Part 133

The agony of colic is well known, but it is generally of little danger in the absence of inflammation. In peritonitis (inflammation of the bowels), the temperature runs quickly up to over 101° F.; in colic it scarcely rises more than a degree, if even thus far, above the natural temperature. A severe pain in the side causes pleurisy to be suspected. If the temperature is normal, there is no pleurisy, and the pain is probably neuralgic. Diarrhœa may continue for a few days, and the patient feels so out of sorts that typhoid fever seems to have set in; but all the specific forms, such as typhoid, typhus, scarlet fever, diphtheria, or measles, are accompanied by such an increase of body heat as will probably send up the record to 101° F., or possibly 3-4° higher. A child with persistent vomiting, sore throat, and high temperature will probably in a day or so show the rash of scarlet fever. In any case, when a temperature remains above 100-101° F. for more than 1-2 days, without obvious cause, the doctor should be consulted. If the child has disordered stomach or sustained a chill, the thermometer will record fever; but, after a purgative in the one case and a tepid or hot bath in the other, the increased heat will be found to be gone, and with it any alarm which may have been felt. In the course of an inflammation or fever, the friends can be informed by the medical man what degree of heat he expects, and should this be exceeded the doctor should be informed of the fact. Indeed the clinical thermometer is invaluable, especially to families at a distance from their medical adviser. It can be obtained from any instrument maker for 7_s._ 6_d._-12_s._ 6_d._, or more. Its application is a very easy matter. The bulb containing the mercury should be placed in the mouth or arm-pit; care should be had in the last case that clothes do not intervene between the instrument and the arm, and that it is so placed in the arm-pit as to be completely surrounded by skin. The patient must then press the arm gently to the side so as to retain the instrument, and in 5 minutes the thermometer will show the body’s temperature.

Dollond, 1 Ludgate Hill, London, E.C., sells an improved Lens Clinical Thermometer. The importance of the “lens” front cannot be over estimated, for with such a thermometer there is no difficulty in reading off the temperature even in the dull light of a sickroom, for the thin thread of mercury is magnified quite twenty times its size. This thermometer is made with a contraction in the tube near the bulb, which prevents the mercury returning, until shaken down. The price of this thermometer is 7_s._ 6_d._

W. H. Harling, 47 Finsbury Pavement, London, E.C., is the maker of an excellent clinical thermometer with lens front, which registers the temperature in the space of a single minute. It is furnished with a metal case having a bayonet fastening, and costs only 8_s._ 6_d._ The same maker supplies also ordinary clinical thermometers, in cases, at prices ranging from 3_s._ 6_d._ upwards. Other sickroom requisites are noticed on p. 1007.

When used to take the temperature of patients suffering from infectious disease, the thermometer should be disinfected by being washed in “Sanitas” or carbolic acid solution after each time of using. In taking the temperature under the tongue, the index should be “set” as directed, and the bulb should be placed as far back under the tongue as convenient and agreeable; the mouth should then be kept shut, and the patient should breathe through the nose: 3 minutes are sufficient for taking the tongue-temperature. In the arm-pit the thermometer should be left for 5 minutes and the fore-arm should be made to lie across the chest, so that the thermometer may thus be made to rest in a sheltered position.

Temperatures should be taken in ordinary cases at 8 A.M. and 8 P.M.; 2 o’clock is a convenient hour for a third observation. Variations in temperature occur in healthy persons, but such change does not usually amount to more than 2° or 3° F. What is to be regarded as deserving of attention under the ordinary circumstances of life is a fall below 97°, or a rise above 99·5°. In fevers, as a rule, the temperature does not rise above 106°; but in fever a heat of 108°, continuing even for a very short time, would be regarded as a most dangerous symptom. A very high or very low temperature must be looked upon as dangerous; should it be excessive either way, the case will probably prove fatal. A very sudden change is suspicious, and very frequently dangerous. In children, however, the presence of indigestible food in the intestinal canal may suffice to cause a rapid rise in the temperature. After the temperature has been stationary for some time, or has commenced to fall, a fresh rise may herald the advent of some complication, or the approach of a new disease. An unexpected fall may denote hæmorrhage, exhausting diarrhœa, or the perforation of the peritoneum or pleura (lining membranes of the abdomen and chest). A considerable rise during the course of a disease which is not generally regarded as febrile--viz., in tetanus, epilepsy, and cholera--usually precedes death.

_Making a Medical Coil._--Procure a well-seasoned walnut board about 21½ in. long, 3 in. wide, and ⅜ in. thick. From this cut one length 12 in. long for the base board _a_, and 3 pieces 3 in. square (like _b_) for the coil heads; when cut, a fillet 8 in. long must be nailed or screwed on the two sides of the base board (as shown in _a_); these fillets should be ¼ in. square section. Corresponding square nicks must be cut of two of the square heads (as shown at _x_ in _c_). All the woodwork when thus squared and finished should be soaked for ¼ hour in melted paraffin wax, and then rubbed dry while still warm.

Obtain a thin brass tube (known in the trade as “triblet tubing”) about ½ in. diameter, 4½ in. long; turn up a short plug and button to fit one end of this tube and serve as a handle (see _d_). This may be fastened to the tube by driving in 3 fine brass brads, and filing off the heads flush with the tube.

Cut up about 100 lengths of straight iron wire (best soft annealed) No. 22 gauge, say, about 4½ in. in length; fill the brass tube with them as tight as you can fit them; cut them all to the same length (they must protrude a little beyond the tube). Now draw out about 2 in. of the iron bundle and wrap it tightly round with twine, leaving about ½ in. free. Draw more out, and continue wrapping until you have wrapped to within ½ in. at each end of the bundle. Tie the string, and withdraw the bundle from the brass tube. Melt a little solder in a ladle, dip the ends of the iron bundle into soldering fluid (zinc dissolved in hydrochloric acid), and then at once into the melted solder. Allow the bundle to cool; file off the superfluous solder, so that the bundle will just enter freely into the tube. It should appear like _e_ when the string has been removed.

The next operation is to make a good stout paper tube, also about 4½ in. in length, into which the brass tube _d_ can slide easily. To make this, put a few turns soaped writing paper round the tube No. 1, then roll and glue seven turns of good stout brown paper, 4½ in. in length, round this writing paper, or else it will be difficult to draw out the tube. This paper tube _f_ must be allowed to dry thoroughly while still on the brass tube _d_. When quite dry, it must be slipped off, the writing paper lining drawn out, and then it must be soaked for a few minutes in melted paraffin wax.

The iron bundle should also be allowed to stand in melted paraffin wax for some time, and then stood up to drain in a warm place. This will prevent rusting. When quite cold, all superfluous paraffin having been removed, a strip of brown paper, ½ in. wide, is rolled round one extremity of the iron bundle, until it is of such a diameter as to fit tightly into the paper tube _f_. This paper strip must be cut off at this point and glued tightly round the end of the iron bundle. The brass tube _d_ is then slipped over the iron bundle until it just reaches the little paper collar just made. The brass tube and bundle together are pushed, button end first, into the paper tube _f_; and when the paper collar round the iron bundle is just about to enter the paper tube, it is to be well served with hot glue and forced into the tube. The whole must now be allowed to dry and set thoroughly.

Taking one of the 3 in. heads (the one which has not any nicks in the sides), bore a centre hole with a brace and centre bit, just large enough for the paper tube _f_, with its iron core, to fit tightly (see _b_). Putting a little thin good hot glue round the free extremity (the end opposite to that at which the brass enters), push it into the hole in the square head, until it projects about ⅛ in. on the other side. This must be allowed to dry thoroughly before proceeding to the next operation.

Now proceed to wind the primary coil. To this end, take about ½ lb. No. 24 silk-covered copper wire, and wind it round the tube, as shown at _g_, from end to end, in continuous layers, taking care to put a sheet of paraffined paper between each layer, and also to baste each layer with melted paraffin wax before winding on another. About 4 layers will thus be got on, and an even number of layers must be aimed at, so as to get the 2 ends of the wire at the same extremity, and able to fasten them under the binding screw _y_. To effect this, before screwing down the said screws, the ends of the copper wire are stripped of their covering and wound once round the screw of the binder. Free ends of wire, at least 6 in. in length, must be left for attachments, &c. This is shown at _h_.

This primary coil, with its iron core, sliding brass tube regulator, &c. may now be fastened to the base board by means of 2 screws from underneath, as shown at _i_, at 4 in. from one end, and therefore 8 in. from the other. One of the free ends of the primary wire is brought to one of the binding screws _v_, while the other connects to the clapper _z_. A short piece of wire connects the platinum screw pillar _w_, to the other binding screw, which is not visible, as it is behind the platinum pillar. At this point it will be well to try the working of the primary coil. For this purpose, couple up the 2 binding screws on the base board with a good bichromate cell. Connect the two binding screws _u_ in _i_, with the 2 brass handles intended for use. Screw up the platinum screw _w_ till the clapper _z_ begins to vibrate. Now hold the handles in your hand. As long as the brass tube _j_ is entirely over the iron core, little or no sensation is perceptible. If an assistant pulls out the tube, little by little, the current will be found to increase in strength until the regulator tube is quite out.

The secondary coil now demands attention. A paper tube, precisely similar to _b_, but of such a size as to slide easily over the primary coil _i_ is prepared, and paraffined. This must be cut exactly the length of the coil _k_, leaving the knob _j_ projecting. The 2 square pieces of board in which the nicks were cut (_c_) must then have central holes cut in them to take this paper tube, and then glued, one at each end of the said tube, as shown. Two small binding screws are then to be inserted in the centre of the upper edge of each square. A bung is now placed in each end of the tube, and a ¼ in. iron rod pushed through both, to serve as an axle. This is then mounted on 2 standards, as shown at _n_; and beginning by attaching one end of the uncovered wire to the binding screw _m_, about ½ lb. No. 36 silk-covered copper wire is now carefully coiled on, being most diligent in avoiding kinks, breaks, or flaws of every description. Each layer must be paraffined and separated from its neighbour by paraffined paper. When the quantum of wire has been laid on, the finishing end is connected to the binding screw in _n_. The last coil should be covered with paraffined paper, and finally covered with a jacket of good silk velvet. The secondary coil is then complete, and may be slid in its place over the primary coil _o_. When it is quite over the primary, the secondary current will be at its strongest, if the metal tube regulator is drawn out; it will be weaker as the metal tube regulator is more and more inserted; or may be even more delicately regulated by sliding the secondary coil itself more or less over the primary. The secondary coil, while the primary is being excited with a freshly made pint bichromate, will give a ½ in. spark when the regulator is out and the secondary coil right over the primary. This will pass easily through a dozen persons. (S. R. Bottone.)

There are various other sickroom appliances demanded in special cases which do not require description here. Most may be had of such well-known firms as Salmon, Ody & Co., 292 Strand, and Savory and Moore, 143 New Bond Street.

=Feeding patients.=--A nurse should bear in mind these two leading facts; that while in sickness there is usually a greatly increased tissue-waste, and consequently an increased necessity for nutriment, there is almost always a decreased appetite, or no appetite at all--often such a repugnance to food that, if left to himself, the patient would prefer taking none at all. Hence, although the medical attendant may decide what is the most suitable form of nourishment, on her devolves the more difficult task of inducing the sick person to take it. With this view, she must exercise all her ingenuity to tempt and encourage him, by bringing everything in the neatest possible form. On no pretext whatever should there be any cooking in the sickroom; nor should she take her own meals there; nor should any food be left standing near the patient. On the contrary, though his nutriment must be brought to him frequently--more frequently, of course, the less he can take each time--and punctually, it should only be in such quantity as he is likely to consume; and immediately that is done, everything in connection with food should be removed from sight and smell until the next time.

The nurse must devote much of her attention to the subject of diet, observing carefully the patient’s appetite, and attending carefully to the quantity of food and the effect of it. The sense of taste of many people is very acute when they are ill, and you must take care that the spoon in the arrowroot, which looks perfectly clean, does not taste to the patient of the soup for which it was used last. Eatables should not be kept in a sickroom: if you are obliged to have anything within reach, put it under a cover; a tumbler turned over does very well for biscuits or jelly, and for larger things a bell glass is useful; tin boxes, the next best thing, generally make a noise when they are opened. The water given to a sick person should not only be boiled and allowed to cool, but ought always to be filtered. It should frequently be changed, as it quickly absorbs the impurities with which the air of a sickroom is charged, and becomes injurious, if not dangerous to drink. In cases of faintness, where stimulants are not ordered, the patient should be made to sip some liquid slowly; the mere effort of sipping accelerates the action of the heart.

When solid foods cannot be taken, the best kinds are those which contain the most nourishing properties in the smallest and most easily digested form. Prominent among these is well-made beef tea: not the greasy watery broth which so often goes by that name, but nearly pure beef juice which has been slowly extracted, with the addition of little or no water, from fresh lean beef. A good substitute may be found in Bovril, which has the great advantage in an emergency of being immediately procurable at a chemist’s or grocer’s. Home made beef tea takes a long time to prepare properly, and even then it is deficient in staminal properties, whereas Bovril contains the entire nutritious constituents of pure beef, of which it takes 40 lb. to make 1 lb. of Bovril extract. Of equal value is milk; which, especially when combined with bread and butter, is very nourishing, and forms a most valuable article of sick diet. If it seems to disagree, or curdle on the stomach, it can generally be prevented doing so by the addition of about ⅓-¼ its bulk of lime-water. These may be varied by mutton broth, chicken or rabbit jelly, eggs in any form--plain, in custard, or in pudding with arrowroot and sago--and real turtle soup; which latter is, however, so terribly expensive as to be outside the reach of most people. Jellies made with gelatine, which contains scarcely any nutriment, are almost useless; and tea should be given only as an indulgence when specially wished for, and then it should be very weak, and with plenty of milk. All food given to the sick should be very fresh, of the best quality, and most carefully cooked.

_Boiled Flour Gruel._--Where the illness has been long and tedious, and the strength reduced, the following will be found very useful: To prepare the flour, put into a basin as much as it will hold, pressed tightly down. Then tie a cloth over it, and allow it to boil hard for 6 hours. Then take off the cloth, and let the flour stand in the basin till next day, when remove the crust which will have formed, and put the remainder away in a covered jar. For use, mix 4 tablespoonfuls flour smoothly into a paste, then pour on it ½ pint boiling milk or water, and boil for 10 minutes, constantly stirring to avoid lumps. Brandy, sherry, lemon juice or cream may be added, according to taste. Gruel may also be made from baked flour, but it is not so easy of digestion.

_Rice Gruel._--1 oz. each rice, sago, and pearl barley boiled in 3 pints water, which, in 2 hours, generally reduces it to 1 qt. Strain and flavour to taste. This forms a good nourishing diet, especially with the addition of a little isinglass.

_Onion Posset or Gruel._--This has been found very efficacious for colds, and is made with Robinson’s groats with the addition only of an onion, which should have been previously boiled for 6 hours. The yolk of an egg well beaten is an improvement.

_Chicken Broth._--The younger and fatter the birds are for this the better. It is made by immersing the legs, neck, and trunk of a fowl into just as much water as will cover them, and boiling gently for an hour. The white meat makes a delicious entrée if cut up finely and treated as a veal mince. Potato flour is useful for thickening in cases where boiled flour is not handy; but home-made things are always the best, as the ingredients are known.

_Oyster Fritters._--Remove the beards, and put each oyster into a tablespoon, and fill with a batter made as follows: 1 oz. rice flour mixed with 2 tablespoonfuls water, 1 teaspoonful vinegar, and 2 salad oil, the yolk of an egg, and a little salt and pepper. Allow the batter to stand, and just before using, beat the white of an egg to a stiff froth, and mix with it. Fry the oysters covered with the batter in boiling fat, turn them, place them on blotting paper to drain; serve on a hot dish, and garnish with slices of lemon, and thin rolls of brown bread and butter alternately.

_Potato Chops._--Mash nicely with a little milk, butter, pepper, and salt, any potatoes left from the day before, spread evenly over a boned loin chop previously sprinkled with finely chopped fried mint. Fry to a golden brown in boiling fat, then place it on blotting paper to remove the superfluous grease. Garnish with fresh mint and watercress.

_Jellies and Creams._--The following recipes were published by Mary Hooper, in the _Queen_:--

When jellies and creams are ordered for sick people in families where there is not a good cook, they are usually obtained from the confectioner; but this is not at all in the interest of the invalid, and efforts should be made to provide his diet from the home kitchen. An idea prevails that it is very troublesome to make jelly. It is not at all necessary to clear the jelly through a bag for invalids, nor indeed for ordinary domestic use. By a little care in the use of citric acid, which is perfectly wholesome, a jelly nearly as bright as that which has been cleared with eggs may be produced. In some cases, jelly without wine is required for invalids, when coffee, cocoa, or Seville orange jelly will probably be useful. It is difficult to make these jellies palatable without making them sweet, and they will only keep a short time. If the doctor does not object, or where it is desirable to give stimulants in a disguised form, a very small quantity of absolute alcohol may be used, and it will obviate the last-named disadvantages.

Milk jellies, or creams, whenever they can be taken, are an excellent form of diet, and are very easily prepared by the following recipes. For those who require a quickly-made cream, “Nelson’s Blanc mange” will be found very useful; it merely requires to be dissolved in milk or water, and in a very short time is ready for use. This blanc mange is made of very rich milk, and tastes equal to that prepared at home with cream. The unflavoured blanc mange should, as a rule, be selected for invalids, as any home-made flavour can be added to it. These flavourings--lemon, Seville orange, almond and vanilla--are very easily prepared by infusing any of the three first-named in gin, the latter in brandy. As these are more digestible than any which can be bought, it is well worth while to take a little trouble in the matter. It is sometimes necessary to tempt the appetite of an invalid by a pretty looking dish, which is also nice and nourishing. Such a dish can be easily made by the recipe for Alexandra Cream.

Simple Jelly.--Soak 1 oz. gelatine in ½ pint cold water for 1 hour or more. It is an advantage to soak gelatine overnight when convenient, because it is then more easily dissolved. Boil 6 oz. lump sugar in 1 pint water, skimming it until clear; then throw in the soaked gelatine, let it boil slowly for 5 minutes, removing all scum as it rises. Dissolve in a basin ¼ oz. citric acid, in lump, in ½ gill boiling water, pour the jelly on to this, when more scum will rise, which should be carefully taken off. Now add 1 gill wine and a little lemon flavouring, and, when nearly cold, put the jelly into a mould. Lemon juice can be used instead of the citric acid, but the jelly will not then be so bright.

Cocoa Jelly.--Mix 1 dessertspoonful cocoa in ½ pint water, stir over the fire until it boils, sweeten it with ¼ lb. lump sugar, or according to the taste of the patient. Stir into it, whilst boiling, ½ oz. gelatine, soaked in ½ pint cold water for some hours, flavour with vanilla, and stir occasionally until the jelly begins to set.

Coffee Jelly.--Soak ½ oz. gelatine in ½ pint cold water, dissolve it in ½ pint very strong coffee, sweetened to taste. Extract of coffee can be used to flavour this jelly, and answers well.

Porter Jelly.--Procure a cow-heel (which should be thoroughly cleaned) and 2 calves’ feet; wash them in cold water, and put them into a pan with 5 pints water, and let them boil until the meat leaves the bones; strain the liquor through a hair sieve, and let it stand for one night in a cool place. Next morning put the stock into a pan with 1 lb. loaf sugar, ½ pint porter, the juice of 4 lemons with their rinds cut very thin, and the well-beaten whites of 8 eggs. Let all boil together till it rises to the top of the pan; then throw in a teacupful of cold water; then let it boil slowly about 20 minutes, at the expiration of which time add 1 wineglassful brandy. Boil 5 minutes longer, then lift the pan from the fire, and let it remain at the side of the fire, to keep hot. In about ½ hour the scum will collect in a lump, leaving the liquor quite clear. Run it into moulds.