Chapter 75

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.

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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 assist 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 pronounced 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.

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Linseed meal poultice.--Stir the meal slowly and evenly in boiling water; boil this mixture for several minutes and stir briskly all the time, and when thick enough it is well beaten with a spoon to remove lumps. If this is properly done it will be a light smooth paste, just stiff enough to drop away from the spoon. Use a muslin or coarse cloth and spread the poultice on this to the depth of one-half inch, leaving one inch space to turn in. Put vaselin over the surface, thin, and cover with a thin layer of gauze or thin cloth. Turn the edges over and roll in a towel to keep it warm and carry to patient. Keep them warm,--one should never be removed until another is ready to be put on. The skin should always be wiped dry before another is applied. Oiling the poultice prevents irritation of the skin and pimples. Cover the poultice loosely if possible with a layer of cotton-wool and oiled muslin to retain the heat and moisture longer. It should be changed every three hours at least. Apply hot and never keep on when it is cold. It should never be used a second time.

Starch Poultice.--This is used in skin diseases for its soothing properties. Mix the starch first with a little cold water and then add enough boiling water to make a thick paste, which is then spread on muslin covered with a layer of gauze.

The Jacket Poultice. For lung affections.--Two layers of thin muslin are shaped so as to fit closely around the neck and under the arms and come over the chest and back, low enough to cover the lungs. Three sides are now closed, and the prepared linseed is poured into the bag and regularly distributed. Close the open end and then apply. Cover it with wool and oiled silk and keep in place with safety pins or tapes which are tied under the arms and over the shoulders. When changing the poultice be careful not to expose the patient. A cotton-wool jacket should be worn a few days after the poultice has been discontinued.

Cold is applied either by means of the cold bath or by compresses, pack, sponging, coils or ice.

Cold Compresses are made by using two or three thicknesses of lint or linen wrung out of cold water or ice water and applied over the inflamed part, and changed frequently. A little vaselin may be rubbed on to prevent the skin from becoming irritated. They are very useful where little weight can be borne. If iced compresses are used a small block of ice partially wrapped in flannel is placed in a basin; there should be two compresses, one of which is kept on ice while the other is on the patient.

Compresses are very good in the early stage of tonsilitis, quinsy, sore throat, laryngitis and croup.

Ice-bags (India Rubber).--With these, cold can be best applied and with less trouble. These are made in different shapes. For instance helmet-shaped to fit the head and long and narrow for the spine.

Crush the ice in small pieces and mix in it a little common salt,--never fill the rubber bags more than half full; expel the air as much as possible by pressing before screwing on the top. Always place a layer of lint, cotton or thin cloth between the skin and the bag. The extreme cold is not only painful but liable to irritate the skin, and may cause frost-bites. Its effect should be watched carefully. Sometimes the weight causes discomfort. In such cases suspend the bag. For the head, fasten a bandage to the neck of the bag and pin the two ends to the pillow just high enough to allow the cap (bag) to barely touch the head. Care should be taken to refill the ice-bags before the ice has melted. At times a piece of ice is wrapped in moist lint or old linen and passed gently over the head in order to cool the head.

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For Appendicitis.--There should be quite a thickness of cloth between the ice bag and the skin. The latter must not become too cool. In this disease this bag is a great reliever of the pain and generally used.

Ice Poultices.--In some cases these are better than the ice bag for the reason that they fit the body better. They are usually made of two parts of crushed ice to one of linseed meal or bran, together with a small amount of salt. Make two bags of oiled silk,--one should be smaller than the other. Close all sides but one, with adhesive plaster. Fill the smaller bag two-thirds full of ice, close and slip it into the larger bag.

Ice Water Coils.--These can be bought. They can also be made from rubber tubing. Sew this upon a piece of rubber cloth in circles about one inch apart for five or six rounds; leave a yard or two of tubing at each end to be used as a siphon, A large pan of ice water is raised above the patient into which one weighted end of the tubing is placed, with a funnel inserted into it, covered with gauze to prevent clogging, while the other end is laid in a second basin on the floor which receives the water. The upper pan must be kept filled. This is very good for delirium in brain fever, etc., when applied to the head and also good for bleeding from the bowels in typhoid fever. The stream of water can be regulated if necessary by a stop-cock.

Lotions.--Lotions are medicated moist applications, and may be either hot or cold.

Counter--Irritants are agents applied externally to produce irritation or inflammation in order to relieve a diseased condition in an adjacent or deep-seated part of the body. Mustard foot-bath relieves pain in the head by drawing the surplus blood away from the head. The mildest mustard counter-irritant is the mustard poultice. It can be made with one part mustard to six of linseed meal. Never use boiling water with mustard.

Mustard Poultice.--Use of ground mustard, one-fourth to one-eighth of the amount of meal used. Make into a paste and stir this into the linseed, after it has been prepared for the poultices. The white of an egg is used in this poultice as it may keep the poultice from blistering.

Yeast Poultices.--These stimulate ulcers, gangrene and sloughing conditions. Mix eight ounces of soft yeast with as much water. Add enough flour to make a sponge, but not too stiff. It should be kept warm until fermentation begins; then apply every day. Finely powdered charcoal can also be added.

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For Soothing Effect.--Hop bags or bran bags, dipped in hot water, may be applied, protected and kept in place with a bandage.

Spice Poultice.--This is very good for pain in abdomen in children especially. Equal parts of ground cinnamon, cloves, allspice and ginger, one-quarter part cayenne pepper, if needed very strong. Place all together in a flannel bag and spread equally. Wet with alcohol or brandy. When dry, re-wet. This is a mild warming dressing.

Spice Poultice from a Stanlyton, Va., Mother.--"Take one teaspoonful each of mustard, ginger, black pepper, cinnamon, cloves, nutmeg, or as many ground spices as one has in the kitchen; mix them well in a bowl while dry, adding boiling water slowly and stir constantly until it is of the consistency of soft putty; spread between soft thin cloths and apply to the affected parts as hot as the patient can bear it. When it is cool heat it again and apply."

Mother's Flour and Water Poultice.--"Make a thick poultice of flour and water; bake soft and apply hot. Have another ready for change, if necessary. This is good for any pain."

Poultice of Peach Tree Leaves from our Mother's List.--"Put a handful of peach leaves in a vessel and let boil well; add enough meal to thicken, spread between thin muslin cloth and apply to parts affected. This is a splendid poultice."

Mild Plaster for Children.--"Two teaspoonsful of flour, three teaspoonsful of mustard, a little fresh lard and a few drops of turpentine, Mix up with warm water."

Fomentations.--This is the best way to apply moist heat, but it is troublesome, as they should be changed very frequently, at least every ten minutes when heat is required. They should never be left on until they are cold and clammy. Sheets of lamb's wool make the best material. Cut these layers into sizes required and encase them in a gauze cover over which is put a layer of oiled silk. Coarse old flannel or an old blanket will do well. Take two layers of the flannels, dip in the boiling water and wring. Two should be at hand. Dry the skin first and then put on the flannel. It should be covered with enough material to keep in the heat and moisture. Hops, etc., can be put into the water.

Turpentine Stupes.--This is prepared the same way, except turpentine is added. After the flannel has been wrung out, add from ten to twenty drops of turpentine, or add two or three teaspoonfuls of turpentine to one pint of boiling water and put the flannel in it and wring out and apply. Put a towel over the stupe. This is especially for gas in the bowels.

Mustard Stupe.--Put a tablespoonful of mustard in one pint of hot water. Make a paste of the mustard before it is put into the hot water, to avoid forming lumps; never use boiling water. Wring the flannel out after it has been in this solution and apply to the part.

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Mustard Plaster.--This is made of different strengths, depending upon the length of time it is desired to keep it on and the sensitiveness of the skin.

1. Equal parts of mustard and flour. 2. One of mustard and two of flour. 3. One of mustard and three or four of flour. White of an egg added makes it better and not so blistering.

A paste is made with warm water and spread between the layers of muslin and left on no longer than ten minutes. When the skin is red remove the plaster. This is used when you wish a quick counter-irritation.

Mustard Plaster.--This is made stronger, 1 to 2 to 3 parts meal.

Mustard leaves or Sinapisms may be bought at a drug store. They are no better than you can make. Use plasters.

Capsicum and Belladonna Plasters.--May be bought. In applying, heat the back of the plaster slightly; the face of the gauze is pulled off and the plaster placed where wanted. To remove soak first with alcohol.

Spice plaster.--Mix two teaspoonfuls each of ginger and cloves with a teaspoonful of cayenne pepper, one tablespoonful of flour, enough brandy or water to make a paste. Spread this between two layers of muslin.

For Turpentine and Mustard Stupes see above.

Tincture of iodine, chloroform and liniments are also counterirritants, also castor oil, and pure tartar emetic, and cartharides.

Cupping, Wet and Dry.--This is sometimes used to relieve inflammations of the eye, lung or kidney, or even muscular pains like lumbago. Wine-glasses will do as well as any you can buy.

Dry cupping.--Take a piece of wire, wrap a small piece of cotton about the end, dip this in alcohol, light it and swab the inside of the glass, remove and apply the glass. The heat causes the air to expand and it is driven off and the partial vacuum formed is filled by the skin and tissues over which the glass is placed. The edges of the cup must not be warm enough to burn the patient. Six or seven cups may be applied at one time and allowed to remain five minutes, after which they are removed by pressing the flesh around the edge and inserting the finger there so as to let in the air.

Linseed meal poultices can be applied afterwards to keep up the work begun.

Wet cupping.--Scrub the skin with hot water and soap, wash off with a five per cent (1-20) carbolic acid solution. Make a few cuts over the parts desired with a clean knife and apply the cup prepared in the way above directed. Remove the blood and check the bleeding, if necessary, by sponging. Place a pad on the part and hold this in place by a bandage or adhesive strap.

Blistered Skin. To dress.--Puncture the lower part with a clean instrument and catch the fluid on absorbent cotton. Dress it with oxide of zinc ointment or vaselin on lint or clean linen and strap on. It is best not to remove the skin from a blister at the first dressing.

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HOW TO DETERMINE THE DOSE FOR CHILDREN.

We have endeavored to always give the dose throughout this book as we recognized the lack of accurate and detailed information regarding the administering of medicines as one of the weak features in practically all home medical books. If we have overlooked a few instances we wish to provide for such omissions by giving the table of doses generally used by nurses as a basis for determining the dose of any medicine she may be using for a particular age.

Rule usually followed.--For children under twelve years of age. Make a fraction. Use the age of the child for the upper number, numerator. The number below the line, denominator, is twelve, added to the age of the child. For example: If your child is two years old you would begin by placing two as numerator, thus 2/, then you add 2 + 12 = 14 and place 14 below the line and you have 2/14 or 1/7. You then take 1/7 of the adult dose for your two-year-old child. If the dose for an adult is 21 drops, a child of two years is given 3 drops, etc.

DOSE IN DROPS FOR DIFFERENT AGES.

If the dose is a spoonful or 60 drops for an adult, the other doses would be correct for the ages given below:

21 and over 60 drops 15 years about 33 drops A few more or less if robust or weakly 12 " " 30 drops " 10 " " 27 drops " 8 " " 24 drops " 6 " " 20 drops " 5 " " 17 drops " 4 " " 15 drops " 3 " " 12 drops " 2 " " 8 drops " 1 " " 4 drops "

Exceptions to this rule are calomel and castor oil, when half an adult dose can be given between 12 and 18.

Opium is dangerous to children and old people and should be administered by a physician or trained nurse.

"Lest We Forget." COMMON TABLES OF MEASURES. APOTHECARIES' WEIGHT.

Apothecaries' Weight is used in prescribing and mixing medicines

Table.

20 grains equal 1 scruple 3 scruples " 1 dram 8 drams " 1 ounce 12 ounces " 1 pound

The pound is the same as the pound Troy. Medicines are bought and sold in quantities by Avoirdupois Weight.

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1 grain equals 1 drop or 1 minim 60 grains or drops " 1 teaspoonful 1 teaspoonful " 1 fluid dram

8 drams (or 8 teaspoonfuls) make 1 fluid ounce 2 tablespoonfuls make 1 fluid ounce

1/2 fluid ounce is a tablespoonful 2 fluid ounces is a wineglassful 4 fluid ounces is a teacupful 6 fluid ounces is a coffee cup 16 ounces (dry or solid) is a pound 20 fluid ounces is a pint

MEDICINE CHEST.--More important than the furnishing of the house is the medicine chest. If you are beginning housekeeping let this be your first consideration. Do not put it off because it is a little trouble and costs a few dollars. Yon would not think of leaving your front room or your "spare room" half furnished. Your health is of vastly more importance than the looks of your best rooms. There may come a time when you cannot secure the doctor for several hours or get into a drug store. Be prepared for this emergency and either fix up a home-made box with shelves, etc., or buy a regular medicine chest; in either case have a lock to it and the key where you can find it but where the children cannot reach it.

We give below a few of the necessaries and you will of course add to this list. One mother writes that she went to the store and bought several tiny little bells and tied one of these bells around the neck of each of the bottles in her medicine chest that contained poison. There was no danger of her getting the wrong bottle in the dark. Contents of the Medicine Chest.

Ten cents worth of Alum. A small bag of Burnt Alum. A small bottle of Castor Oil. A small vial of Bichloride of Mercury Tablets. A box of Boric Acid Powder. A $mall bottle of Glycerin: A bottle of Extract of Witch-hazel A small bottle of Syrup of Ipecac. A bottle of Whisky and one of Brandy. A box of English Mustard. Medicine glass. A small box of Cold Cream. Soft rubber Ear Syringe. A Clinical Thermometer. An Eye Stone. A pad, pencils, and labels. A small bottle of Carbolic Acid. A roll of Adhesive Plaster. A small box of Pineoline Salve. A bottle of Arnica.

Hung near the chest should be a fountain syringe with the rubber catheter for use in irrigating the bowels and a hot water bag.

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HOW TO CARE FOR THE DEAD.

The limbs should be straightened before the body becomes stiff (rigor mortis). The eyes should be closed and the jaws held in position by means of a support placed firmly under the chin; for this a roller bandage or a small padded piece of wood is generally used. Of course if the person has worn false teeth, and they have been taken out during the last hours, they should be replaced immediately after death. The nostrils, mouth, rectum, and vagina should be packed with absorbent cotton to prevent the escape of discharges after death. After this bathe the body, if so desired by the relatives, with a two per cent watery solution of carbolic acid, and if there are any wounds they should be covered with fresh cotton and neatly fastened with a bandage. The hips may be enclosed in a large triangular binder; the knees are held together by a broad bandage; the hair should be brushed smoothly, and finally stockings and a simple nightgown should be put on. If the case be one of the infectious diseases, wrap the body in a sheet wrung out of a five per cent watery solution of carbolic acid and this sheet should be kept damp.

The room where death occurs should be tidied and regulated to make it look natural and comfortable. The undertaker can be sent for as soon as desired by the family. But if such care as directed has been given, the undertaker need not be hurried.

ENEMA.--Enemata (Injections).--There are various methods used for injecting fluids into the body. When they are introduced into the intestines, we speak of giving enemata (enema is the singular). They are named according to their purpose.

1. Simple laxative or purgative enemata.

2. Nutritive enemata for the purpose of nourishment.

3. Sedative enemata for local or systemic quieting effects.

4. Astringent enemata to check bleeding and diarrhea, like hot water, ice water, solution of alum or nitrate of silver.

5. Emollient (soothing) enemata for soothing irritated and painful mucous membrane; starch and drugs are also used.

6. Antispasmodic enemata to relieve flatulence such as the turpentine enemata.

7. Anthelmintic (against worms) for destroying worms; salt, turpentine and quassia are used.

8. Antiseptic or germicidal enemata used in dysentery.

9. Stimulating enemata, like hot water, hot strong coffee, hot whisky and water, salt water.

10. To relieve thirst, water one pint or normal salt solution (one dram to a pint of water) and injected high up.

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ENEMATA are given either high or low.

A high enemas thrown high up into the bowel.

A low enema is injected into the rectum only, through a hard rubber tip to a syringe.

Directions.--There are many ways of giving a simple enema.

Position.--A good way is to place an adult patient on his left side, with the knees bent up close. Protect the bed with a rubber sheet and towel under the patient. The basin of water can be placed on the rubber sheet and the enema given under cover.

Amount.--An adult person will take one to four pints. A child one-half to one pint. For an infant about two ounces will do.

What material? A simple enema can be made with good castile soap or good brown soap and water, temperature about 95 degrees F. When ready for use make into a good suds.

Syringe.--Use a bulb syringe, see that the syringe is filled full to the nozzle before the nozzle is put into the bowel. Any air left in the syringe will pass into the bowel and cause pain. Oil the nozzle with vaselin or sweet oil and then gently put the nozzle into the rectum. It is better to introduce an oiled finger through the sphincter muscle and pass the nozzle along the finger and gently into the bowel. It should be in the bowel two or three inches. Do not attempt to force the nozzle through any obstruction. Introduce the water slowly in a gentle and steady stream. The main object is to distend the rectum by means of the water, thereby producing reflex stimulation. The worm-like movement of the bowels results, thus bringing about an evacuation. The patient should retain it for ten or fifteen minutes to get the best results. A folded towel placed against the anus will assist the patient in resisting the desire to expel the water. A large amount should be given in one-half hour if the first one does not produce the desired result.

Sometimes a laxative enema is necessary.--Olive oil or glycerin or castor oil may be used.