ordered, especially in long wasting diseases like typhoid fever.

The kind of food.--Under each disease directions for the kind of food, time, and quantity have been given. In diseases like typhoid fever, special care must be given. It is better in that disease to give too little than too much food and the proper kind of food must be given. I shall never forget the death of a minister in my childhood days. I was about four years old. This minister was loved by everyone and when he died of typhoid fever, everyone was grieved and shocked and they could not understand why God should take such a useful man away. It made a great impression upon me. I found out more about the "why" afterwards. This minister was in the convalescent stage and very hungry. He wanted a genuine boiled dinner. That is bad enough for a well man. The doctor forbade it, but the family gave him the dinner and the result, of course, was fatal. It could not be otherwise. We often blame God for our own sins. Many people are killed by kind friends. I have seen it more than once. Peanuts, popcorn, and candy have caused many convulsions in children and some deaths.

It is generally allowable to give a little liquid food every two hours in acute diseases. It should be given at regular intervals in the conscious or unconscious patients, especially in long continued diseases.

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LIQUID DIET.

1. Cream soups; tomato, pea, corn, celery, rice, spinach, asparagus, potato.

2. Gruels; oatmeal, cornmeal, cream of wheat, flour gluten (for diabetes).

How to Albuminize Fruit Juices.--Into a cup of lemonade, orangeade, grape juice, etc., put white of an egg slightly beaten, mix thoroughly, strain and serve.

The following may or may not be albuminized.

3. Fruit juices; lemonade, orangeade, unfermented grape juice, currant, berry juice.

4. Milk; peptonized milk, albuminized, buttermilk, malted milk, and milk porridge.

5. Stimulating drinks; tea, coffee, cocoa.

6. Broths; beef broth, mutton broth, chicken broth, bouillon, consomme, oyster broth, clam broth, oyster soup, clam soup, beef tea, and beef juice.

7. Eggs; raw eggs and egg-nog.

8. Cooling and nourishing drinks; oatmeal water, rice water, barley water and toast water. Ices and ice cream may be included in the liquid diet list.

SOFT DIET.--This diet includes everything in the liquid diet list, and the following additional foods:

1. Bread: soft bread; dry toast; milk, water or cream toast, brown bread (after the first day on soft diet).

2. Eggs: poached, soft-boiled and shirred.

3. Cereals: all cooked for some hours; cornmeal, oatmeal rice, sago, wheaten grits and cream of wheat.

4. Desserts: junket, custards, milk puddings, rice, thoroughly cooked, tapioca, jellies, baked and stewed apples, prunes whipped and stewed, ices and ice cream.

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CONVALESCENT DIET.--This includes everything in the liquid and soft diet lists and the following in addition:--

1. Breads: wheat, rye, Boston brown and graham bread and biscuits.

2. Meats: broiled steak, mutton, fish, game and fowl, or stewed fowl. Also calf's head, calf 's brains, shell fish and oysters.

3. Eggs, as in soft diet.

4. Drinks as in soft diet.

5. Vegetables: tomatoes, green peas, string beans, potatoes (Irish and sweet), lettuce, cresses, asparagus, onions, celery, spinach and mushrooms.

6. Desserts: custards, creams, jellies, ripe fruits and stewed fruits. No pastry or rich puddings.

FOODS FOR DIFFERENT MEALS FOR THOSE WHO CAN EAT, BUT WHO DO NOT HAVE MUCH APPETITE.

Breakfast; drinks: tea, coffee, cocoa, milk or albuminized fruit juices; cereal with cream; eggs; omelet, scrambled or poached on a piece of round toast, or soft boiled in a hot cup; muffins or gems.

Dinner; broiled porterhouse or tenderloin steak; baked potatoes; bread or rolls; pretty salad, as apple salad in apple case; custard baked in souffle dish; tea, cocoa or milk.

Supper; broiled squab, raw oysters or meat balls, asparagus tips on toast, fresh or stewed fruit, bread cut in fancy shapes.

Foods that may be taken together.--Meat; eggs: soft boiled, poached, shirred or baked; potatoes, baked, boiled or mashed; fruit sauce and ices may go with the following: stewed tomatoes, salad, spinach, or cucumbers, acid drinks, etc., any foods prepared with vinegar.

Meats, vegetables cooked in milk, or served with cream sauce, cream soups and eggs prepared with milk may be given with fruits, vegetables, drinks, etc., containing no acids.

Foods that should not be taken together.--Any food prepared with milk should not be given with lemonade, tomatoes, salads containing much vinegar or any foods served with vinegar or lemon juice.

Diets in Fevers.--Furnished us by a Trained Nurse in a Hospital.

May Take--

Foods.--Soups, clear or thickened with some well-cooked farinaceous substance, mutton, clam or chicken broth, beef tea, peptonized milk, panopepton with crushed ice.

Drinks.--Pure cold water, toast water, lemon or orange juice in cold water, jelly water, cold whey; all in small quantities sipped slowly.

Must Not Take--

Any solid or vegetable food or fruit until so directed by the physician in charge,

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Diet in Debility sent us from one of our Leading Hospitals.

May Take--

Soups.--Any broth thickened with farinaceous material, chicken or beef soup containing chopped meat, rich vegetable soups, whole beef tea.

Fish.--All fresh fish, boiled or broiled, raw oysters.

Meats.--Beef, mutton, chicken, game, boiled ham, lamb chops or cutlet, broiled bacon, tender juicy steak, hamburger steak.

Eggs.--Soft boiled, poached, scrambled, raw with sherry wine.

Farinaceous.--Cracked wheat, rolled oats, mush, sago, tapioca, hominy, barley, macaroni, vermicelli, rolls, biscuits, cakes, whole wheat bread, corn bread, milk toast, dry toast, brown bread.

Vegetables.--Nearly all perfectly fresh and well cooked.

Desserts.--Custards, egg and milk, rice or apple pudding, baked apples, fruit jams, jellies, cocoa junket, marmalade, sweet fruits, calf 's foot jelly.

Drinks.--Cocoa, chocolate, milk hot, cold or peptonized, pure water, plain or aerated, wineglassful of panopepton.

Must Not Take-

Hashes, stews, cooked oysters or clams, pork, veal, thin soups, turkey, salt meats, except ham and bacon, cabbage, cucumbers, turnips, carrots, squash, spices, pickles, vinegar, pies, pastry, bananas, pineapples.

DISHES FOR THE SICK ROOM.

Oatmeal Gruel.--Boil one part oatmeal and two parts water in double boiler two hours; strain through gravy strainer, add one quart sweet cream, a little sugar, pinch of salt. Do not make it too sweet.

Raspberry Shrub.--Place red raspberries in a stone jar and cover them with good cider vinegar, let stand over night, next morning strain and to one pint of juice add one pint of sugar, boil ten minutes, bottle hot. When desiring to use place two tablespoonfuls full of the liquid in a glass of ice water; very nice.

Root Beer.--Take blackberry root, black cherry bark, spruce boughs, wintergreens, sarsaparilla roots; steep in a large vessel till all the goodness is out; strain, and when lukewarm put in a cup of yeast, let work, bottle up, sugar to sweeten.

Cream Toast.--Toast a piece of light bread and moisten it with hot water; butter and then put on a layer of sweet cream on top and place in oven a moment. This is easily digested.

Lemon Jelly.--On one box gelatine pour 1 pint cold water and let stand one or two hours. Then put on 4 cups of granulated sugar, squeeze juice of 4 lemons with the grated rind of one. When gelatine is dissolved, pour over it one quart boiling water and stir. Pour this over sugar and lemon juice and stir thoroughly until all is dissolved; strain. Put fruit in if desired--turn into molds, cool until firm.

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Baked Custard.--One quart milk. 4 eggs beaten light (separately). 5 tablespoons sugar, mixed with the yolks; nutmeg and vanilla. Scald but do not boil the milk, add, gradually, yolks and sugar, then add whites and flavor. Pour into dish or cups, set in pan of hot water, grate nutmeg over top and bake until firm. Eat cold.

Mountain Dew.--Yolks of two eggs, 3 crackers (rolled),--four if small. 1 pint milk, pinch of salt, cook in double boiler. Beat whites of two eggs stiff, add 3/4 cup sugar, lemon extract for flavor. Set in oven and brown. This will serve four people.

Raspberry Vinegar.--Equal parts of red and black raspberries, wash them and cover with cider vinegar, let stand over night. Strain and to each pint of juice take 1 lb. white sugar and boil 15 minutes. Bottle ready for use. To drink use about 2 tablespoons in glass of ice water.

Milk Porridge.--l tablespoon each of cornmeal and wheat flour wet to a paste with cold water, cook in two cups boiling water twenty minutes, then add 2 cups milk and cook a few minutes, stirring often.

Lemon Velvet.--l qt. milk, 2 cups sugar, juice of 2 lemons. Chill the milk, then add the sugar and lemon mixed, and freeze like sherbet.

Ice Cream.--Mix 3 cups sugar and 2 tablespoons flour and stir into 2 qts. hot milk until flour is cooked. When cool add 1 qt. cream, whipped, and one tablespoonful vanilla. Freeze.

Sago Custard.--Soak 2 tablespoons sago in a tumbler of water an hour or more, then boil in same until clear. Add a tumbler of sweet milk; when it boils add sugar to taste, then a beaten egg and flavoring.

Crust Coffee.--Toast bread very brown, pour on boiling water, strain and add cream and sugar. Good for stomach and diarrhea.

Cream Soup.--One pint boiling water, one-half cup of cream, add pieces of toasted bread and a little salt.

Cinnamon Tea.--To 1/2 pint fresh milk add stick or ground cinnamon, enough to flavor, and white sugar to taste; bring to the boiling point and take either warm or cold. Excellent for diarrhea in children or adults.

Barley Water.--Add two ounces pearl barley to 1/2 pint of boiling water; simmer five minutes, drain and add 2 qts. boiling water, add two ounces of sliced figs, and two ounces of raisins; boil until reduced to one quart. Strain for drink.

Arrowroot Custard.--One tablespoonful of arrowroot, one pint milk, one egg, two tablespoons sugar. Mix the arrowroot with a little cold milk and beat in the egg and sugar, pour into the boiling milk and scald until thickened, flavor and pour into cups to cool.

Odors.--A few drops of oil of lavender poured into a glass of very hot water will purify the air of the room almost instantly from cooking odors; the effect is especially refreshing in a sick room.

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Dainty Way to Serve Egg on Toast.--Pile the well-beaten white of an egg on a slice of buttered toast, which has been softened with hot water. Make a hollow in the white and drop the yolk therein. Set in the oven to cook the egg.

Oatmeal Gruel.--Pour boiling water over a cupful of rolled oats, stir and let stand a moment, then strain off the liquid. Season with sugar and a little cream if desired. Especially good for children.

Prepared Flour for Summer Complaint.--Take a double handful of flour, tie up in a cloth and cook from three to six hours in a kettle of boiling water. Take out and remove the cloth and you have a hard, round ball. Keep in a dry, cool place. Prepare by grating from this ball into boiling milk enough to make it as thick as you desire, stirring it just before removing from the fire with a stick of cinnamon to give it a pleasant flavor. Salt the milk a little. This is very good for children having summer complaint.

Chicken Broth.--Take the first and second joints of a chicken, boil in a quart of water until tender, season with a very little salt and pepper.

Fever Drinks--Pour cold water on wheat bran, let boil one-half hour, strain and add sugar and lemon juice. Pour boiling water on flaxseed and let stand until it is ropy, pour into hot lemonade and drink.

Egg Gruel.--Beat the yolk of an egg with one tablespoonful sugar, beating the white separately; add one cup boiling water to that yolk, then stir in the whites and add any seasoning. Good for a cold.

Diabetic Bread.--Take one quart of set milk or milk and water, one heaping teaspoonful of good butter, one-fifth of a cake of compressed yeast beaten up with a little water, and two well-beaten eggs. Stir in gluten flour until a soft dough is formed; knead as in making ordinary bread; place in pans to raise, and when light bake in hot oven.

Lime Water.--Into an earthen jar containing hot water stir a handful of fresh unslaked lime. Allow it to settle; then decant the clear fluid and bottle it. Water may again be added to the lime, and the mixture covered and allowed to stand to be decanted as needed.

Vanilla Snow.--Cook one-half cup of rice. When nearly done add one-half cup of cream, small pinch of salt, beaten white of one egg, one-half cup of sugar, flavor with vanilla. Pile in a dish and dot with jelly. Serve with sugar and cream.

Omelet.--One egg, white and yolk beaten separately; two tablespoons milk, one-third teaspoon each of flour and melted butter, a little salt. Add the beaten white last. Pour in small spider in which is a little melted butter (hot) and cook over moderate fire. When it thickens and looks from under the edges, fold it over and slip it on a hot dish.

[NURSING DEPARTMENT 649]

Almond Milk.--Blanch one pound of sweet and two of bitter almonds that have been soaked in cold water for twenty-four hours. This is done by pouring boiling water over the almonds when, after a few minutes, they can easily be pressed out of their hulls. Grind the almonds in a mill or pound them in a mortar; mix with a half-pint of warm milk or water and allow the mixture to stand two hours after which strain through a cloth, pressing the juice out well.