Part 132

With paralysed and other helpless patients, frequent washing or sponging is more necessary, and the draw-sheet becomes useful. This consists of a small sheet folded lengthwise 2 or 3 times, so that when placed beneath the patient it may reach from the middle of the back to the knees. One end of the folded sheet should be the part first used, the rest being loosely rolled up to within a few inches of the patient’s side. As the sheet becomes soiled, the unused portion is unrolled sufficiently for the soiled part to be drawn from under the sick person, and a clean part substituted. The soiled portion is rolled up as it is withdrawn, and secured by a safety-pin. A piece of waterproof sheeting or a strip of thin oil-cloth passed beneath the draw-sheet still further protects the bed.

Bedding and pillows should not be too soft, otherwise the patient is continually sinking into hollows, and becoming hot and restless in consequence. When a patient needs to be propped up, the greatest mistakes are made. Pillows are jammed and wedged in at the patient’s back till he is completely built in. A cheap and simple pillow which doctors strongly recommend as a support in such cases is made of chaff, or chopped straw, and stuffed hard. It is covered with any cheap material, and is shaped like a writing desk--that is to say, it is made to slope. It should be a little longer than an ordinary pillow, and should be 8-12 in. deep behind and 3-4 in. in front. Ordinary pillows (1 or 2) placed upon this as a basement make a capital back-rest for persons suffering, say, from bronchitis. Such a rest has many advantages: it does not give way, hence the patient no longer finds himself from time to time in a deep hole; it allows the arms and shoulders free movement; it is also cooler, and permits more frequent change of posture. In propping a patient up it should always be remembered that the back needs support as well as the head and shoulders.

A very great comfort to sick people, especially to those who have to be left much alone, is to be furnished with some simple arrangement by which they can raise themselves into the sitting posture and so maintain themselves with slight effort. This can be attained by fixing a length of strong webbing to the foot of the bed, and placing knots upon it at intervals, so as to enable it to be more readily and firmly grasped. A netted bed-rest, 3 yd. in length, is a very simple and useful contrivance; its main use is the same as that of the knotted webbing, but by allowing it to pass round the back of the invalid, and spreading it out, it makes an exceedingly pleasant bed-rest, fashioned on the principle of the hammock. A swing bed-rest has several advantages. It is very cool, and allows a free play of air on all sides of the patient, which is a very important advantage. It permits, moreover, considerable movement, and does away with the fatiguing restraint of keeping the body in one position. If the ventilation through the network be too great, or the weather be cold, a pillow can be placed against the patient’s back, within the rest. Instead of the rest being netted, it may be made of strong towelling, which will bear rougher usage. Its strength and serviceability will be increased by stitching here and there bands of webbing; and at each of its narrower ends strong broad tapes must be fastened, by which it can be secured to the foot of the bed. Such netted bed-rests can be had (5_s._ 6_d._ each) at the Depot for Ladies’ Work, 16, King Street, Manchester.

Bedridden patients, and those who are paralysed or otherwise reduced to a condition of great weakness, often complain that they are continually slipping down in the bed. Often a box or footstool is slipped in at the foot of the bed, that the patient’s feet may be pressed firmly against it to prevent slipping. But this cannot be long continued where the legs are weak, for the muscles become exhausted, the knees give way, and then the slipping goes on just as badly as ever. This can be prevented, if a little round pillow, 3-4 in. only in diameter, be fixed so that the patient, though lying down, as it were sits upon it. Such a pillow, to answer its purpose, must be tied in its position very securely, and this may be done by a piece of webbing attached to each end, and tied either to the head or sides of the bedstead.

Following is a way to make pillows with paper stuffing. Use any sort of paper, and tear all into small square or oblong pieces. Then roll each piece between the finger and thumb into a tiny spiral, exactly as if beginning to make round spills. It is very little trouble to do. It is a most suitable occupation for blindman’s holiday, or for people with weak eyesight; and the pillows, as may be supposed, are far more elastic than if made of the same paper, flat. Of course, it is most suitable for an under pillow, if one has a choice; but so long as there are so many unfortunate invalids without any pillows at all, the plan is worthy of remembrance.

A table to stand on the bed is very convenient for trays, &c. It can be bought ready made, and is not at all expensive, or a very little ingenuity is needed to make one. About 2 ft. long, hollowed out on one side, and 1 ft. broad, is a good size. The legs may be 6-7 in. high.

The bed can be refreshed and aired by raising and lowering the clothes so as to produce a fanning motion. To turn a pillow without fatiguing the patient, put the hollowed palm of one hand at the back of his head while with the other you quickly reverse the pillow and replace it. To lay a bed with a waterproof sheet for temporary use, first make the bed with a blanket beneath the under sheet, and then spread the waterproof, a blanket and another sheet, without tucking in. When done with, it is only necessary to draw out the waterproof with its blanket and sheet, leaving the patient on a fresh sheet. No amount of care will keep crumbs out of a sickbed; they catch in every fold and frill and pass up the sleeves, and demand a search after every meal in which bread figures. To avoid rucks in the under sheets, stretch it tight on the mattress and fasten it down with safety pins.

=Sickroom accessories.=--These are of a varied character, and will be described under separate headings.

_Poultices._ Linseed.--The great art of poultice-making consists in applying it to the patient sufficiently hot, and, therefore, it is advisable to warm all the materials before beginning. Put the linseed (crushed or meal) before the fire or in the oven for 20 minutes to heat. Use by preference a tin bowl, and scald it with boiling water; then pour in as much boiling water as will be needed for the poultice, sprinkle in the hot linseed with one hand, and stir vigorously with a knife to the required thickness. To judge of this requires some practice. A poultice should be somewhat moister, if applied to an open wound, than if it is intended to relieve some internal pain; but in no case ought it to be sufficiently moist to stick in patches to the skin of the patient. The next step is to take a square of rag or paper ½ in. larger all round than the poultice is intended to be; spread the linseed on this about ½ in. thick, leaving the edges clear; fold the rag over on each side, and apply at once, covering with a pad of cotton wool and a layer of indiarubber or oil silk to keep the heat in. It is a good plan to oil the face of the poultice with a feather, as this effectually keeps it from sticking to the skin, even if it is not well mixed, and it is better than to put the poultice into a muslin. If, however, the muslin is preferred, on no account should a bag be made, for the poultice cools while it is being put in. A large piece of old linen, folded over at the back, like a parcel, keeps the linseed in, and makes at the same time a pad to cover it. Failing linseed meal, you can use either oatmeal or bran; if oatmeal, then boil it with the water like porridge. A poultice should be larger than appears absolutely necessary. It is intended to allay pain and inflammation, and as the pain probably extends beyond the inflamed part, a large poultice should be made to cover the inflamed part. Dr. Atkinson says that meal deprived of its oil is far better than that from which the oil has not been extracted. The latter does not retain its heat as long, and, unless covered by some fabric, is not so easily removed as the poultice made from the former. The exhausted meal takes up more water, and retains its heat longer. In making a poultice, the meal should be thoroughly stirred with a spoon while boiling water is gradually added, and when of proper (rather soft) consistence, should be spread on linen. The ability to bear the heat on the back of the hand is a good test of the degree to be used. The poultice should be applied directly to the skin, without intervening fabric, and be covered on the outside with good oiled-silk. A teaspoonful of laudanum may be sprinkled on the surface to increase its anodyne effects, or in place of water may be used a boiling infusion of camomile or poppy-heads. When the skin is inflamed, 3 grs. sulphate zinc or alum may be added to each oz. of water. A solution of 1-40 of carbolic acid may be used instead of simple water in the case of sloughing wounds. Once in 4 hours is a good rule to follow in changing poultices on the chest, the front and back being covered by separate poultices, and only one should be removed at a time. A fresh one should be ready when the change is made. Frequent changes are most grateful in cases of abdominal pain.

To relieve spasm, as in colic--intestinal, biliary, or renal; to relieve inflammation of the pleura (lining membrane of the chest), the lungs, the liver, or other organs, it is essential to apply the poultice as hot as possible, while protecting the skin from being scalded. In order to do this, a flannel bag should be prepared, a convenient size being 12 in. by 8; this should be closed at 3 edges and open at the fourth; one side of it should be 1-1½ in. longer than the other, and it is convenient also to have 4 tapes attached at the points which form the corners when the bag is closed, in order to keep the poultice in position. Besides this, another strip of flannel should be prepared of the same breadth as the length of the bag, and long enough to wrap round it once or oftener. Crushed linseed, bowl, and spoon should be got together, and the spoon and bowl thoroughly heated by means of boiling water; the poultice should then be made with perfectly boiling water, and rather soft. As soon as it is ready, it should be poured into the bag, previously warmed by holding it before the fire; the flap which is formed by the longest side of the bag should now be turned down and fastened in its place by a few long stitches with a needle and thread; it should then be quickly wrapped in the strip of flannel (also previously warmed), and fastened _in situ_, if necessary, by means of the tapes. It may be covered outside with a sheet of cotton wool. In this way the poultice may be applied boiling hot to the skin without burning; the 2 layers of flannel which are at first dry allow the heat to pass very gradually indeed to the skin; as the moisture of the poultice soaks through them they become better conductors, and the heat passes more quickly, but the increase is so gradual as not to cause any painful sensations whatever, but only one of soothing and comfort. The poultice also naturally keeps much longer hot, and the necessity for changing it arises much less frequently. The difference between the effect of a poultice made in the ordinary way and in the manner just described is sometimes exceedingly striking. It is, perhaps, less marked in cases of inflammation than in those of spasm.

Bread.--In a small and perfectly clean saucepan have a teacupful of boiling water. Add breadcrumbs, or the crumb of a stale loaf: 1½-2 oz. will be sufficient for this quantity of water, and let it soak over the fire for about 5 minutes. Then turn it into a piece of rag, and spread it of suitable size and evenly. This plan ensures its being hot.

Mustard.--If a mustard poultice is wanted it can be made in the same way as linseed, save by adding a certain proportion of dry mustard to the linseed. Some persons prefer to boil a little mustard in the water that is to be used. Dr. Tyson, of Philadelphia, recommends the addition of molasses to mustard in making plasters. This furnishes a mild persistent counter-irritant which can be worn for hours. Leaves of so-called “mustard paper” may be made as follows: The mustard must be deprived of all fatty matters; the adhesive agent must contain neither alcohol, resin, nor fatty matter; nor must it be of the nature of a plaster. Submit the mustard farina to strong pressure, and wash with sulphide of carbon or petroleum essence. Spread on paper an adhesive liquid formed of a solution of 4-5 parts caoutchouc in 100 parts mixed carbon sulphide and petroleum essence. Sprinkle over the freshly coated paper by means of a sieve, the prepared mustard. Pass between two rollers, and afterwards gently warm to promote volatilisation of the liquid solvents used. Cut to pattern as required.

_Court Plaster._--This is generally bought. To make it, soak isinglass in a little warm water for 74 hours, then evaporate nearly all the water by gentle heat, dissolve the residue in a little proof spirits of wine, and strain the whole through a piece of open linen. The strained mass should be a stiff jelly when cool. Now stretch a piece of silk or sarcenet on a wooden frame, and fix it tight with tacks or pack-thread. Melt the jelly and apply it to the silk thinly and evenly, with a badger-hair brush. A second coating must be applied when the first has dried. When both are dry, apply over the whole surface 2 or 3 coatings of the balsam of Peru. Plaster thus made is very pliable and never breaks.

To make it without silk, mix enough collodion with castor oil to render it elastic when dry, the oil having profusely been rubbed with some zinc oxide. Into this mixture dip glass plates, and, after drying, redip and redry 2 or 3 times, or until a film of suitable thickness is obtained. Upon this paint the usual solution of isinglass to give it adhesiveness, and, after again drying, separate it from the glass.

_Applying cold to the Head._--Take one fold of cotton or linen rag, soak it in cold water, the colder the better, squeeze dry and apply it as rapidly as possible. Do not take a large piece of cloth folded several times, and keep squeezing it in your hand till it is quite hot and then put on. One fold of cloth, the thinner the better, dipped often in the cold water and rapidly applied gives great relief in headaches, for example. If you can procure ice put a piece in the water. Ice is sometimes ordered to be kept constantly on the head; to keep it from melting, wrap it up in flannel, or put it in sawdust, and in a cool place. To break ice, use a large needle. Ice-bags can be bought for 3_s._-4_s._, or it may be put in a bladder and applied to the part, or a bag may be made of guttapercha and chloroform. By putting a little chloroform along the edges and folding them over, you can make a very useful bag for ice; the ice should be broken in small pieces before being put in the bag, and be removed as soon as it melts.

_Fomentations._--A very good, perhaps the best, plan is to put a piece of flannel, folded 4 or 5 times thick to the required size, into a potato-steamer over boiling water. In this way it soon becomes hot, and little or no wringing is necessary. Where a potato-steamer is not to be had, however, the following plan should be adopted. Take a strong towel or cloth, or a piece of ticking, and pin or tack a deep hem in each end. Into these run two short, strong sticks--anything will serve: a couple of iron spoons, and even a small poker, such as is called a “curate,” though this last is rather long for choice. Lay the towel, or “wringer,” as it is technically called, over a large basin, so that the sticks hang outside; place the folded flannel in the middle, and pour boiling water over. The flannel can easily be wrung dry by one pair of hands, and if it is not made by the bed side, it can be carried there without fear of cooling in the wringer. Sometimes opium or turpentine is to be added. The quantity of either to be used will be prescribed by the doctor, and it should be sprinkled on the side of the flannel that is to go next the skin, immediately before applying it to the patient. The flannel should be covered with wool and oil-silk, just as a poultice is covered. Fomentations are, in many cases, as efficacious as poultices, and they possess, besides, the advantage of being easier to make, and of costing practically nothing, since the flannels can be used repeatedly. For the very poor, the cost of linseed for poultices is often a serious item. There is no danger of scalding if the flannel is squeezed so dry that it cannot drip nor wet the palm of the hand.

Another plan is described as follows: Take your flannel folded to a required thickness and size, dampened quite perceptibly with water, but not enough to drip, and place it between the folds of a large newspaper, having the edges of the paper lap well over the cloth, so as to give no vent to the steam. Thus prepared, lay it on the stove or register, and in a moment steam is generated from the under surface, and has permeated the whole cloth, heating it to the required temperature.

_Blisters._--Blisters and leeches should only be used under medical direction. Before the application of either, the part should be well washed with soap and warm water. Then, in the case of the blister, it has only to be slightly warmed before the fire and left on until “it rises,” and a good-sized vesicle has formed (which will usually be in about 8-10 hours), when the water must be let out by snipping the skin with the point of a sharp scissors--a perfectly painless operation--and the blistered surface dressed with spermaceti ointment spread on soft lint.

_Leeches._--Leeches can generally be induced to bite by putting a few drops of milk or blood on the spots they are intended to take. They will usually fall off of themselves when filled, but if they remain on too long they must not be pulled off, but a little salt shaken on them, which will soon make them let go. Another simple and easy way of detaching leeches is to drop a few drops of camphor julep (mist. camph.) on the part, when they will soon relinquish their hold. The bleeding from their bites will also generally stop without interference. If it should continue to an undesirable degree, the nurse may nearly always stop it by making gentle pressure over the bite with her finger, or applying a little powdered alum or the muriated tincture of iron (tinctura ferri perchloridi). Never leave a patient for the night until all bleeding has completely ceased. The bleeding may be increased, when desired, by fomenting with warm water.

_Enemas._--A nurse is often required to administer an enema or injection--which in many conditions of disease is a most valuable method of treatment. Be careful not to disturb or uncover the patient until quite certain that you have arranged ready to hand everything that will be required. Almost any variety of injection apparatus answers the purpose sufficiently well, but in using the rubber ones care must be taken to squeeze out all air from the bulb before commencing, else the air will be forced in by the first compression. The most convenient position for the patient is lying on the left side. Then the nozzle of the instrument, having been well greased and warmed, should be passed slowly and carefully into the bowel, the point being directed slightly backwards. On no account whatever must the least force be used. If there is any difficulty or pain in introducing the tube to the required distance, the nurse must wait for a minute or two, when, in all probability, the opposing muscle having become relaxed, it will pass in easily and without pain. The injection should then be given very slowly and quietly, and without any jerking or irregularity of motion, especially if it be desired that it should be long retained; it must be stopped immediately if the patient calls out that he can bear no more. Enemata are generally either nutrient or purgative; but occasionally other medicines are given in this way. The nutrient are of extreme value, as it sometimes happens that, when nourishment can be taken in no other way, sufficient may be supplied by this means to tide over the period of danger. A good nutritive enema may be made as follows: The yolks of 2 fresh eggs well battered in about ½ pint strong beef tea, or in 2 tablespoonfuls (half a canister) of Brand’s extract of beef, dissolved in warm milk. About ½ wineglassful port wine, or 1 tablespoonful brandy may be added in cases of extreme exhaustion. It should be given at about blood heat--100° F. An active purgative enema may be made with: 4 tablespoonfuls castor oil, 1 teaspoonful oil of turpentine, and about 1 pint well-strained gruel, or soap and water. An enema of plain soap and water often answers very well.

_Clinical Thermometer._--In trifling ailments its use is for reference; in serious attacks it may give immediate warning that the physician is required; and even while the doctor is in attendance he often wishes observations regarding the temperature to be taken several times a day, in his absence, for his guidance and information. Following are a few illustrations of the uses to which the clinical thermometer may be put by any intelligent person. The natural temperature of the human body is 98·4°F. and the little arrow on the thermometer indicates this normal degree of heat, so that when the index rests at the arrow, the natural temperature is proved to be present. It is the variations above or below the arrow that mark the presence of disease.