Home nursing--motherhood--care of children

Front matter

Class "R T~6 1

Rnnlc ,F & 9

Copyright^

Part I.— Home Nursing I.— Material And Spiritual Equipment Of The Home Nurse

Ethics of Nursing — What Room Should be Chosen — Care in Ventilation — Devices for Ventilation — Freeing the Invalid from Noise — Simple Furnishings in Sick Room?— Bedsteads — Mattresses — To Make a Sick Bed — Daily Care of Sick Room — Care of Utensils — How to Save Steps . . 7

II.— GENERAL CARE OF BED PATIENTS

Structure and Function of Skin — The Cold Bath— Frequency of Bathing in Sickness — The Bed-Bath — The Foot-Bath — Care of the Hair — Care of the Mouth — Changing Sheets for Bed Patients — Changing Night-Dress — Prevention of Bed-Sores — Lifting and Moving Patients — Mechanical Appliances ............. 23

III.— ENEMATA, SUPPOSITORIES, AND DOUCHES

Administration — The Laxative Enema — The Purgative Enema — The Nutritive Enema — The Starch Enema — The Turpentine Enema — Rectal Irrigation — Suppositories — Douches — Gargles, Sprays, and Inhalations — Care of Utensils ............. 42

IV.— OBSERVATION OF SYMPTOMS

Circulation — How to Take Pulse — Temperature — Use of Clinical Thermometer

— Respiration — Observation of Symptoms . . . . . -55

V.— INFLAMMATION, EXTERNAL APPLICATION, MEDICINES

Inflammation — Treatment — Dry Heat — Hot-Water Bags — Moist Heat — How to Make a Poultice — Fomentations — Cold Applications — Ice Coils — Counter-irritants — Massage — The Giving of Medicine — Hypodermic Injections — Care of Medicines ........... 69

VI.— CARE OF OPERATIVE CASES

Preparation for Operation — Emergency Preparation — Preparation of Patient — Full Preparation, for Operation — The Anaesthetic — Assisting the Surgeon — After-Care of Patient— The Problem of Food — Cases of Minor Surgery — Convalescence ........... 90

VII.— ACCIDENTS AND EMERGENCIES

Shock — Hemorrhage — Bleeding from Nose — Bleeding from Lungs — Fainting — Fractures — Dislocations — Contusions — Sprains — Chilblains — Frostbites — Toothache— Warts— Cuts — Burns and Scalds — Foreign Bodies — Sunstroke and Heat Exhaustion — Artificial Respiration— Insect Bites — Bites of Snakes and Rabid Animals — Poisons . . . . • • .no

2 CONTENTS

VIII.— INFECTION AND CONTAGION

Micro-Organisms and Disease — Transmission of Disease — The Protozoa — Disinfectants — Methods of Disinfection — Typhoid Fever — Erysipelas — Mala-' rial Fever — Dysentery . . . . . . . . . .131

IX.— INFECTIOUS DISEASES (CONTINUED)

Influenza — Pneumonia — Tuberculosis — Forms of the Disease — Heredity — Channels of Infection — General Precautions — Special Precautions for Attendants — Exercises Beneficial to Those with Tendency to Tuberculosis — Suggestions for Patients — Care of Patients — Cerebro-Spinal Meningitis . 150

X.— ACUTE AND NERVOUS DISEASES

Rheumatism — Tonsilitis — Bronchitis — Pleurisy — Appendicitis — Bright's Disease

— Neurasthenia — Hysteria — Epilepsy — Insanity . . . . . .166

Part Ii.— Motherhood I.— The Physiology And Hygiene Of Pregnancy

Indications of Pregnancy — Quickening — Dress — Need of Fresh Air — Exercise

— Food — Bathing — Sleep and Rest — Heredity . . . . . .185

II.— AILMENTS OF PREGNANCY

Nausea — Constipation — Increased Salivation — Varicose Veins and Hemorrhoids — Decay of Teeth — Palpitationi — Sciatica — Pruritus — Irritation of Bladder — Abdominal Bandage — The Physician — Midwives — Advice of Friends —

* Receipts for Special Diet ......... 201

III.— PREPARATIONS FOR CONFINEMENT

Preparations for the Mother — Baby's Wardrobe — List of Clothes — The Nursery Furnishings . . . . . . . . . . .218

IV— LABOR

Duration of Pregnancy— Preparations for Confinement — Stages of Labor — Contractions of the Uterus — Emergencies — After-Treatment of Mother — After- Treatment of Baby .......... 234

V— AFTER-CARE OF MOTHER AND CHILD

Rest — Dressings — Breasts — Diet — The Baby's Bath — The Cord-Dressing — Order of Dressing — Care of Eyes, Nose, Mouth, and Breast — Tub Baths — The Band — Feeding . . . . . . . . . . 245

VI.— ABORTION AND PREMATURE BIRTH

Abortion — Premature Birth — Care of Premature Baby — Gavage and Lavage —

Suppressing Milk — Milk-Leg — Inexorable Laws of Nature . . . 262

VII.— HABITS AND METHODS OF TRAINING

Law of Habit — Unwise Training — The Day's Routine — The Baby's Laundry —

Details of Bath — Naps — The Outing 276

LIST OF ILLUSTRATIONS

Part Iii.— Care Of Children L— Infant Feeding

Mother's Milk — Weaning — Cow's Milk — Modification of Milk — Prepared Foods

— Points to be Noted — Schedule for Feeding — Household Measures . . 293

II— DIETARIES

Digestion — Needs of the Child — Diet Lists from Eleven Months to Three Years and a Half — Sweets for Children — Family Breakfast — Family Dinner—Supper—The Child at Table 310

III.— SCHOOL CHILDREN— THEIR FOOD AND EXERCISE

Breakfasts — Luncheons — Physical Activities and Mental Development — Health

* IV.— POINTS ON HYGIENE

"Toughening" — Baths — The Teeth — Footwear — Dress ..... 336

V.— DISORDERS OF CHILDREN

Symptoms of Illness — Colic — Jaundice — Inflammation of the Eyes — Thrush — Diarrhoea — Constipation — Convulsions — Teething — Milk Crust — Eruptive Disorders — Hives — Prickly Heat — Ringworm — Croup — Rickets — St. Vitus's Dance ............. 349

VI.— CONTAGIOUS DISEASES

Mumps — Whooping-Cough — Measles — Chicken-Pox — Scarlet Fever — Necessary Precautions in Contagious Diseases — Scarlet Fever is Infectious — Diphtheria ............. 368

VII.— PROBLEMS OF PUBERTY

Development of the Child — Puberty — Instruction to the Child — Masturbation

— Menstruation — Bathing During Menstruation . . . . .381

LIST OF ILLUSTRATIONS

Glass Sputum Mug with Metal Cover

Metal Frame .

Paper Filler .

Invalid's Drinking Cup

Woven Wire Mat .

A Nursery Ice-Chest

Water Cooler

A Rubber Ring

Horseshoe Air-Cushion

Canvas and Wood Bed-Rest

34 34 38

LIST OF ILLUSTRATIONS

A Cradle to Lift the Clothes .

The Iron Standard Bed Table

The Wooden Leaf Bed Table

Trabaud Back Protector on Douche Pan

A Fountain Syringe

Hard Rubber Syringe

Rectal Tube with Return Flow

Douche Pan .

Glass Nozzle .

A Clinical Thermometer

Hot-Water Bag

A Stupe Wringer .

Rubber Ice-Bags .

Hypodermic Syringe of Glass and Asbestos

Room Hastily Prepared for Operation .

A Nightingale

Pocket Sputum Flask

Abdominal Bandage

A Meat Press

"Eureka" Bed-Pan .

"Perfection" Bed- Pan

Baby's Band .

Baby's Shirt .

Band

Skirt

Petticoat

Dress

White Enamel Bath-Tub for Baby

Rubber Tub ....

The Flannel Petticoat and Dress

Slipping on the Flannel Petticoat and Dress

Placing Baby in the Bath

Feeder for Premature Baby

The Murphy Bandage .

Bath Under the Blanket

"Hygeia" Nursing Bottle

A Graduated Glass

Stomach of Infant Five Days Old (Natural S

Glass Cylinder Showing the Capacity of the ize) Stomach

Part I Home Nursing Material And Spiritual Equipment Of The Home Nurse

Ethics of Nursing— What Room Should be Chosen— Care in Ventilation- Devices for Ventilation — Freeing the Invalid from Noise — Simple Furnishings in Sick Room — Bedsteads — Mattresses — To Make a Sick Bed — Daily Care of Sick Room — Care of Utensils — How to Save Steps

THE thought of accepting an invalid as a member of the household is always a trying one, and often brings consternation into otherwise quiet homes. Possibly a few suggestions may lighten the burden of such a situation, and encourage the mother, sister, or wife who is to act the part of nurse pro tern, and who needs to know something of the equipment, both material and spiritual, for such an undertaking.

The clean gingham dress of the hospital nurse, worn both winter and summer, is a familiar sight, and Dress of typifies that absolute cleanliness w 7 hich is both her i n g nurse personal and her professional characteristic. It is quite possible for the acting nurse also to don a cotton gown, which should be simple and easily laundered. Having once felt the comfort of such a working-dress she will hardly wish to return to the heavy woolen skirts so unsuitable for the sick-room.

We all recognize the absurdity of a nurse's going, as one once did, to take charge of a case and appearing before her patient arrayed in a pink silk waist, yet the same incongruity would not appear so great if one of the family, or a familiar friend who was serving in the capacity of nurse, were the offender. The principle, however, is quite the same in either case.

But far more important even than the matter of The f dress and quite within the possibility of every one, is care of the need of frequent bathing on the part of the nurse perso™ anc * proper attention to neatness in the details of her toilet — the clean, well-trimmed nails and hair carefully and simply arranged.

Deft hands, quick insight, a gentle bearing, good Blessed temper and a generous dash of humor are priceless

cli3.r3.ctci""

istics in a blessings in a sick-room, and may be cultivated in a sick-room vef y j ar g e measurej if their value is sufficiently appreciated. The nurse who pounds the pillow on the patient's bed or clumsily jars it every time she passes, who is ill-natured and unkempt, or who reveals by her manner that her work is arduous, is distinctly working against the recovery of her patient, though she may little realize the cost of her thoughtlessness.

ETHICS OF NURSING

It is no time when a person is sick to regale him The Gold- with grewsome or unpleasant tales; yet how often a en ue garrulous neighbor delights in the opportunity of setting forth some harrowing incident while, it may be, the distressed patient is too weak even to protest. The ethics of nursing is a large subject, but perhaps, after all, the practice of the Golden Rule is its simplest expression.

CHOICE OF A ROOM

As regards the chief features of importance in the

selection of a sick-room, namely, the securing of good

air, quiet, and plenty of sunshine, we must recognize

The room that there are many households where these conditions

best

adapted- can not be ideal. But wherever a choice is possible, the vaiid'T use room best adapted for an invalid's use should be selected even at the cost of some inconvenience to other members of the family, since comfortable and hygienic surroundings are a large factor in the recovery of a patient, and model conditions will be described, because the ideal must always be the standard toward which we progress.

An airy, spacious room, having a southern exposure and several windows, so that the sunlight can Having flood daily, and far enough removed from the noise conditions of the kitchen or front door to secure absolute quiet, affords the best possible conditions for a very ill patient.

VENTILATION

If once we heartily believed the truth that the body starves for lack of oxygen as it plainly does for lack of food, there would be no necessity for the protest against tightly closed and ill-ventilated rooms. The starvation for oxygen, it is true, is much more slow, and it may be years before one sees evidence of the depletion the body is undergoing in cases where the supply is insufficient, whereas the daily demand for food is a crying one that can not be overlooked.

In spite of our ignorant efforts to keep out the fresh The body's air, enough oxygen sifts in through the cracks of oxygen doors and windows to satisfy, in a small measure, the demands of the body, and thus relieve the feeling of suffocation which is the most urgent call of the organism to supply its need. If this were not so, the suffering would be such that one could not tolerate the

conditions. As proof of the impoverishment that ex- Proof of ists under bad conditions, one has only to .cite the physical effects upon the system observed after a night spent in a closed room — the dull head, lack of appetite, lassitude, and general depression — and compare this, if one has ever experienced it, with the feeling of exuberance and delight in nature felt after a night spent in the open air. It is when disease comes, hcwever, in sick- that the real difference between the well and the illnourished body is most apparent. Not infrequently people who have never known sickness, but who have all their lives disregarded the laws of health in respect to ventilation and whose bodies have lived on a meagre supply of oxygen, are not able to resist the approach of disease.

For the sick-room, low windows admitting an abundance of fresh air and sunshine are much needed, while the addition of a balcony opening out provides attractively for the convalescent days, both in summer and winter.

Open win- Window-boxes help to make the chamber cheerful, in^iid° r and are in no way objectionable; but plants filling a side boxes wni dow and shutting out the sunshine should be confor plants demned.

If the window is arranged to lower from the top — and all windows should properly be so arranged, since the foul air of a room has a tendency to rise — ventilation in cold weather is made easy. By reversing the position of the sashes, a current of air escapes in the centre between the unevenly fitting framework. But Good better still for use in the winter, is a board four or five of et ve°n- S inches wide and perhaps an inch thick, just long tiiation enough to fit the window if slipped under the lower sash. This method provides a larger current of air in the centre between the sashes, and in either case there is no draught possible. Another device is to fasten a piece of cloth across the lower part of the window from side to side, so that the air can not blow directly into the room when the bottom sash is raised.

The use of small screens will not be forgotten, and often one may be improvised by means of a clothes-horse and a couple of sheets or light shawls. A high- The use

, , , , , , - of screens

back chair may also serve the same purpose, and for a baby's crib an open umbrella does very well if nothing better is at hand to protect against the draught.

A fireplace provides another means of ventilation besides adding greatly to the charm of the room.

Ventilation is generally a possibility in any sick-room, but absolute quiet is not so easily secured, and on this account certain cases must be sent to the hospital.

It must be borne in mind that when the doctor advises the hospital it does not necessarily mean the des- what peration of the case, but very possibly that the in- a hospital creased facilities for the proper care of the patient imv ieb which the hospital affords are demanded in order to hasten recovery.

NOISE

There are some devices by means of which an invalid may be spared the irritation of trifling noises and the sharp, sudden sounds always much more annoying than the dull, continuous rumble of the street or the general stir about the household. A creaking door-hinge can be oiled, even if one has nothing but How to vaseline with which to do it, and on the door of the l^noiiel" sick-room, which must be frequently unlatched, a in horne

- 1 J nursing

small towel may be twisted from one handle to the other to prevent its closing tightly, or a rug be pulled across the threshold to serve the same purpose.

Windows which rattle can be made secure by the aid of a few pegs whittled from burnt matches, and Devices should be attended to before the patient is settled for the night. If a dripping faucet can not be turned off, a cloth may be tied over it, and the loose, creaking boards in the floor may become such familiar spots to the thoughtful nurse that she almost unconsciously avoids them. If a grate fire or stove is in the room, the care of it may be made far less trying to the nerves of the sick one if the coal is placed in a large paper and laid on the fire when replenishing it, instead of being shoveled in the usual way. A wooden poker can be substituted for an iron one, and large clinkers removed with the hand instead of turning them down with the ashes when a new fire is to be built.

Whispering is always exasperating to a sick per- The tone son, and whatever conversation is necessary in the voice room or immediately outside the door should be

carried on in low, quiet tones, but never in a stage whisper. One's manner of addressing a patient should be considerate, particularly if he is very ill. He should never be startled by loud or abrupt tones from behind, but having first gained his attention speak distinctly but with quiet voice. These suggestions Hints for are scarcely necessary to one who has had experience perienced with sick people, but to the uninitiated, particularly if she be young and vigorous, without "nerves" herself, they may possibly be of value, as it is a most difficult thing to realize exactly how an ill person craves the relief from noise and confusion or appreciates any effort to minimize such for him.

FURNISHINGS OF THE SICK-ROOM

As to the furnishings of the sick-room, the No fumi- greatest simplicity is required both from the hygienic essentials and from the aesthetic standpoints. The sleepingroom, even in health, should be a place free from the unnecessary adornment of heavy hangings and Crowded bric-a-brac, gathering millions of microbes which elude the most careful housewife. If possible, let the walls be painted some neutral tint restful to the eye, so that they may be easily cleaned, and have no more furniture in the room than is absolutely necessary for use. A bed, table, easy-chair, lounge, and screen constitute the essential furniture. A hardwood floor is best, but if it is necessary to carpet, straw matting is better than wool, and can be found in very attractive styles. Lightweight rugs that can be taken out and shaken every day may be used on the hardwood floor.

A set-bowl in any bedroom is always objectionable, and is not to be tolerated if the modern method Avoid bad of open plumbing has not been adopted. The constant escape of poisonous gases by means of leaky traps is something that should be guarded against at all costs. But it is a simple matter, fortunately, to cover or plug up the escape holes, and water may be kept standing in the bowl if the bedroom is so equipped, though the better plan, of course, is to remove all plumbing to an adjacent room not used for sleeping.

The most suitable bedstead for a sick-room is readily admitted to be the single or three-quarter The bed size iron frame with double woven wire mattress and position having a height of two or two and a half feet. This frame painted white can be easily and thoroughly cleaned, and its height makes it convenient for lifting and moving a patient. It should stand in the room in such a position that the patient does not directly face the light from any window, and also so as to be easily accessible from both sides.

In spite of the supposition that the feather bed Never a has been relegated to the garret- or made over into bed pillows, it is still necessary to emphasize the fact that it is wholly unsuitable for an invalid's use. It is quite impossible to take proper care of a patient unless this is discarded. It retains the heat of the body, and if it becomes damp is an offence, if not a positive menace. It is also very difficult to lift a person from side to side as he lies in the hollow.

The hair mattress is, of course, the most satisfactory bed, yet some patients complain of the tuftings, and it must be admitted that if the strings give way the hair may move and cause irregularities in the surface of the bed. The mattress manufactured Mattress by the American Interlaced Curled Hair Company tuftings of Philadelphia, Pa., is especially sanitary, and as the hair is in sheets it requires no tufting and is easily kept in order. The ticking can be slipped off and washed, and as the interior itself is very porous it is cooler and can be more easily cleansed and fumigated than any other mattress more compactly made. In The value cases of long illness a second bed is of great value, beds and by bringing both beds close together the patient

can be drawn on a blanket or stout sheet from one mattress to the other and the mattress thoroughly aired on a balcony or in another room every day. A mattress turned once a day does not readily get out of shape, but in case it begins to sag, a light shawl or blanket folded not too thick can be placed under the centre to keep it level. 'Mattresses should Care occasionally be wiped over with a cloth wet in some

mattress antiseptic solution and put out of doors to dry. A whisk-broom may be used instead of the cloth if preferred and the mattress thoroughly sprinkled with the solution.

PREPARATION OF A SICK-BED

To prepare a sick-bed, place first a stout pad to cover the centre of the mattress, and over this, drawn Th f P a f

' and under

tightly and evenly, the bottom sheet, which should be sheet neatly tucked in at the corners. Next should always come a protector of some sort large enough to extend from the edge of the pillow to within two feet of the bottom of the bed. This protector may be of black or white rubber, enamel cloth (which, however, cracks easily), or sheets of tar paper folded' between newspapers, if rubber is not obtainable or if the patient has serious objection to its use on account of its heat. In cases where there is no immediate cause _

The pro-

for the rubber sheet it may be placed next to the tector and mattress, and thus serve to protect it in case of any accident occurring.

The rubber sheet is to be covered by what is known in hospital phraseology as the "draw-sheet," an ordinary-sized sheet folded with two hems together, though, if desired, a single piece of cotton of the width of the doubled sheet would answer the purpose quite well and be somewhat more easily laundered. This is put on so that the hemmed edges come at the bottom and the other edge high enough under the pillow to prevent the possibility of a restless patient getting the elbow under it. It should be tucked in at one edge evenly and then drawn as tight Care as possible from the other side, pulling always at the draw sheet centre first, and, after tucking that in, making smooth the rest of the side. In tucking in the draw-sheet with a patient in bed, this method of procedure is essential if the sheet is to be made tight. The patient, if able, should lift the hips slightly while the sheet is being tightened.

A draw-sheet properly put on ought to add much to a patient's comfort, as it ensures a smooth, firm surface underneath the back and it can be changed so easily that the patient need have no sense of fatigue while it is being done.

The covering for the bed ought always to be light, Blankets but sufficiently warm, and the top sheet should fold than quilts over the edge of the blankets to keep them from becoming soiled. Blankets, or even lightweight shawls, if one is reduced to an extremity, are far better than bedquilts of any sort, and two light blankets are warmer than one very heavy one, because of the layer of air between them which acts as an additional covering. The coverlet, if heavy, may be replaced by a sheet, though dimity is being sold now in place of the Marseilles or other heavier materials. At night it should be removed and folded neatly to keep it fresh for day use. In tucking in the clothes at the bottom of the bed, they ought not to be drawn tightly over a patient's toes, a fact which some nurses, overzealous for appearance, are apt to forget. In some cases where there is extreme Comfort nervousness or where the feet are particularly sensifirst P : at a p nt tive to any irritation, it is better not to have the pearance c i thes tucked in at all at the bottom. The comfort

second

of the patient should never be sacrificed in order to gain a better appearance of the bed.

DAILY CARE OF ROOM

The daily care of the sick-room is most important. The room should at all times present a tidy and restful appearance. If the weather is cold a light shawl may be thrown over the -patient's head and extra covering provided so that the apartment may be thoroughly aired. This should be done both night and morning for a few minutes, and in cases Frequent where the air becomes offensive it should be done several times during the day.

If there is a carpet on the floor the surface dust can be removed by going over it lightly with a damp To clean cloth wound round a broom. No thorough sweeping ^ c * t r c should be attempted with the patient in the room. A damp dust-cloth is also to be used for the furniture, so that as little dust is stirred up as possible. Soiled dishes and remnants of food should never be allowed to stand in the room, but should be removed at once after the patient has eaten. Frequently he will insist that it does not matter, or will even object ness tX atid to tidiness, but there is an unconscious feeling of rest orderliness that is engendered through orderliness of which he is himself quite unaware, and this should not be denied him. A little tact or playful insistence will usually remedy any objection on his part. The same thing is true in regard to the serving of meals to a convalescent or to some member of the family who is temporarily kept in bed and who thinks to save work by urging that he does not care how things are served. He may be quite honest in his feeling, and yet find that the dainty service tempts his appetite so that he is able to eat a far better meal than otherwise.

The necessary medicines, mouth-wash, pitcher of water, and all the paraphernalia of the sick may stand on a small table or shelf, placed if possible out of sight of the patient, as it is pleasanter to have all the reminders of sickness removed. A clean towel on the table looks more suitable than an elaborate table-cover, and a fresh sheet of white wrappingpaper laid over that saves laundry and may be changed every day or two as necessary.

If the patient is able to be moved into another

In case room there should be a weekly cleaning of the sick-

cieaning y room, with thorough sweeping, cleaning of brasses,

beating of mattress and airing of blankets, since

fresh air has germ-destroying powers that may be

utilized by every one.

Large and small squares of cloth are needed for Of the various purposes about the sick-room, and can easily squared be. made and kept on hand for use when required, of cloth There should be several bed-pan covers, made of heavy cloth or doubled thicknesses of old sheeting, furnished with loops to hang by, and separate smaller cloths for wiping the bed-pan and the wash-bowl. It is convenient to have these latter of different size or of figured cotton, so that they can be readily distinguished from each other. Pieces of old sheets or toweling can be cut into convenient sizes and hemmed to slip under the bed-pan when it is used, and a quantity of small pieces of old cotton torn into squares of about six inches will be found useful for the necessary bathing after the bed-pan has been used. Absorbent cotton can of course be used for the same purpose, but is more expensive.

GARE OF UTENSILS

The care of the utensils in use about the sick-room must not be overlooked. The utmost cleanliness is necessary in regard to them. Bed-pans and urinals should be rinsed each time after their use with cold water, and then washed with scalding water and soap and dried with a cloth kept for the purpose. A weekly scouring with sapolio is necessary if the use of the pan continues many weeks. Sputum mugs should be boiled every day for twenty minutes, and a small pan kept expressly for this use.

In preparing a mug for a tuberculosis or pneumonia case one should be selected which is smoothlv Special glazed so that no germs may lodge in any crack. If sputum this is neatly lined with toilet-paper, letting the paper mug entirely cover the edge and fold down over the out-

Glass Sputum Mug with Metal Cover

side of the cup, the lining can be very easily lifted out and burned and a fresh lining made. It is best to have two mugs, so that one may be in use while the other is being sterilized. A very useful cover can be made by cutting out a piece of cardboard the size

Metal Frame

Paper Filler of the cup and putting a large safety-pin through the centre for a handle.

Excellent appliances for the use of tuberculosis patients are made, consisting of a papier-mache form which is inserted in a covered metal holder.