Mrs. Beeton's Book of Household Management/Chapter LXXI
THE NURSE
CHAPTER LXXINursing Recipes for the Sick-Nurse, and Domestic Medicines
Sick Nursing.—All women are likely, at some period of their lives, to be called on to perform the duties of a sick-nurse, and should prepare themselves as much as possible, by observation and reading, for the occasion when they may be required to fulfil the office. The main requirements are good temper, compassion for suffering, sympathy with sufferers (which most women possess), neat-handedness, quiet manners, love of order, and cleanliness. With these qualifications there will be very little to be wished for; the desire to relieve suffering will inspire a thousand little attentions and surmount the distaste which some of the offices attending the sick-room are apt to create.
Where serious illness visits a household, however, and protracted nursing is likely to become necessary, a professional nurse will probably be engaged who has been trained to her duties. Such nurses may be obtained from the nursing homes in connexion with most of the large hospitals throughout the country. Their usual fee is two to three guineas a week. The advantages of employing such a nurse in cases of serious illness are many. The patient receives every care and attention from one who, by training and experience, has learnt of what attentions such a patient stands most in need. The doctor is helped by having at each visit an accurate report of the patient's condition, the amount of sleep enjoyed, the alterations in the pulse or temperature, etc., since his last visit. He is thus better able to form an opinion of the progress of the case, and adapt his treatment accordingly. The mistress of the house has time to devote to her household duties, to supervise the preparation of the invalid's food, to answer inquiries as to his progress, and by her companionship to relieve the monotony of the long weary time the invalid must necessarily experience. How common it is, when the mistress takes upon herself the duties of nurse, to find the patient neglected, not for want of attention, but for lack of knowledge, the household management disorganized, and the mistress herself worn out and ill from anxiety, watching and over-work.
Professional nurses need not only the qualifications already named. In addition to their training they should be physically strong, have good health, nerves well under control, and be sure that nursing is a congenial occupation. What a friend or relative can do in the time of sickness for one she holds dear—the taxing of strength, the loss of sleep that she can make light of in such a case—all this is no proof that she is fitted for the post of a professional nurse. Her very passion for self-sacrifice is against this, for a nurse must do her work in a business-like way; she must not over-fatigue herself; should eat, drink, and sleep well, and take regular exercise; while it should not cause her (as it does so often to the amateur) actual suffering to see pain inflicted when it is necessary that an operation should be performed. She should be able, like the surgeon, to think of the future good instead of the present suffering. To some nervous, highly-organized persons this would be impossible, and they are therefore unsuited for nursing as a career, although they may be the most devoted and patient attendants upon those they love.
But there are, of course, many cases in which the simple domestic nursing that almost every woman could undertake is all that is necessary: infantile complaints; accidents in a thousand forms; slight attacks of disease unattended with great danger; and the preliminary stages of, and convalescence from, more serious troubles for all of which some knowledge of the general treatment of the sick is absolutely essential.
In the first stage of sickness, while doubt and a little perplexity hang over the household as to the nature of the sickness, there are some things about which no doubts exist: the patient's room must be kept in a perfectly pure state, and arrangements made for proper attendance; for the first canon of nursing, according to Florence Nightingale, its apostle, is to "keep the air the patient breathes as pure as the external air, without chilling him." This can be done without any preparation which might alarm the patient; with proper windows, open fireplaces, and a supply of fuel, the room may be as fresh as it is outside, and kept at a temperature suitable for the patient's state.
Arrangement of the sick-room.—Windows must be opened from above, and not from below, and draughts avoided; cool air admitted below the patient's head chills the lower strata and the floor. The careful nurse will keep the door shut when the window is open; she will also take care that the patient is not placed between the door and the open window, nor between the open fireplace and the window. If confined to bed, she will see that the bed is placed in a thoroughly ventilated part of the room, but out of the current of air which is produced by the momentary opening of doors, as well as out of the line of draught between the window and the open chimney, and that the temperature of the room is kept about 60°. (The "cool bedroom" temperature is 56°; the "warm bedroom," 64°.) Where it is necessary to admit air by the door, the windows should be closed; NURSING, No. 3.
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1. Bandage for pressure in region of the temple. 2. Application of Four-tailed Bandage for fracture of lower jaw. 3. To commence a Capeline Bandage. 4. Capeline Bandage complete.
TO CHANGE SHEETS.
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Fold the old sheet lengthways in a narrow roll until it reaches the side of the patient, then fold the clean sheet in the same way, leaving enough unrolled to replace the portion of the dirty sheet that has been folded.
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Place the clean roll by the side of the dirty one, and a very little shifting will take the patient over. Remove the dirty sheet and unroll the clean one. but there are few circumstances in which good air can be obtained through the sick-room door; on the contrary, the gases generated in the lower parts of the house are likely to be drawn through it into the invalid's room. When these precautions have been taken, and plain, nourishing diet, such as the patient desires, supplied to him, probably little more can be done, unless more serious symptoms present themselves; in which case medical advice will be sought.
Ventilation.— Under no circumstances is ventilation of the sick-room so essential as in cases of febrile diseases, usually considered infectious, such as influenza, whooping-cough, small-pox and chicken-pox, scarlet fever, measles, and erysipelas; all these are considered communicable through the air, but there is little danger of infection being thus transmitted provided the room is kept thoroughly ventilated. But if this essential condition is neglected, the power of infection is greatly increased by being concentrated in the confined and impure air; it settles upon the attendants and visitors, especially where their clothes are of wool, and is frequently communicated in this manner. A sheet wrung out in some disinfecting fluid and kept moistened with it, should be hung across the door or passage-way in all cases of infectious diseases.
The comfort of feverish patients, and indeed of most sick persons, is greatly increased by being sponged with tepid water in which camphorated spirit is dropped in the proportion of 1 teaspoonful to 1 quart of water. The patient's face may be sponged every 2 hours in warm weather. An impression prevails that flowers poison the atmosphere of a sick-room. The contrary is, however, the case. By absorbing the carbonic acid in the room and giving out oxygen, the air is purified by the plants. Lilies, and some other very odorous plants, may, however, give out smells unsuited to a sick-room, the atmosphere of which should always be fresh and natural.
Atmosphere of the sick-room.—Under all circumstances this should be kept as fresh and sweet as the open air, while the temperature is kept up by artificial heat. Care must be taken that the fire burns clear, and gives out no smoke into the room; that the room is kept perfectly clean, and wiped over with a damp cloth every day, if boarded or laid with linoleum; or sprinkled with damp tea-leaves, or other aromatic leaves, and swept, if carpeted; that all utensils are emptied and cleaned immediately after use, and not once in four-and-twenty hours, as is sometimes done. A slop-pail should never enter a sick-room; everything should be carried direct to the water-closet, emptied there, and brought up clean; in the best hospitals the slop-pail is unknown. "I do not approve," said Miss Nightingale, "of making housemaids of nurses—that would be waste of means; but I have seen surgical sisters, women whose hands were worth to them two or three guineas a week, down on their knees, scouring a room or hut, because they thought it was not fit for their patients; these women had the true nurse spirit." Offensive odours are sometimes dealt with by sprinkling a little liquid chloride of lime on the floor. Fumigation by burning pastilles is also a common expedient for the purification of the sick-room. Both of these methods are useful, but only in the sense hinted at by the medical lecturer, who commenced his lecture thus: "Fumigations, gentlemen, are of essential importance; they make so abominable a smell, that they compel you to open the windows, and admit fresh air." In this sense they are useful, but unless the cause of the offence is at once removed and fresh air admitted, fumigations and sprinklings are perhaps worse than ineffectual, as they conceal a source of danger.
The sick-room should be perfectly quiet in all dangerous illnesses: talking, gossiping, and, above all, whispering, should not be allowed. Whispering, indeed, is absolute cruelty to the patient; he thinks his complaint the subject, and strains his ear painfully to catch the sound. When it is necessary to speak, do so distinctly and clearly, so that the patient may hear what is said. It is not advisable to speak of him or his case, but avoid all appearance of mystery. Avoid rustling dresses and creaking shoes; where the carpets are taken up the nurse should wear shoes of list, or some other noiseless material, and her dress should be of soft texture that does not rustle. Instead of a coal-scuttle a basket should be used, filled with convenient sized coals that can be put upon the fire with tongs, while a stick might take the place of a poker, and thus save a great deal of noise when it is necessary to make up the fire.
If there are any superfluous articles of furniture, boxes, etc., in the room, take them away at once, and let the sick-room be as free as possible, so that its cleansing and sweeping will occupy less time. In the case of an infectious disease, move things only into an unused room, where they can be disinfected later on.
An extra room adjoining the sick-room is invaluable to a good nurse, for here, if it be warm weather, she can, when necessary, have a fire, can air linen, wash up any plates, glasses, etc., and do a hundred and one little duties she would otherwise be compelled to perform in the sick-room, thus saving much disturbance to the patient, and keeping the sick-room as it should be kept, free from noise or litter of any sort.
Never let the patient be waked out of his first sleep by noise, nor roused by anything like a surprise. Always sit in the apartment so that the patient has you in view, and is not under the necessity of turning to speak to you. Never keep a patient standing; never speak to one while he is moving. Never lean on the sick-bed, and prevent all noises over-head. Above all, be calm and decisive with the patient.
The sick-bed.—A careful nurse, when a patient leaves his bed, will open the sheets wide, and throw them back, so as to thoroughly air the bed. She will avoid drying or airing anything damp in the sick-room. A small bed, or rather a narrow one, is best for an invalid, for if he has to be moved it is far easier for the nurse to manage it than on a wide one. A hair or wool mattress is better than a feather bed.
Changing Sheets.—There are several ways of changing sheets, but perhaps there is no more simple and easy way than that of rolling up the dirty sheet lengthways in a narrow roll till it reaches the side of the patient, treating the clean sheet in the same way, that is, rolling it half-way across, leaving enough unrolled to replace the portion of the dirty sheet that has been folded. Place the clean roll by the side of the dirty one, in the manner shown in the illustration, and a very little shifting will take the patient over them, when the dirty sheet can be withdrawn and the clean one unrolled and spread in its place.
Under-sheets for a sick-bed should be small ones, only just large enough to tuck in at the sides, and should never be wound round the bolster.
A very hard pillow should be used as a foundation when it is necessary to make a pile for the patient to sit up in bed, as in cases of bronchitis.
For a helpless patient a draw-sheet is often needed, which may be made by folding a large sheet lengthways to about a yard wide. This should be laid across the middle of the bed over a mackintosh, with one end reaching only to the side of the bed, and the surplus at the other formed into a roll that can be unwound as the sheet is drawn from the other side. Be most careful to have this draw-sheet so firmly fixed with safety-pins or by being tucked under the mattress that it will not ruck or crease, and so cause great discomfort, if not pain, to the patient.
Fresh smooth sheets and cool pillows afford great comfort to most invalids, and a good nurse will be on the watch for opportunities of replacing a pillow and changing or smoothing a sheet when these offices can be performed without inconveniencing or disturbing her patient.
Invalid's Food.—"Patients," says a distinguished nurse, "are sometimes starved in the midst of plenty, from want of attention to the ways which alone make it possible for them to take food. A spoonful of beef-tea, or arrowroot and wine, or some other light nourishing diet, should be given constantly, for the patient's stomach will reject large supplies. In very weak patients there is often a nervous difficulty in swallowing, which is much increased if food is not ready and presented at the moment when it is wanted: the nurse should be able to discriminate, and know when this moment is approaching."
Never bring a large plateful to an invalid; let it be, if anything, rather less than more than you think he will take; a little can easily be added, but the sight of much food will sometimes prevent a patient taking any.
The diet suitable for patients will depend, in some degree, on their natural likes and dislikes (which the nurse should of course ascertain), and still more on the nature of the disease. Beef-tea is useful and relishing, but possesses little actual nourishment; when evaporated, it presents a teaspoonful of solid meat to a pint of water. Eggs are not equivalent to the same weight of meat. Arrowroot is less nourishing than flour. Butter is the lightest and most digestive kind of fat. Cream, in some diseases, cannot be replaced. Observation is, however, the nurse's best guide, and the patient's appetite the rule. Half a pint of milk is equal to a quarter of a pound of meat. Tea and coffee are both too much excluded from the sick-room.
Food must not be kept in the sick-room, since it is deteriorated by the air there; the continual presence of food, besides, is highly objectionable to a patient, being likely to destroy what little appetite he has. In no cases should food removed from the sick-room be consumed by other members of the family. It should be thrown away at once or burnt.
A nurse's dress should be of some washing material that neither rustles nor crackles; her shoes should be soft ones that do not creak; her sleeves should be loose enough to roll back, and she should have a plentiful supply of large white aprons. A professional nurse would wear a neat white cap. Suffering people, are apt to be impressed by trifles, such as a black dress having a gloomy look, while a bright one has a cheering effect, and every one prefers to see a pretty pink cotton gown, for example, in a sick-room, than a sombre, black-looking one. The print is not only pleasanter to the eye; it has the additional advantage of not being so liable to convey infection as a stuff gown.
Doctor's orders are never disregarded by a nurse worthy of the name. Should she by watching the case think any other treatment or diet would be beneficial to the patient, she should not act upon her own opinion, but state it to the doctor. She should always report to him any change she observes in the patient, which she should be watchful to detect. Such hearty co-operation is of incalculable help to a medical man.
Convalescence.—In this stage the patient is often more difficult to manage than when seriously ill; he is more wayward and fanciful, more easily put out, and more easily impressed by his surroundings. The room should be kept as bright and pretty as possible; he should be tempted to eat what is best for him, and firmly refused whatever might be detrimental. Anything that can be done to while away the long hours of weakness should be tried, whether it be reading aloud, or by the nurse engaging herself with some occupation that it would be pleasant for the invalid to watch. In some of the rooms of a suburban hospital looking-glasses are so fixed that patients in upper rooms have a view of the lovely garden, and can, without moving and without any glare, lie and watch the waving trees and flowers below. In cases of long illness, this might give great pleasure to sufferers incapable of being moved.
Recipes for the Sick-Nurse
ADMINISTERING MEDICINE
Although medicine is given by medical advice, and at the time the doctor orders it, as a rule, it sometimes happens that a bottle sent has only indefinite directions, such as "A dessertspoonful twice daily," or " A wineglassful every 4 hours"; and when the nurse is an amateur the best times to administer may not be known. Medicine which has to be taken at intervals during the day should be given first at ten o'clock in the morning; if only once during the day, then at nine in the morning or at bedtime; if twice, at ten and four.
It is always safest to have a medicine-glass marked with the different measures, for the size of the spoons may considerably vary in different households; and it cannot be too firmly impressed upon the nurse, whether professional or amateur, that regularity and exactitude in the administration of medicine are absolutely essential, the only deviation from the time fixed for it being made when the patient happens to be asleep at the specified hour.
In administering castor-oil it is best to wet the glass thoroughly first with water or lemon- juice, since this prevents the oil sticking to the sides of the glass and the patient's lips. A little brandy is often poured on the surface of the oil.
BRAN POULTICE
Place the quantity of bran required, according to the size of the poultice, upon the top of boiling water, and when the heat has penetrated the bran, stir it gently in. Pour off the superfluous water, spread the bran thickly on a piece of clean old linen or calico, and apply the poultice as hot as it can be borne. A layer of fine muslin should intervene between it and the skin. The poultice must not be in a sloppy state.
BREAD POULTICE
Boil about ¼ of a pint of water in a small, clean, lined saucepan. Into this put 2 ozs. of stale bread without crust, and let it soak for a few minutes. Pour off, and lightly press out the superfluous, water, spread the pulp thickly between two pieces of muslin or clean old linen, and apply hot, with one or two thicknesses of clean old rag outside to keep the heat in.
BREAD POULTICE (Another Recipe)
Cut a slice of crumb of bread the size required out of a stale loaf, put it in a warmed basin, and pour boiling water over it; leave it for a few minutes, covered with a plate, to soak. Then drain off all the water, spread the poultice on a piece of soft linen rag, and apply it as hot as it can be borne. It is much neater and generally as efficacious to wrap the poultice up in fine muslin, so that the bread does not adhere to the skin, and the whole may be removed without any mess. Rag must be placed outside in either case, to keep the heat in.
BREAD-AND-WATER POULTICE (Abernethey's Plan)
First scald out a basin; then, having put in some boiling water, throw in coarsely-crumbled bread, and cover it with a plate. When the bread has soaked up as much water as it will imbibe, drain off the remaining water, and a light pulp will be left. Spread this a third of an inch thick on folded linen, and apply it when of the temperature of a warm bath. To preserve it moist, occasionally drop warm water on it.
LINSEED-MEAL POULTICE
A linseed poultice being always needed hot, care should be taken that it is made so. Put the meal into the oven to heat for a quarter of an hour, and scald out with boiling water the basin in which it is to be mixed. Have also in readiness 2 plates in the oven, and a piece of tow, pulled to shape, or a portion of old linen, upon which to spread the poultice. Into the basin put as much linseed as will be required, and pour on boiling water, stirring vigorously with a knife, until the mass is of the consistency of thick porridge. Then turn the contents of the basin out upon the tow or linen, spread the linseed to an even thickness, and turn the edges of the tow or linen in as quickly as possible. Roll your poultice up and place it between the 2 hot plates to carry to the patient. Having put it on the patient, cover it with cotton wool or flannel to retain the heat as long as possible.
MUSTARD POULTICE.
This most useful application is made in a variety of ways. The simplest, the cleanest, and most efficacious for ordinary purposes, we believe to be the following: Take a piece of soft flannel, dip it in boiling water, wring it out immediately, and sprinkle one side of it with fresh flour of mustard. The flannel should be laid upon a hot plate while being sprinkled, that no warmth may be lost. Another way of making a mustard poultice is by spreading a large tablespoonful of mustard, made in the ordinary way as if for table, on a piece of soft linen, and warming it before the fire when it is to be applied. A third, and better plan if warmth be needed, is to make a common linseed or bread poultice and stir into it a tablespoonful of mustard, either fresh or mixed. It is generally desirable, with poultices made on either of the last two plans, to place a piece of fine old muslin or gauze between the poultice and the skin.
MUSTARD-AND-LINSEED POULTICE
Mix equal parts of dry mustard and linseed-meal in warm vinegar. When the poultice is wanted weak, warm water may be used instead of the vinegar; and when it is required very strong, only a very little of the linseed-meal must be added to the mustard. Apply in the ordinary way.
FOMENTATIONS
A fomentation is an external application of a hot fluid, generally by means of a flannel, to some affected internal organ such as the throat, or to the muscles round a joint, with the object of procuring relief of pain by exciting a greater flow of blood to the skin covering the affected part. What the hot bath is to the whole body, indeed, the fomentation is to a part. The swelling which accompanies inflammation is rendered much less painful by fomentation, owing to the greater readiness with which the skin yields than when it is harsh and dry. As the real agent of relief is the heat, the fomentation should be as hot as it can comfortably be borne, and to insure effect should be repeated every hour. Fomentations are of various kinds: emollient, when an infusion of mallows is required; sedative, when poppy-heads are used; but the most simple and often times the most useful that can be employed is "hot water," applied by a flannel.
HOT-WATER FOMENTATION
BORACIC FOMENTATIONS
May be made with boracic lint; that is, lint impregnated with boracic acid. A piece of this lint, of suitable size, is wrapped in a cloth and wrung out in boiling water. It is then applied to the part, and covered with protective wool, and a bandage.
Boracic fomentations should always be used in preference to bread or linseed poultices in cases of poisoned fingers, whitlows, abscesses, boils, etc. They do not retain the heat quite so long, but on the other hand are much cleaner than poultices, which become very offensive if the skin breaks or discharge is present.
BOROGLYCERIDE FOMENTATIONS
Are made by wringing out ordinary lint in a solution composed of 1 teaspoonful of boroglyceride to 1 pint of boiling water. Apply as above.
SANITAS FOMENTATIONS
Are sometimes used. They are prepared in the same way, viz., 1 teaspoonful of Sanitas to 1 pint of boiling water. Wring out the lint and apply in usual way.
OINTMENTS FOR CHAPPED HANDS
Ingredients.—1 oz. of bitter almonds, oil of sweet almonds, the yolk of 1 egg, and a little tincture of benzoin; 10 drops of oil of caraway.
Mode.—Blanch the almonds, beat them to a paste by working in gradually the oil of sweet almonds and the egg, then add the benzoin and oil of caraway, and beat till the ointment is of the consistency of thick cream. Before going to bed, the hands should be well washed with soap and warm soft water, thoroughly dried with a soft cloth, and the ointment then rubbed well into them. It is desirable to keep the hands covered with a pair of soft kid gloves while the ointment is upon them.
Another ointment can be made with Goulard's extract, 1 fluid drachm; rose-water, 1 fluid oz.; spermaceti ointment, 2 ozs. Melt the ointment, and rub it up with the extract of Goulard mixed with the rose-water. Apply in the same way.
LINIMENT FOR UNBROKEN CHILBLAINS
Ingredients.—1 teaspoonful of flour of mustard, half a pint of spirits of turpentine.
Mode.—Infuse the mustard in the turpentine, shake it well during twenty-four hours; then strain it off quite clean through muslin. Apply the clear liquid to the chilblains and rub it well in.
LOTION OF VINEGAR
One part of vinegar to three of water is a commonly-used lotion for sponging invalids. Equal parts of vinegar and water may be usefully employed for bruises.
EVAPORATING LOTION
Sal-ammoniac, ½ an ounce; vinegar, 5 ozs.; rectified spirit, 5 ozs.; water, a pint. Mix together. This is a useful application in sprains and bruises, and also for the head in cases of inflammation of the brain. Rags steeped in the lotion should be kept constantly applied,
ARNICA LOTION
Tincture of arnica, in the proportion of a teaspoonful to 2 ozs. of water, is a useful application in sprains and contusions.
ANODYNE LOTION
Mix 1 oz. of soap liniment, ½ an oz. of laudanum, and 8 ozs. of water together. This forms a useful soothing application to an inflamed and painful part, but care must be taken to see that the skin is not broken.
Another.—Take 2 drachms of sugar of lead, 1 oz. of laudanum, and 8 ozs. of water; mix them together and apply to the painful part.
STIMULATING LOTION
1 oz. of compound camphor liniment, mixed with 1 oz. of soap liniment, may be rubbed upon the chest with the hand in cases of chest cold, or applied on a flannel round the throat in quinsy,
COLD CREAM UNGUENT
(Used as a Mild Unguent to Soften the Skin, Prevent Chaps, etc.')
Ingredients.—2 ozs. of spermaceti, ¼ of an oz. of virgin wax, ¼ of a pint of oil of sweet almonds, ½ a pint of rose-water.
Mode.—Dissolve the spermaceti, wax and oil of sweet almonds by steam, then beat them till quite cold in half a pint of rose-water.
TO MAKE COLD CREAM
A very simple way of making this is to put 1 lb. of lard in a basin and fill up with boiling water. When cold, and the lard has risen to the top, take it off and repeat the process. When again cold, whisk it up with a paper knife until it becomes a perfectly smooth cream, then add enough essence of lemon to give it perfume.
TO MAKE COURT PLASTER
Make a strong jelly with isinglass by putting it into warm water to soak for three days, evaporating the water, dissolving the results in spirits of wine, and then straining. Stretch a piece of thin black silk upon a frame (a work-frame answers well for this) making it perfectly tight, then melt the jelly and coat the silk with it thinly. Repeat the coating when it has cooled, then give the plaster two coats of balsam of Peru in the same way.
CAMPHORATED SPIRITS OF WINE
(Useful as an Embrocation for Sprains, Rheumatism, Chilblains, etc.")
Dissolve 1 oz. of camphor in ½ a pint of rectified spirits of wine. Keep well corked down.
TO TREAT A CUT
To promote rapid healing the essential thing is to make the wound and surrounding skin absolutely clean by washing thoroughly with pure soap and hot water. When clean, rinse in fresh water and carbolic lotion (carbolic acid 2 teaspoonfuls; water 1 tumblerful), if available. Then apply a firm bandage of clean old linen rag. If the bleeding from a cut is profuse, a few turns of bandage firmly applied over the bleeding part will stop it until medical assistance arrives.
TO CURE A COLD
(A most Efficacious and Simple Remedy for a Severe Cold in the Head)
Take a small basin, put into it boiling water and strong camphorated spirit, in the proportion of 1 teaspoonful of spirit to ½ a pint of water. Wring out a sponge in this as hot as possible, and apply it to the nose and mouth; draw in the steam with the nose first and then with the mouth; swallow the steam, and, to prevent any escape, cover the head with a flannel. Continue this treatment for several minutes, having another hot sponge ready when the first gets cool. Sponges so wrung out in the same mixture may with great benefit be applied outwards to the throat and chest.
Camphorated sal-volatile is a good medicine for a cold, 30 drops in a wineglass of warm water several times in the course of the day.
TO APPLY A BLISTER
Wash the skin with soap and water, warm the blister at the fire and lay it on, leaving it there for seven hours or more till it rises. Snip the bladder then formed with sharp-pointed scissors to let the water out, then dress with ointment spread upon lint. The ointment should always be spread on the smooth surface of the lint.
TO APPLY LEECHES
TO TREAT A SCALD OR BURN
Before a doctor can be summoned it is always necessary to do something to allay the dreadful pain caused by either of these accidents. The clothing will have to be first most carefully removed, being cut away if necessary. A solution of carbonate of soda has a very soothing effect, if applied with a linen rag, continually moistened. Ice broken up and mixed with lard, if renewed directly the ice melts, will also greatly allay the pain from burns. A slight burn can be treated at once by rubbing soft soap well in, after which it may be oiled with carron oil (equal parts of olive-oil and lime-water), and floured. Cold water should be poured over a person when scalded before attempting to remove the clothing. Consult also "What to Do in Case of Accidents."
BANDAGING
We need only mention here a few simple bandages that could be applied by a non-professional nurse. Every one should know how to roll a bandage. The great knack of rolling it is to get it perfectly tight and even. The first few turns can be taken round a knitting needle, which should then be withdrawn. Nursing Illustration No. 1, figs, 1 and 2, show clearly how to do this.
In cases of broken bones send at once for the doctor, but pending his arrival do not move the patient unless splints have been applied to the injured part.
In applying a bandage to the legs of a rickety child, for instance, place the splints (a plain piece of wood wadded with wool) on the inside of the leg, the end projecting an inch or two below the foot, and pass the bandage (outer side against the skin), completely around splint and leg at the ankle, once; then simply wind it round and round upwards, and fasten with a safety pin. A bandage about 3 yards long and 2½ inches wide would be required for this purpose. (See Nursing Illustration No. 1, fig. 6.)
A bandage for a finger would be from half an inch to an inch wide. To apply it, one or two turns round the wrist should be taken first, from under to over, then the bandage should be brought along the back of the hand and wound spirally down the finger from the tip, wound down to the root, crossed over the back of the hand, passed twice round the wrist, and the two ends tied together. (See Nursing Illustration No. 1, figs. 3, 4 and 5.)
In bandaging a wrist, begin by placing the end in the palm of the hand; pass the roll over the thumb-joint, thence once completely around the hand above the thumb (thus holding the end firmly in position), then wind it closely up and up the wrist and arm, making reverses with the finger as the arm gets thicker.
TO PUT AN ARM IN A SLING
A ready sling for an injured arm can be made from a large handkerchief or neck muffler, by folding it into a triangle, passing it under the arm, and tying the two ends into a reefer knot at the back of the neck or on the shoulder. The apex of the triangle should then be brought around the elbow and pinned. (See Nursing Illustration No. 2, fig. 2.)
Care should be taken in arranging this or any sling that it gives the required support to the arm, and cannot slip or give way.
If the sling is to support the hand, the part of the triangle that goes in front of the hand should be passed over the shoulder on the side of the neck opposite to the injured limb. If it is intended to support the elbow (as in the case of a fractured collar bone), the reverse should be the case, the outer part of the sling passing over the shoulder on the same side as the elbow that is to be supported. The sling should always be arranged so that the hand is raised a little above the level of the elbow. (See Nursing Illustration No. 2, figs, 1, 2 and 3.)
TO PUT A BROKEN LEG INTO SPLINTS
In cases of emergency, umbrellas, walking sticks, or broom sticks make excellent splints. Tie one of these to the side of the limb by a handkerchief and bandage as shown in Nursing Illustration No. 2, fig. 4.
BANDAGES FOR THE HEAD
(See Nursing Illustration No. 3)
The bandage shown in fig. 1 is a simple head bandage, consisting of a couple of turns round the forehead and occiput, and to prevent these from slipping a turn under the chin is taken and the ends knotted over the place where pressure is required.
As an application for a simple fractured jaw the four-tailed bandage shown in fig. 2 is very efficient. All that is required is a strip of calico 4 inches wide and about 1 yard long; split each end into two, leaving about 7 inches in the middle of the bandage undivided, in the middle of which make a short longitudinal slit into which the point of the chin is placed. The two lower tails are tied on top of the head and the two upper ones are tied behind the back of the head. To prevent slipping the upper and lower tails are tied together.
The Capeline bandage shown in figs. 3 and 4 is very useful for keeping dressings on the head or for pressure on the scalp. Two bandages are knotted together and the knot placed just under the external occipital protuberance; they are then drawn round to the centre of the forehead and twisted on themselves, one being carried straight back over the top of the head, and the other continued round to the back of the head to fasten this one down. This is repeated till the entire scalp is covered.
Domestic Medicines
And the Illnesses and Complaints they should be used for
All drugs should be kept in bottles under lock and key, and should be properly stoppered and carefully labelled.
Alum (Dried).—This substance may be used with advantage in case of bleeding piles, leech bites or slight cuts. It should be freely dusted over the part after wiping it dry.
Arnica.—This is a useful application in sprains and bruises. The tincture should be freely brushed over the part 3 or 4 times a day by means of a camel-hair brush.
Borax.—This substance, either dissolved in water or mixed with glycerine or honey, is used in the treatment of the white mouth of infants (thrush), or the small ulcers that are often met with on the mucous surfaces of the lips and gums. It should be freely applied to ulcers with a feather or small brush. For thrush, dip a clean soft linen rag in it, and wipe the mouth out.
Camphorated Oil.—This is a useful application in chest colds, and chronic rheumatism in joints, or old sprains. It should be warmed at the fire or by placing the bottle in hot water, and then rubbed into the part with the hand for 15 to 20 minutes by the clock.
Castor-Oil.—This is a gentle but efficient purgative. Dose: 1 teaspoonful to children, 1 tablespoonful to adults. It is useful in cases of obstinate constipation, or where an indigestible article of diet is giving rise to griping pain.
Dill Water.—This is frequently given to children during teething, when they appear to suffer from flatulence, or are griped and uncomfortable. Dose: 1 teaspoonful to a child 1 year old.
Epsom Salts.—The dose for an adult is up to half an ounce. They should be taken the first thing in the morning with a warm drink afterwards. Epsom salts are useful in cases of lead-poisoning, or where it is desirable to increase the flow of bile, but are too violent in their action for habitual use in chronic constipation.
Ergot.—In the form of the liquid extract, this drug is useful in an eminent degree in cases of blood-spitting or flooding after confinement. For the former, it may be given in doses of 15 drops every 3 hours; for the latter, 1 teaspoonful, to be repeated in a quarter of an hour if necessary.
Gallic Acid.—This is useful in cases of spitting or vomiting of blood. Dose: 10 grains, with 15 drops of dilute aromatic sulphuric acid in water, for the blood-spitting, and alone in milk or water for vomiting of blood, every 3 or 4 hours.
Iodine.—The tincture of Iodine is very useful as a counter irritant and as a help to absorption in the case of chronic swellings. Painted on the gums, it will often relieve toothache; painted on swollen glands, it will help the swelling to disperse; painted on such swellings as water on the knee, it will help the water to become absorbed.
Ipecacuanha.—Given as powder, 20 grains at a time, it is a useful emetic in the case of adults; in children, in the form of wine, it is useful for the same purpose in doses of 1 teaspoonful in tepid water, repeated every quarter of an hour, and drinks of tepid water given between, and is often so administered in croup. In bronchitis and bronchial catarrh it may be given to children in doses of 2 to 5 drops every 3 hours on a lump of sugar, and a proportionately larger dose to adults.
Iron Alum.—This is a powerful astringent. It is useful in checking bleeding after extraction of teeth or in cases of bleeding from wounds. Wool moistened with a strong solution of the astringent should be applied to the bleeding part.
Laudanum.—This must be given with extreme caution. It should only be given to children under medical advice. In adults, it is useful for the relief of such pain as colic, when it may be given either with a dose of castor-oil, or with 15 drops of spirit of chloroform in water. The dose of laudanum for an adult is up to 20 drops, and the dose of spirit of chloroform may be increased to same amount. (For overdose, see previous section, "What to Do in Case of Accident.")
Lime-Water.—This is a useful preparation to give children with their milk when they are suffering from acidity or diarrhœa. A tablespoonful may be mixed with a wineglassful of milk. In cases of vomiting in adults it is also most useful mixed with milk.
Magnesia.—This may be given in doses of 20 or 30 grains, in a little milk or water, to an adult, or 5 to 12 grains to those under 12 years. It is very useful in acidity of the stomach.
Mustard.—A tablespoonful in a tumbler of tepid water is a useful emetic. Applied as a poultice or leaf to the chest, it is useful in bronchial colds.
Oil of Eucalyptus.—Derived from the Australian Blue Gum tree. It is a valuable disinfectant and deodorant, rivals quinine as a remedy for malarial fever, and as a sedative to the bronchial tubes is unrivalled. It may be taken internally on sugar, 3 to 5 drops occasionally for cough; it may be inhaled for bronchitis, or laryngitis, 10 drops in a jug of boiling water and the steam to be inhaled; it may be rubbed into the skin as a disinfectant in scarlet fever and other infectious diseases, made into an ointment with vaseline as a base; and it may be sprinkled lightly about a room as a deodorant.
Quinine.—This is an excellent tonic in cases of debility, and may be given in doses of 1 or 2 grains 3 times a day, dissolved in a little steel-drops or made into pills. It is useful in the same or larger doses in neuralgia, and the combination with steel-drops will materially assist. In ague, given in large doses—8 or 10 grains it is most useful. (It is also prepared in a more palatable form as Quinine Wine—quinine and orange wine. Dose: for an adult, as a tonic, 2 tablespoonfuls 3 times a day.)
Rhubarb.—This may be kept in powders in a stoppered bottle, each containing from 10 to 15 grains. One powder given with the same quantity of magnesia in a little water will act as a mild purgative in the case of an adult. It is useful in dyspepsia.
Spirits of Camphor.—Most useful in the case of a bad cold in the head. When first contracted 5 to 8 drops on a lump of sugar 2 or 3 times a day will give great relief and check the course of the cold; and the nasal congestion will be lessened by frequently inhaling the fumes through the nose.
Spirit of Sal-Volatile.—This is useful as a stimulant in fainting, hysteria, flatulent colic, and after a bite from a venomous animal. Dose: 1 teaspoonful in water, for an adult, which may be repeated in 2 or 3 hours.
Steel-Drops.—This is a useful preparation of iron, and may be given with advantage in cases of debility where there is anaemia or poverty of blood. Dose: 10 to 15 drops for an adult 3 times a day in water. It should be taken through a glass tube, and the teeth well brushed afterwards, as the iron has a tendency to blacken and destroy the enamel. In cases of erysipelas larger doses are required : 20 drops in 1 teaspoonful of glycerine mixed with water may be taken every 3 hours.
Sweet Spirit of Nitre.—This is useful in cases of fever, and also for kidney troubles. It should be given in doses of 10 to 40 drops, largely diluted with water, every 3 hours.