Part 131

_Illness._--Infantile disorders within the range of domestic medicine are chiefly diarrhœa and constipation. The former, in a suckled child, will probably be due to the condition of the mother, who should carefully regulate her own bowels, taking a simple aperient, like castor oil or rhubarb if necessary. Diarrhœa, with bottle feeding, may arise from sour food: boil the milk, mix it with barley water instead of water, make it weaker, and add 2 tablespoonfuls lime-water or a few grains soda bicarbonate to every ½ pint food. See that cold to feet or body is not the cause. For constipation, generally occurring in bottle-fed infants, reduce the food, omit lime-water, and change one meal a day from milk to thin oatmeal gruel. Avoid medicines, except perhaps 30 gr. manna in 1 tablespoonful distilled water, or 1 tablespoonful fluid magnesia in the food of one meal for a day or two, or castor oil if a severe case. Gentle injection of a little warm water is an excellent thing in stubborn cases. Vaccination is a paramount duty hardly requiring mention. Especially beware of chills during convalescence. Exposure to cold after scarlet fever brings dropsy and kidney diseases, and consumption and bronchitis follow whooping-cough and measles.

Medicines kept should be under lock and key, for obvious reasons. The following may be found useful:--Ipecacuanha wine and powder, say of the former 2 oz. and of the latter 1 dr.; grey powder, 1 dr.; castor oil 6 oz.; antimonial wine, 1 oz.; sulphate of zinc, 1 dr.; fluid magnesia, 6 oz.; lime-water, by the gallon, if the infant is brought up by bottle; laudanum or solution of morphia, 1 oz.; Bow’s liniment, or camphor liniment; spongio-piline, for application of fomentation or as a poultice. Lint, oiled silk, and gutta-percha tissue, with 6 oz. carbolic lotion, strength 1 to 40. These are mostly for use by the medical attendant; amateur doctors should restrict themselves to giving a dose of castor oil or fluid magnesia.

_Moral Training._--Why do women intrust their young children to the care of low-minded ignorant girls, when least able to take care of themselves, yet exercise so much caution to prevent familiar intercourse with servants and inferiors in later youth? With proper treatment, plenty of well-bred and well-educated girls could be found to take nursemaids’ places, to the great advantage of both children and nurse. Obviously, no girl who is not fit to be a companion, an intimate companion, of the mother, is fit to be the guardian and guide of that mother’s children. The nursemaid should be a girl or woman of culture, and not be expected to do anything menial. Early training of children is of great importance. Be with them as gentle, loving, and patient as you can be, but at the same time be firm. Never deceive a child, and never let it weary you into granting a request you have once refused as injudicious. Teach it from the first to bear and to forbear, to obey at once, and to be courteous; the little wretch who snatches anything he fancies, and howls like a monkey if crossed is a pitiable little object, the victim to his parents’ folly, who were too selfish to give themselves the trouble and vexation of training him.

Never allow children to be rude and unceremonious to each other because they are brothers and sisters. Be extra careful of your language and manners before children. Never lose your temper with them, never frighten them, and above all things do not strike a child on the head; there is a certain portion of the body especially intended by nature for receiving castigation. Never flatter nor pet a child, nor allow self-admiration to grow upon it. Reduce children’s parties to sensible hours--3-7 for the little ones, and not later than 9 for the older ones--and provide more sensible amusements and less empty show and finery. Dancing, magic-lanterns, shadows, and scores of simple games will occur to every one. Avoid all toys which are painted or gaudily coloured.

One word about foreign nurses. They are often engaged with the object of early commencing the acquirement of a foreign language, generally French. But it must not be forgotten that the class of girl obtainable as a nurse is not likely to be capable of teaching the refined language or accent. These nurses may be engaged through the International Institution, 69 Berners Street, London, W.

_THE SICKROOM._

=The Room.=--The rules which apply to dwelling rooms generally have a double importance in the case of the sickroom. The sanitation, ventilation, warming, and lighting, all demand extra care and attention. A southern aspect is preferable to any other; the room should be cheerful, spacious, and lofty, and subject to the invaluable effect of sunshine. It would be desirable for all houses, even of moderate size, to have some one corner suitable for a sickroom. If space admits of such a room being entirely isolated from the rest of the house, so much the better; but much may be done by securing two rooms opening into each other, with hot and cold water supply within easy reach, and a closet properly placed. When necessary, the room should be kept clean by dusting with a damp cloth, rubbing the floors in the same way.

Ordinarily, the chimney is the best ventilator, especially when the fire is burning, which increases the upward draught. Never stuff up chimneys: and except in very warm weather, always keep a fire in the sickroom. It is not always easy to maintain at the same time proper warmth and ventilation. But as a person is not liable to take cold when well covered up in bed, a little of the window may almost always be kept open, without fear of its doing harm, especially if a piece of fine gauze be gummed or tacked across the opening so as to break the force of the entering air. In ordinary sickness the best temperature is 62°-70° F. It should not be allowed to vary much, and as feeling is often deceptive, it is always advisable to keep a thermometer in the room.

For the removal of slops, the ordinary paraphernalia of the housemaid should be completely excluded from the sickroom, as both noisy and disgusting. All vessels when used, instead of being put under the bed, must be immediately removed and emptied outside, and brought back carefully rinsed, and, when necessary, deodorised with a little Condy’s fluid. Allow no confusion of medicine bottles, soiled glasses, spoons, and such matters about the room: those in immediate use should be kept arranged ready to hand; all others should be removed.

Even with the greatest care fires will burn down low, and it is necessary to have some means of restoration at hand. Few people know how valuable wine corks are for this purpose; they should always be saved, and a few kept in a corner of the coal basket. Orange and lemon peel likewise, when well dried, make capital fire revivers; and rather than that the fire in a sickroom should be allowed to go out, use a lump of white sugar or a sprinkling of brown, which will create in a moment a bright flame and revive the dying embers. Employ a pointed hard wooden stick instead of a poker; it makes so much less noise. Let a basket take the place of the coal-scuttle, and let its contents consist of fair-sized lumps, about as big as a French roll; a housemaid’s glove should be at hand to put these on with. This is the provision for the day. For the night small paper bags, such as fruiterers use, should be filled with about 1 lb. of small coal. This does not burn so fast or make so much flame as the lumps, whilst the feeding of the fire by these means divests the process of noise.

As little furniture as possible should encumber the room. No foot-stools, boxes, or baskets should be in the way, to be tripped over; no knick-knacks crowded on tables or mantelpieces to harbour dust, take up room, or tumble down with a crash. Various forms of sickroom furniture, adapted for confirmed invalids and serious surgical cases, are made by Alfred Carter, 97 Holborn Viaduct, and by Robinson and Sons, Ilkley, Yorkshire, whose catalogues will be worth getting.

Of carpets, the less the better; but if any are used, mere strips or rugs are best, as they are easily taken up and shaken, or cleaned. Curtains should be got rid of, especially if of woollen or stuff; cotton and linen should be used for any sofa or chair coverings.

Windows should be made to open easily from both top and bottom, whilst some contrivance is necessary to prevent any rattling noise from either window-frames or outer blinds. Venetian blinds, imperfect at the best, are quite unsuitable for a sickroom, being always noisy, and sure to admit alternate rays of light. Nothing wakes many people so quickly as light--a mere crevice unprotected is often enough. In the evening, be sure that the light of the lamp or candle does not fall in the patient’s eyes; there is nothing more distressing. Gas in a sick room is not healthy; a Queen’s reading-lamp, with a green shade, is pleasant for a stationary light, and a candle for moving about.

Real quiet is of paramount importance. Even “noiseless” crockery can now be obtained. The principle adopted is that of noiseless tyres to wheels, made of rubber, such tyres being fitted to the bottoms of the jugs, basins, &c.

One thing that would give great pleasure to many a bedridden sufferer is a looking-glass--sometimes two may, from the position of the bed, be necessary--fixed so as to reflect all the passers-by, or to show a patch of bright flower garden, bringing some of the outside life into the sickroom. Ferns growing beneath a bell glass, where they need no care or attention after they are once planted, may also be introduced. Plants in pots and cut flowers will occur to every one; it only remains to observe that growing plants, for their own sake as well as for the patient, should be moved out of the room at night, and that cut flowers from the side of a fever patient must be burnt in the room when they are dead, and not carried into any other part of the house.

=The Nurse.=--The _Lancet_ insists that there is no more excuse for a nurse making a “guy” of herself than for her being decked out in vulgar finery, with her hair got up after an elaborate style which it would take her half the day to arrange. Print dresses of pretty pattern, or grey alpacas, according to season, with a light white cap, linen cuffs and collars, scrupulously white and clean, and a coloured neck ribbon, would be infinitely preferable to the black costumes of the sisterhoods. The heavy woollen dresses worn by some sisterhoods are not all that is desirable in a sanitary point of view. They do not “show dirt,” it is true; but it would be better if they did; and in their folds it is not impossible that germs of disease may be carried about. It may be laid down as a rule that nothing in a nurse’s dress that rustles, creaks, flaps, or catches can be in place. It is evident that this rule forbids silk dresses, stiff stays, trailing robes, and ornaments that are likely to throw things down. High heels are, of course, quite out of the question, as is any fashion which interferes with easy movement on the part of the nurse. Quietness, softness, usefulness are the points to be aimed at in the costume of a nurse; and if brightness can be given by a ribbon, the brightness may well be superadded. A nurse should wear no rings, and her nails should be kept cut very close. The sleeves of her dress should admit of being turned or rolled up above the elbow.

Never think any change in the patient’s manner or appearance too trifling to tell the doctor of it. Unimportant as you may deem it, it may be the very symptom he is watching for. Tell the doctor everything fully and truly, and above all, obey him implicitly. Never act against his orders, or tamper with them in any way. If you think any change in treatment judicious, ask his opinion first before trying it, but do not do things unknown to him. In this watchfulness and strict obedience lie the chief difference between professional and amateur nursing, and also too often the great advantage gained by employing the former over the latter. The several symptoms should be written down by the nurse from time to time on a slip of paper, always at hand, for the doctor.

Always save whatever has been vomited by a patient for the doctor to see, and be able to give information as to when the vomiting took place, whether directly after food or liquid had been taken, or not; notice whether there was much straining or retching before actual vomiting occurred, also if it was preceded by pain, and the situation of the pain. Remove the vomit from the room immediately.

In the case of coughing, observe whether it comes on in paroxysms, or is incessant; whether it is dry and hard, or moist and accompanied with expectoration; whether it is worse at any particular time, and is attended with pain. If there is expectoration, this should be kept for the doctor’s inspection. If blood is brought up, note whether it is coughed up, vomited, or brought up from the back of the throat or mouth; remark whether the expectoration adheres to the side of the spitting-cup, or flows easily.

The number of times the bowels are moved in the 24 hours must be noted, and whether the motion is attended with pain, griping, or straining; also the colour of the motion, and, if the patient passes worms, whether they are round or flat, tape, or small and thread-like. Note in what quantities urine is passed; also how often, whether with any discomfort or pain either before or after, its colour and consistence, and if there be any deposit, its colour also.

Do not forget to give messages of inquiry, as sick people think much of such kindnesses. Do not read letters out without reading them to yourself first; you may come upon some passage about the patient that you do not care to repeat, and your hesitation will make him anxious and uncomfortable. In convalescence books are often a difficulty, and require most careful choosing. Something not exciting, but thoroughly amusing, is generally the best thing--the lightest novel you can find. In any case, be careful not to read too long at a time; the strain of listening and attending is very tiring. In extreme weakness, when there is nothing to be done, say something from time to time to take off the sense of loneliness, but do not ask unnecessary questions or touch your patient--it is very tiring; and never at any time lean against the bed and shake it, and do not put anything heavy over the patient’s feet; the weight tires, and a hot bottle warms much more effectually.

Remember that the process of settling for the night takes a long time, and be sure to begin early. Some people sleep better in the first part of the night, and you should notice the hour at which the patient gets sleepy, and arrange accordingly; if kept awake long past that hour, a restless night will be the consequence. It is never wise to wake the patient, even to give medicine, except by the doctor’s orders. You should have a small tray arranged with all the things you are likely to want in the night, except medicines. By means of the judiciously-placed screen, anything that has to be brought in can be quietly handed over the top without a sound. Door-hinges and handles should be carefully eased and oiled.

Real quietude means the absence of all excitement, and it must be remembered that anything out of the common will tend to excite the mind of a sufferer. Do not, therefore, walk on tip toe, for this, in addition to its unusual elaboration of the gait, invariably causes a certain amount of creaking. Speak in low tones, but do not whisper. A whisper will often awake a sleeper who would not be disturbed by an ordinary conversation; and never say “hush!” Let your clothes and foot covering be of as noiseless and unobtrusive a character as possible, and instead of gliding and tottering about like a rickety ghost, do not hesitate to walk. If you have occasion to say anything in the room, say it so that the patient can hear it if he wishes, and do not let him be aware of your conspiring privately with the others, especially at the door. The door has much to answer for. If it be visible from the bed, people open it cautiously, put their heads in and slowly withdraw again. If, as is more frequently the case, it is screened by the bed curtains, mysterious openings and shuttings are heard, unattended with any apparent ingress or egress, and _sotto voce_ colloquies going on outside. When you enter, do so honestly and at once. Do not spend 5 minutes in turning the handle, thereby producing a series of irritating little clicks, finally terminating in a big snap, with which the door flies open. If the latch be at all rusty, a handle that is slowly wound back in this way will often stick, and either require to be rattled back in position, or, if left as it is, may start back suddenly, after a time, of its own accord, with a report like a pistol shot.

A bracket or table on the landing or in an adjoining room, where one can keep a basin, water, and a cloth for washing cups, &c., can nearly always be managed; and even if one has to carry everything up and down stairs, the comfort to the patient of systematic, dainty cleanliness more than repays the trouble. Some nurses seem to think it enough to place anything used outside the sickroom door, trusting to a chance maid seeing it and carrying it off. But this proceeding often worries the patient most exceedingly. He or she lies there and fidgets over the chance of that stray cup being whisked over by a passing skirt, with an ominous clatter and smash; and though this probably does not happen, the expectation of it keeps the mind on tenter-hooks, and prevents needful rest.

Let visitors sit between the door and the patient, getting the benefit of the air and not between him and the fire, thus getting in the direct current of foul air rushing towards the fireplace; they should be well in sight of the patient, and never admitted at meal times. While talking to the patient it is better to sit by the side of the bed and as near the pillow as possible, so that you may converse easily, while your face and body are turned in the same direction as his. By this means you can make all necessary observation of his features without enforcing the arrest of his eyes on your own, which is so embarrassing and disagreeable to one lying in bed, and is almost unavoidable when facing him. Keep him in as comfortable a position as possible, by all means, but do not be too demonstrative in smoothing the pillows and little offices of that sort. Fidgety attentions will worry and do more harm than downright neglect.

=The Bed.=--The best kind of bed for the sick is a small iron bedstead, about 3½ ft. wide and not too high, with firm, level, spring mattress, and light warm covering, avoiding large heavy linen counterpanes, which, though oppressively weighty, give but little heat. It should be placed in such a position as will be most out of draughts, and at the same time convenient for the nurse in performing personal services for the patient. It must never have either side against a wall, nor be between the door and the fire. It is a point of some importance, especially in cases of long illness, to arrange the position of the bed so that the sick person can see the fire or look out of window. A second bed, or hammock, or stretcher on wheels, is often very useful for shifting the patient on to while airing and making the other bed.

Good bed-making is imperative in sickness, and nothing is a better test of a nurse’s capacity than the way she keeps her patient’s bed. Some nurses are eternally fidgeting till they work the unhappy invalid into a frenzy. Others, again, in their dread of disturbing him, let the patient toss everything to the wildest confusion, trusting to one grand and general clearing up to set matters right. A good nurse keeps things straight almost unconsciously, taking advantage of any chance the patient gives to smooth out the crumpled sheet, or tossed bed-clothes, with a strong even pull, or to replace a heated, crushed pillow with a fresh cool one (though careful that, if cool, it is not chilly). Remember when smoothing a sickbed never to jerk or twitch the clothes, and be always sure your attempts do not endanger anything that may be lying on the bed, and whose downfall would most certainly disturb and flurry the invalid. A wide bed in a measure is a substitute for having 2 beds, as considerable relief may be obtained by using alternate sides of the bed; moreover, you can cool one side when the patient is on the opposite side, by turning back the clothes so as to let the air reach the lower sheet. Bed linen should always, if possible, be exposed to the open air, in the sun and wind, before using, as this freshens it most effectually, whilst a drop or two of good lavender or rose water sprinkled on sheet and pillow-case add greatly to the pleasantness. The best way of making a bed so as to give the least possible disturbance to the sick person, and prevent bed sores, is laid down in these rules:--(1) Keep the sheet below the patient perfectly smooth; (2) wash the parts where the bone is prominent daily with soap and warm water, dry them well, rub them over with a little spirits of wine or whisky to harden the skin; (3) change the patient’s position frequently; (4) never let him lie on a blanket; a freshly-made bed, a good sponge over with vinegar and water, would often, after a restless, sleepless night, have the good effect of making the patient fall into a sound sleep. It is best to make a good lather with the soap, and not to use much water. Zinc-powder and boracic acid powder are often used to powder the back after the washing.

A very common torment of invalids is the weight of the bed clothes. They are heavy, but not warm. For the rich, blankets and eiderdown quilts are easily obtained; but for the poor, paper is far better than many more costly coverlids. It is by no means necessary to spend money on a paper blanket, though these are excellent; a few sheets of brown paper, or even newspapers, pasted together to the size of the bed, add greatly to the warmth and practically nothing to the weight. If it is not the beat possible covering, it is very good, and absolutely costless.

It is often necessary to change the sheets without disturbing the patient. This can be done either from side to side or from head to foot. The former method consists in loosely rolling up the soiled sheet sideways, from the side of the bed where there is most unoccupied space, until the roll can be pressed against the patient’s side. The clean sheet, previously loosely rolled up from side to side, is then unrolled over the uncovered part of the bed, until the clean roll lies by the side of the soiled one. The patient is now lifted over on to the clean sheet, the soiled sheet is taken away, and the spreading of the clean sheet is completed. The second plan is to roll up a clean sheet loosely from end to end. Beginning at the head of the bed, the soiled sheet is rolled down from underneath the bolster, and the clean sheet unrolled after it, and arranged in its place. The shoulders of the patient should then be raised a little, and the soiled sheet rolled down from under them, while the clean sheet is unrolled to follow it. The hips, and lastly the legs and feet, are to be gently raised one after another in a similar manner, the soiled sheet taken away at the foot of the bed, and the unrolling of the clean sheet completed.