Part 141

Hot water of a temperature varying from 110° F. to 150° F., has been found highly serviceable in relieving painful conditions induced by improper feeding. This beverage, diluting the ordinary fluids and secretions of the digestive system, effects the work of the liver and kidneys, and produces the happiest results. Dr. Cutter, of New York, has summarised the methods of using hot water. He tells us that the water must be really hot, and not merely lukewarm. If lukewarm, it will only excite vomiting; whereas, when really hot, it appears to soothe the irritable lining membrane of the stomach and bowels. The quantity of hot water to be taken at a draught, according to Dr. Salisbury, varies from ½ pint to 1 pint or more at a drinking. The test of benefit being derived from the use of hot water is said to be that derived from the kidney-secretion, which should be pure, free from odour and deposit. Regarding the times at which hot water should be taken, 1-2 hours before each meal, and ½ hour before retiring to rest, are stated as the periods most suitable for its administration; while the water must be sipped, and not taken so fast as to cause distension of the stomach. Dr. Cutter says that ¼-½ hour may be consumed in the draught of hot water. This form of hydropathic treatment, according to the authorities just named, should be practised in cases of digestive troubles for a period of 6 months or thereabouts. Regarding the amount of liquid to be taken with a meal, not more than 8 oz. has been prescribed as the regulation quantity; a larger amount tends to dilute the gastric juice to too great an extent. Various additions may be made to hot water by way of rendering it palatable, although persons accustomed to drink it in time learn to like it.

Dr. Milner Fothergill made some experiments with our ordinary native fruits, to test the value of correcting the acid by means of alkali to render the fruit more suitable for dyspeptics. The result was that the amount of bicarbonate potash required for each lb. of fruit was found to be about as much as would lie upon a shilling. With all fairly ripe fruit this is just sufficient to neutralise the acidity, and bring out the natural sweetness; indeed, the resultant product was quite sweet enough for most adult palates. Such stewed fruit can be eaten alone, or with milk puddings, cream, or Swiss milk; gooseberries, currants, apples and plums are excellent when so prepared. With dark fruits, as the black plum, the colour is impaired by the alkali, and the fruit is less attractive to the eye than is that of the ordinary stewed fruit, which is of a deep clear crimson. A little cochineal will give the desired colour. Where there is no natural sweetness, to neutralise the acid completely by an alkali leaves nothing, simply a cold mass, to which the palate is indifferent. Such is the case with rhubarb. Here it is well to use half or all the amount of alkali with some sugar. The same is the case with early gooseberries before they have any natural sweetness; no sugar formed in them. Here the full quantity of alkali should be used, and the remaining acidity be met by sugar. When ¾ lb. of sugar is required to sweeten 1 lb. of fruit, only ¼ lb. of sugar is necessary after the alkali has been added. The sour-sweet taste is thus secured, which is toothsome. In these two instances the stewed fruit is only rendered less objectionable to the stomach plagued with acidity, not made quite inoffensive.

_Infectious Diseases._--All infectious (catching) diseases have several features in common. They begin with a period of dormancy (“latency” or “incubation,”) during which the poison is actively developing. The duration of this period in smallpox is 12 days; in typhus fever, 8-14 days; in typhoid fever, 14-21 days; in scarlet fever, 3-6 days; measles about 4 days, at the termination of which the sickness is said to begin, though its distinctive characters may not appear for some days longer. These diseases (fevers) all commence with a marked, and sometimes sudden, elevation of bodily temperature, which, with variations, continues during the course of the illness. Characteristic eruptions appear in scarlatina on the 2nd, smallpox on the 3rd, measles on the 4th day, and so on; with them begins the infection, and increases with the activity of the disease. The following table, modified from that given by Domville in his ‘Manual for Hospital Nurses,’ is exceedingly useful:--

+---------+-------+-----------+---------+------------------- |Period of| Day of| Characters| Duration| Name. |Dormancy.| Rash. | of Rash. | of | Observations. | | | | Illness.| ----------+---------+-------+-----------+---------+------------------- Chicken- |21 days | |Small rose | 6-7 days| pox. | | | pimples, | | | | | becoming | | | | | vesicles. | | Erysipelas|3-7 days | 2nd or|Diffuse | |Most common in face | | 3rd. | redness | | and head, and after | | | and | | surgical operations | | | swelling. | | or injuries. | | | | | Measles | 10-14 |4th day|Small red | 6-10 |Accompanied with | days. | of | dots like | days. | running at eyes and | | fever.| fleabites.| | nose. Relapsing | Sudden | |Purpuric | |Caused by want of Fever. | | | spots | | food. After 7-14 | | | | | days from the | | | | | first attack, and | | | | | during convales- | | | | | cence, it is | | | | | liable to recur 2 | | | | | or 3 times. Scarlet | 4-6 days|2nd day|Bright | 8-9 days|Very infectious. Fever. | | of | scarlet | | Often accompanied | | fever.| diffused. | | by sore-throat, | | | | | followed by | | | | | desquamation | | | | | (peeling off of | | | | | the skin). Smallpox | 12 days |3rd day|Small red | 14-21 |Discrete or | | | pimples, | days. | confluent. Great | | | becoming | | pain in back and | | | then | | intense headache. | | | vesicles, | | Secondary fever | | | pustules. | | sets in about 11th | | | | | day of disease. Typhoid | 10-14 |7th to |Rose- | 22-30 |Seldom infectious. Fever. |days or | 14th. | coloured | days. | Usually caused by |suddenly | | spots, few| | bad drainage. | | | in number.| | Accompanied | | | | | by diarrhœa and | | | | | sometimes bloody | | | | | stools. Typhus | 1-12 |4th to |Mulberry | 14-21 |Very infectious. Fever. | days. | 7th. | colour | days. | Usually caused by | | | general | | over-crowding and | | | over | | destitution. | | | abdomen. | | ----------+---------+-------+-----------+---------+------------------

In scarlet fever, infection is due to the particles which peel off from the skin, the patient should be anointed once a day with carbolic oil, made with 1 part carbolic acid to 50 of olive oil. The efflorescence (peeling off) occurs first on the skin of neck and arms, sometimes as early as the fourth day. The anointing should include the head, the oil being freely applied to the roots of the hair, and continued for 6 weeks, a warm bath being given weekly during that time. After 6 weeks, the patient may mix with the other members of the family; but children should not return to school for 2 weeks longer.

In measles, the same rules are to be observed, with the addition that the discharges from mouth and nostrils should be received on rags and destroyed by burning.

In typhoid fever, the poison is chiefly contained in discharges from the bowels. These may infect the air of the sickroom, the bed, body-linen, w.c., and drains, and, by soaking into wells, they poison the drinking-water--a common and dangerous way by which this fever spreads. The discharges should be disinfected immediately on their escape from the body as will be directed.

Typhus fever is very infectious, and is apt to attack those who are much exposed to it for the first time; therefore engage a nurse who has been previously attacked. The poison is thrown off by the skin and lungs and readily affects clothing, furniture, and everything in contact with the air of the room.

Efficient protection from smallpox is proper vaccination, known by a large mark or scar. Re-vaccination after the fourteenth year is advisable. Smallpox affects at a greater distance than any other, the poison escaping chiefly by the skin and mucous membrane.

Diphtheria poisons by the breath and expectoration; and to avoid contact with these is absolutely necessary. The expectoration should be received into a vessel containing Condy’s fluid, or on rags that may be at once burnt. Gargle the throat frequently with a solution of the same, of the strength of 1 small teaspoonful to 1 qt. water.

Whooping-cough is a disease which is most fatal to children under 2 years of age. The poison comes chiefly from the mucous secretions of the lungs and air passages, and is readily imparted to the clothes of those who nurse the patient; the secretions are infectious from the beginning.

Asiatic cholera rarely visits this country. As in typhoid fever, it spreads by means of the bowel discharges, and the same precautions are needed.

In any infectious disease, where the home has no accommodation for fully carrying out the precautions, the patient should be removed at once to a fever hospital. No time should be lost in obtaining medical advice.

One other source of danger may be mentioned here, and that is the poisonous vapours arising from broken gas mains, which will cause illness and even death from the carbonic oxide present. As a precaution against ground air contaminated with illuminating gas entering houses, open all cellar windows, as well as those on the ground floor of threatened houses, so as to prevent directly sucking in the ground air or render it harmless by dilution. The smell of gas should serve as a warning.

The following advice is addressed to those who have to visit or attend upon infectious cases. Always have the window open before entering the patient’s room or ward. Never stand between the patient and the fire, but always between him and the open window. If possible change your coat before entering the room. Do not go in for any unnecessary physical examination. Stay as short a time as possible in the room. Never, while in the room, swallow any saliva. After leaving the sickroom, wash the hands with water containing an antiseptic. Rinse out the mouth with diluted “toilet sanitas” or Condy’s fluid; also gargle the throat with it, and bathe the eyes, mouth, and nostrils. Expectorate and blow the nose immediately on leaving the sickroom. Keep up the general health by good food, exercise, and temperance. Filter all the air you breathe while in the sickroom or ward through an antiseptic medium, such as a McKenzie inhaler over the nose and mouth; carefully soak the sponge in a strong solution of carbolic acid before entering the sickroom; all the air breathed must necessarily come through this sponge, and the expired air is emitted, by a valve action, at another place.

Nurses should keep themselves and their patients as clean as possible, remembering that the more the infection accumulates, the more dangerous does it become. Special care should be taken, in changing sheets and clothing, not to shake or disturb them more than is absolutely necessary to remove them; as these acts disseminate the particles of skin which are removed with them, and which convey the germs of disease, they should be removed carefully, folded together, and immediately disinfected.

Whatever the nature of a malady, so soon as it is pronounced to be infectious the same precautions should in all cases be taken. Let it at once be decided who is to nurse the patient, and make all arrangements by which nurse and patient may be isolated from the rest of the household. If possible, 2 rooms communicating should be given up to them, and over the outer doors of these rooms sheets should be hung, which must be kept constantly saturated with disinfectants, either Condy’s fluid or carbolic acid in water. No servant in communication with the rest of the household must enter the sickroom; if she does so, she should be isolated like the nurse, and any message that may require to be given must be spoken through the sheet. The best plan is to have a regular nurse from one of the many excellent institutions which provide them; they make the patient more comfortable, take entire charge of the arrangement of the sickroom, and know exactly what is required to be done in an emergency, and for disinfection. At the very commencement all curtains should be taken down, and at once sent out of the house to be disinfected by properly qualified persons; the same course should be pursued with the carpets (woollen articles hold infection beyond any others), and then the floors can be kept sprinkled with disinfectants, besides having a broom steeped in them passed over every morning. Linen used in the sickroom should always be put into water with either carbolic or Condy, before leaving the room; but, even with this precaution, it is far better to send it to be disinfected than to allow it to go to a laundry. The windows should be open, top and bottom, but more especially at the top, during the entire day, and if possible at night also; a thorough draught through the room is most desirable, if the patient can be kept out of the direct line of it. As much as possible, all cups, basins, jugs, and glasses should be kept upstairs; but those that must occasionally be sent down should be carefully washed in Condy and water, and at once placed outside the door, and again passed through disinfectant on their arrival downstairs. The clothes that may have been worn for the day or two before the disease absolutely declared itself should be sent for disinfection, but those which have only been in casual contact may be disinfected at home. A small room should be chosen for the purpose, and the dresses, petticoats, shawls, or other articles hung up, so as to be fully exposed. The doors, windows, and all other apertures must be kept closed, and the disinfection may be effected either by chlorine, which is formed by pouring hydrochloric acid on chlorate of potash, or else by burning sulphur. In either case the quantity must be sufficient to render the atmosphere of the room unbearable to a human being, or otherwise the disease germs will not be destroyed. The bedding and blankets must be sent for proper disinfection at the close of the illness. Nothing should be kept in the room except for use. Clothes in a wardrobe under such circumstances have been known to spread infection 10 years after. Handkerchiefs should be replaced by rags, burnt when used. Letters from the patient should be backed, or written on postcards dipped in carbolic; they are capable of spreading disease otherwise. A thing in which people are often lamentably careless is in allowing books that have been used by the patient to be afterwards used by others. It cannot be too often impressed on the minds of those who have to do with illness, that every book, paper or magazine used by an infectious patient must be burnt without leaving the sickroom. Infection is very often spread by allowing books from a circulating library to be returned to it after use by a person suffering from an infectious disorder.

Infection ceases in the individual as soon as the skin has thoroughly peeled--a process which takes a longer or shorter time in different individuals. The danger after this lies in the clothes, furniture, and rooms, and if these are at once thoroughly disinfected all danger is absolutely at an end. It is impossible to reprobate too strongly the conduct of those who wish and endeavour to shirk the expense and trouble of proper disinfection. It would be well if in such cases doctors would always avail themselves of their power to report the existence of a case of infectious disease to the sanitary officer of the district, when official pressure would at once be brought to bear, and all that is necessary be effected under compulsion.

The cured patient on the day of leaving home should go into a fresh room to dress, and put on things either new or disinfected, not returning to the sickroom. Brushes and sponges, as coming most in contact with hair and skin, are best destroyed. While a patient is in the infectious stage it is best that no letters should be written; but if, as is sometimes the case, some communication in writing must be made, danger is obviated by holding the paper and envelope in the fumes of chlorine.

A few words would not be amiss respecting those in the house who do not enter the sickroom. However great the precautions taken, the air of a house in which there is a case of infectious disease can never be absolutely safe, and it is far better to err on the side of caution than the reverse. Visitors should not be allowed to enter the house, and it is far better and more honest for the servants to state clearly at the door what disease is in the house. Special attention should be paid to the health of each member of the household. Any slight disorder is liable to predispose to infection.

There is a great variety of good disinfectants, and as many different ways of using them. A good plan, both effective and economical, is as follows:--Freely use moistened chloride of lime all through the house, and even in the sickroom, if the fumes are not found to be irritating; secondly, place in various parts of the room 5 or 6 soup-plates, or other flat vessels, containing Condy’s fluid; or hang about in the room as many perforated boxes filled with solid iodine; thirdly, keep the windows opened freely but the doors as seldom as possible; guard it both inside and outside with a large sheet, hung up to at least the height of the door, and at about 1 ft. distant from it, and kept constantly well moistened with a solution of carbolic acid (strength, about 1 of the acid to 40 of water); and, most important of all, receive as soon as possible all discharges, excreta, soiled linen, and all such matters, in vessels containing a strong solution of Condy’s fluid, chloralum, or carbolic acid. Many infectious diseases have (in addition to their common property of infecting the air through the effete products of respiration from the lungs and skin) some special channel of transmission. In cholera, typhoid (enteric) fever, and, in a less degree, typhus and relapsing fevers, it is principally by the excreta from the bowels and kidneys. These should be received at the very moment of their issue from the body into vessels fully charged with disinfectants. In diphtheria, it is by the throat. In erysipelas, hospital gangrene, and puerperal fever, by discharges peculiar to each. In smallpox, by pustular exudation from the skin. In scarlet fever, measles, &c., by desquamation (peeling off of the skin), rendered harmless by slightly moistening the surface of the body once or twice a day with ordinary olive oil or camphorated oil, or a weak solution of glycerine and carbolic acid. Never mix disinfectants; for instance, Condy’s fluid and carbolic acid act in precisely opposite ways, and might decompose each other.

The nurse must not neglect proper precautions for her own safety. She should use disinfectants freely about her own person, be sure that she has a sufficient quantity of undisturbed rest and regular meals, and avoid coming into unnecessary close contact with the patient. She should at once give up the occupation if she feel her general health at all injured. She must also be careful not to undertake a non-infectious case after being in attendance upon an infectious one for a considerable time; and until she has put herself through a complete process of disinfection, and done the same with all clothes worn at the time which she has not discarded altogether. Nothing must induce her to go near a confinement for several (at least 3) months.

Disinfection.--The most useful agents for the destruction of spore-containing infectious materials are:--

(1) Fire: Complete destruction by burning.

(2) Steam under pressure: 230°F. for 10 minutes.

(3) Boiling in water for 1 hour. This temperature does not destroy the spores of _Bacillus subtilis_ in the time mentioned, but is effective for the destruction of the spores of the anthrax bacillus, and of all known pathogenic organisms.

(4) Chloride of lime: a solution of 4 in 100 containing at least 25 per cent. of available chlorine.

(5) Mercuric chloride: a solution of 1 in 500 containing at least 3 per cent. of available chlorine.

For the destruction of infectious material which owes its infecting power to the presence of micro-organisms not containing spores:--

(1) Fire: Complete destruction by burning.

(2) Boiling water ½ an hour.

(3) Dry heat: 230°F. for 2 hours.

(4) Chloride of lime: 1 to 4 in 100 solution, containing at least 25 per cent. available chlorine.

(5) Solution of chlorinated soda: 5 to 20 in 100 solution, containing at least 3 per cent. available chlorine.

(6) Mercuric chloride: a solution of 1 in 1000 to 1 in 4000.

(7) Sulphur dioxide: exposure for 12 hours to an atmosphere containing at least 4 volumes per cent. of this gas, preferably in presence of moisture. This will require the combustion of 3-4 lb. sulphur for every 1000 cub. ft. of air space.

(8) Carbolic acid: 2 to 5 in 100 solution.

(9) Sulphate of copper: 2 to 5 in 100 solution.

(10) Chloride of zinc: 4 to 10 in 100 solution.

Following are recommendations with reference to the practical application of these agents:--

For Excreta.

(_a_) In the sickroom:

For spore containing material:

(1) Chloride of lime in solution, 4 in 100.

(2) Mercuric chloride in solution, 1 in 500; addition of an equal quantity of potassium permanganate as a deodorant, and to give colour to the solution, is to be recommended.

In the absence of spores:

(3) Carbolic acid in solution, 5 in 100.

(4) Sulphate of copper in solution, 5 in 100.

(5) Chloride of zinc in solution, 10 in 100.

(_b_) In privy vaults:

Mercuric chloride in solution, 1 in 500. A concentrated solution containing 4 oz. mercuric chloride and 1 lb. cupric sulphate to 1 gal. water is recommended as a standard solution; 8 oz. this solution to 1 gal. water will give a diluted solution for the disinfection of excreta, containing about 1 in 500 of mercuric chloride and 1 in 125 of cupric sulphate.

(_c_) For the disinfection and deodorisation of the surface of masses of organic material in privy vaults, &c.:

Chloride of lime in powder, diluted with plaster of Paris, or with clean, well-dried sand, in the proportion of 1 part to 9.