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Hygiene of the Nursery.

Chapter X.

Emergencies.

 

In the first Chapter, attention was directed to certain deviations from the features of health that should lead the mother or nurse to suspect the onset of disease. In addition to these, it is of great service to take into account the four seasons of the year, and to be informed of what diseases are most apt to prevail during each.

In the late fall and early winter catarrhal affections are most apt to occur. In catarrh there is an increased secretion of mucus from the lining membrane of either the nose, the throat, the air-tubes or the digestive canal, attended by fever, loss of appetite, thirst and lassitude, with sneezing, horseness, cough, vomiting or diarrhoea, according to the situation of the disease.

As winter advances, the bronchial tubes, the lungs themselves and their investing membranes -- the pleurae -- are liable to attack, and the signs of bronchitis, pneumonia or pleurisy to bedeveloped.

In the changeable weather of spring, together with the catarrhal and inflammatory disorders already mentioned, epidemics of measles, scarlet fever and chicken pox are most prevalent; while during the summer months, disorders of the bowels, such as diarrhoea, summer complaint and cholera infantum, swell the mortality lists of the larger cities.

Again, the influence of any hereditary tendency to disease should always be present in the mother's mind, as this not only makes her alive to the possibility of the onset of illness and leads her to seek medical advice in time, but also induces her to shield anxiously her child from known exciting causes, and to adopt hygienic measures calculated to overcome the constitutional predisposition.

In considering the question of emergencies, under which term will be included both accidents and certain conditions of disease, no reference will be made to the management of serious disorders. These, even in their earliest stages, must receive the attention of a physician.

Accidents and Disorders Occurring at Birth or Soon After.

Injuries Received During Birth.

The shape of the head is sometimes altered by the compression it is subjected to during a prolonged and difficult labor. The deformity is usually in the direction of elongation. The distance from the chin to the back of the head at times measuring six inches or even more. There is no ground for apprehension in these cases, and the head will regain its natural shape without mechanical interference.

Swellings upon the scalp are quite common. They are due to pressure sustained by the parts in labor. Such tumors gradually subside, if kept free from compression and frequently bathed with cooling lotions; of the latter, alcohol and water, the extract of witch-hazel and water, or diluted lead water or serviceable.

The face may be congested and blackened, and the features disfigured and distorted from the same cause. A natural appearance, however, will be recovered in a few days without any treatment.

Bleeding from the Navel-String.

This serious accident occasionally occurs some hours after birth. It arises from the cord being carelessly tied or from its being unusually large at birth, and subsequent shrinking so that the ligature ceases to close the blood vessels.

To arrest the hemorrhage, the infant's clothes and flannel binder must be removed and the cord exposed; then a new ligature, composed of six strands of strong linen thread, must be applied half an inch nearer the body than the original one, and tied tight enough to compress thoroughly the vessels, but not so tight as to cut through the cord.

Ulceration of the Navel.

The cord generally separates from the navel between the fifth and fifteenth day after delivery, and the parts should then heal without trouble. Occasionally, after the falling of the cord, a small growth, about as large as a pea, appears on the navel, giving rise to a discharge of thin liquid. This may be relieved by applying a little powdered alum and afterward dressing with vaseline or oxide of zinc ointment.

Again, though rarely, excoriation of the navel and surrounding skin takes place, and rapidly spreads, assuming an inflammatory character. The attention of the physician must be called to this. Apply a warm water dressing should his visit be delayed.

Secondary Bleeding from the Navel.

At the time of, or several days after, the separation of the cord, bleeding may take place from the navel. In this event, which is fortunately uncommon, place the point of the finger over the part and steadily, but gently, press it until medical aid can be obtained.

When a bleeding growth appears at the navel, wind a piece of very narrow tape closely around it and leave the whole undisturbed. Under these circumstances the hemorrhage quickly stops and the growth soon sprouts over the upper edge of the tape and, strangulating itself, drops off.

Yellow Staining of the Skin.

During the first few days of life, especially after a difficult and tedious birth, there is apt to be intense congestion of the skin, followed, as the redness fades, by a brownish-yellow discoloration. This usually disappears by the tenth day. The coloration resembles that of true jaundice, but there is no yellow staining of the whites of the eyes, nor change in the color of the urine or faeces. Real jaundice occasionally occurs and is a serious condition, requiring careful management.

Retention of Urine and Faeces.

Infants frequently do not pass urine for many hours after birth. Sometimes not for days. This may be due to complete want of secretion or to some temporary engorgement of the kidneys, which can be relieved by drawing the blood to the surface by immersion in a warm bath; a procedure to be adopted in all cases in which no urine is voided during the first twenty-four hours of life. Often, in lieu of the bath, it will suffice to lay a piece of flannel, wrung out of hot water, upon the lower third of the abdomen -- the region over the bladder.

Occasionally some physical malformation leads to retention of urine, and it is the duty of the nurse to be on the lookout, so she may early call the physician's attention to the matter. The same condition may also prevail in the bowel, and when twelve hours elapse without any evacuation the parts ought to be carefully examined.

Swelling of the Breasts.

At birth, or within the following day or two, the mammary glands of an infant may swell, become hard and painful, and secrete a thin fluid much resembling milk. Never make any pressure to remove the secretion, as it may lead to inflammation. When the swelling is moderate, judicious inaction is best, but in severer cases, when the surface is red, and the parts much swollen, and hard and tender to the touch, a hot-water dressing must be constantly applied.

Inflammation of the Eyes.

This is a most important condition, and, from the outset, requires the attention of the physician and the greatest care on the part of the nurse.

The inflammation usually comes on about three days after birth, in the following manner: on waking from sleep, the child's eyelids are slightly glued together; their edges, particularly at the corners, are redder than is natural, and on turning down the lower lid a little white matter will be observed on the inside. Light causes pain and there is a tendency to keep the eyelids closed. After a short time the lids swell, become red on their external surfaces, and a large quantity of matter is secreted and constantly pours from the eye. Apart from pure medicinal treatment, the nurse must keep the eye free from discharge by constantly washing away the matter secreted. Burn the rags or cotton used in this process at once, and it is most important for the attendant not to carry any of the discharge to her own eyes.

Hare-Lip and Cleft-Palate.

These are deformities requiring the attention of the surgeon, and under ordinary circumstances his aid should, in the case of simple hare-lip, be sought within the first six months of the child's life, so that the operation may be well over before dentition begins. The fourth month is the period of election, but should there be difficulty in sucking and any evidences of inanition, the operation may be performed at an earlier age. The operation for cleft-palate should not be undertaken before the end of the second year.

So far as the mother is concerned, the question of importance is whether or not there is any interference with the act of sucking. If hare-lip be trifling, the infant will be able to suck, provided the mother's nipple be large and the milk flow freely; when the reverse is the case, resort to a simple nipple shield. In grave cases, especially when hare-lip is associated with left-palate, the child is unable to suck either from the breast or from the bottle, and must be fed from a spoon. Occasionally one can succeed in feeding a child so affected from a bottle, by resorting to a false palate. This consists of a bit of thin india-rubber, cut the size and shape of the roof of the mouth and fastened by several firm stitches to an ordinary bottle-tip (see Fig. 23).

Figure 23. Tip with false palate.

In using this instrument, the nurse must insert it into the mouth in such a way that the rubber diaphragm will come uppermost and bridge over the imperfect portion of the palate.

Tongue-Tie.

In this condition the bridle beneat the tongue is either too short, or is attached so near the tip of the tongue as to interfere, at first, with the movements of the organ insucking, and, afterward, in speaking. Although frequently suspected, it, in reality, occurs very rarely. The best way to determine if tongue-tie exist or not, is to watch whether the infant can protrude the tip of the tongue beyond the lips. If so, it will be able to suck a good nipple readily, and nothing need, nor ought, to be done. Should the reverse condition prevail, it will be necessary to nick the bridle, and, as there is considerable danger of hemorrhage in this operation, a surgeon must always be consulted.

Accidents and Disorders Occurring in Infancy and Childhood.

Bruises.

A contusion or bruise must be treated as soon as received, if one would relieve pain, lessen swelling and prevent the formation of a black and blue spot. Compresses wet with hot water, a light ice bag, [1] or a lotion of fluid extract of witch-hazel, are the best remedies. A bruise upon the head in the case of a young infant, and especially when followed by paleness and vomiting, is not to be carelessly overlooked, since it is sometimes the origin of convulsions.

Sprains.

Do not make light of a severe sprain, for the consequences are often more lasting than those of a broken bone.

Much care and patience will be required in the management of sprains, the great point being to secure rest for the injured part. Should the knee or ankle joint be involved, put the patient to bed and swathe the part in a hot-water dressing, or in compresses soaked with arnica or fluid extract of witch-hazel. When a joint of the upper extremity is involved, it is, of course, unnecessary to confine the child to bed; but at the same time the limb must be placed in such a position as to be as quiet as possible, while the local applications already mentioned should be employed. Later, passive motion must be practiced in order to prevent permanent stiffness. A sprain, however, needs the surgeon's attention as much as a broken bone.

Fractures.

The breaking of a bone is indicated by deformity of the limb, such as bending, shortening or twisting, and when this occus, much suffering to the patient and injury to the part may be saved by a little careful management. In lifting the child from the spot where the accident happens and carrying him to a bed, it should be one person's duty to support tenderly the injured limb, instead of allowing it to dangle loosely. Once in bed, lay it upon a soft, rather broad pillow; double this around the limb, and tie up tightly so as to afford protection from jars or shaking.

Beyond this, nothing should be undertaken until the physician arrives, except -- in case of fracture of the lower extremity -- the preparation of the bed. This consists in arranging a firm, though not too hard, mattress, with two or three under blankets for the sake of warmth.

Cuts.

These may be clean, as when made by a knife; torn, by a broken plate; or abraded, by a fall on hard, rough ground. If large and deep, the surgeon should be called at once. In trifling cases, the nurse must first thoroughly cleanse the wound by sponging it with hot water, and check the flow of blood by pressure, by the application of hot water, or -- should the hemorrhage be obstinate -- by the use of a solution of alum. In the case of a knife cut, the next step is to press the edges together and fix them in this position by applying a number of narrow strips of surgeon's adhesive plaster at short intervals across the wound. A torn wound may be dressed in the same way, but greater care is required to coadapt the edges. For abrasions, the best application is a piece of lint covered with vaseline or other bland ointment. The plaster dressings need not be renewed until the strips become loose, but the lint and vaseline may be changed twice a day. When an artery is cut, the flow of blood must be checked by pressure on the vessel above the seat of injury; in the case of a vein, below it. Arterial blood flows in jets and is scarlet; venous blood runs in a continuous stream and is purple in color.

Burns and Scalds.

The danger from burns and scalds is in direct proportion to the extent of surface involved and the depth of tissue destroyed. Fortunately, the majority of cases are trifling, and usually the hands or face are the parts that suffer. In these instances there are two things to be done; first, to relieve pain, and second, to encourage healing. To accomplish the former, apply a saturated solution of baking soda; for the latter use some mild ointment -- fresh lard, for example -- and keep the injured part protected from the air by a dressing of cotton batting.

Should the child's clothing take fire, remember that an upright position not only favors the spread of the flames, but encourages their approach to the neck and head. Any movement of the body, too, aids the flames by bringing fresh currents of air in contact with the burning materials. Therefore, do not let the child run about, but seize him, throw him down upon the floor and envelop his body closely in the hearth rug or a woolen table cloth.

Should the child have fallen into a tub of scalding water, remove him immediately and undress him. In taking off the clothing, be careful to do it so gently as not to break the blisters produced by the moist heat, and should the underclothing stick anywhere to the surface, the garments must be cut away piecemeal, leaving the adherent portions untouched.

After the above preliminaries put him, in either case, at once to bed. Next, prepare a number of pieces of old muslin corresponding in size with the injured areas, spread these with fresh lard or cosmoline, apply them and cover all with a thick layer of cotton batting. Should the patient complain of cold hands or feet, or of faintness, a little whiskey or brandy may be administered and artificial heat applied to the extremities if these be uninjured. Nothing else should be done without the physician.

Stings of Insects.

Children, being more ignorant, are more frequently stung by bees, wasps, and other insects, than adults. Examine the wound the first thing with a magnifying glass, and if the sting be still in the tissues, extract it with a pair of tweezers, or squeeze it out by firm pressure in the neighborhood of the puncture. After this, apply aromatic spirits of ammonia or eau de Cologne. These will relieve the pain and itching. When the sting produces great pain and inflammation, apply a flaxseed poultice for twenty-four hours. The frequent use, afterward, of camphorated soap liniment will be productive of good results.

Foreign Bodies in the Ear.

When a foreign substance has entered the ear, the plan for its extraction depends somewhat on the nature of the material. In any case, however, bend the child's head toward the affected side, cuase him to open his mouth as wide as possible, and at the same time gently pull the external ear upward and backward. In this way the external canal of the ear is straightened and stretched to its widest extent, and a small body like a bead may drop out. Another method is to wash the foreign body away with warm water and a syringe. Should the substance be of a nature to increase in size by absorbing moisture, such as a pea or bean, its extraction must be left for the physician, though it is to be delayed no longer than absolutely necessary. When an insect enters the ear, the external canal must at once be filled with fresh olive oil.

Foreign Bodies in the Eye.

A simple plan for removing cinders and the like from the eye is to pull the upper eyelid forward and downward, by grasping the eyelashes, and direct the child to look upward. In this way the lashes of the lower lid are made to sweep over the upper one, and thus may brush away the foreign body. If this be unsuccessful, and the offending substance be in sight, remove it with the corner of a fine handkerchief. If not seen on the eyeball, it must be looked for beneath the lids. It is easy enough to pull down the lower lid and examine its internal surface; in the case of the upper lid, however, it is necessary to perform eversion; this is done by drawing the lid downward and forward, and turning it over a thin lead pencil (Fig. 24).


Fig 24. Method of everting upper eyelid.

Direct the child, in the meanwhile, to look down. When the intruding body is disclosed by this process, it may be brushed away by a little cotton twisted upon the end of a match stick, or better by a small camel's hair brush; the touch must be very gentle, and no prolonged effort made if the mote be imbedded. Treat any slight irritation following this accident and the process of removal by frequent applications of hot water.

Foreign Bodies in the Nose.

Children frequently insert shoe buttons, peas, beans, and other small objects into the nose. When these are not too firmly fixed, or have not been pushed too far up, they may be removed by closing the opposite nostril and causing the child to blow his nose forcibly. Should any difficulty be experienced, it is better to consult a physician than use persistent force.

Foreign Bodies in the Throat.

A large, unchewed mass of food, a fish bone, or some metallic substance, such as a piece of money, may become lodged at some point in the throat.

When this occurs, immediately insert the finger and thumb into the mouth, pass them as far down the gullet as possible, and if any object be felt make an attempt to pull it forth.

Instead of lodging in the upper part of the gullet, the foreign body may be arrested midway in its course to the stomach. Let the child then partially masticate and swallow a piece of bread and several mouthfuls of water, which will probably assist the object's passage into the stomach; if not, medical skill will be required.

Foreign bodies, such as buttons and coins, that pass directly into the stomach give rise to little trouble, and soon find their way through the alimentary canal, and are voided from the rectum with the ordinary faecal evacuations. Laxative medicines are never needed unless the bowels be absolutely confined, and then moderate doses of castor oil are the most suitable.

Bleeding from the Nose.

Hemorrhage from the nose is sometimes so excessive as to lead to debility, or even threaten serious results. An injury or abrasion of the lining mucous membrane is the usual cause of hemorrhage, though it may result from certain constitutional conditions. To arrest the bleeding, put the child upon a bed, with the head and shoulders well elevated. First make pressure, with the thumb and index finger, on the root of the nose, i.e. that portion between the eyes, or on either side of the nostrils where the blood vessels, ascending from the lip, are felt to pulsate. Should this fail, after a reasonable time, plug the nostril from which the blood flows with a cone shaped pledget of absorbent cotton or lint; this may either be dry or saturated with a solution of alum and water as hot as can be borne. The inhalation of the vapor of spirits of turpentine, or the immersion of the feet and legs in a hot mustard foot bath, are each successful in some cases. If the bleeding be obstinate, apply a piece of ice wrapped in flannel to the forehead or the back of the neck.

Ear-Ache.

Ear-ache is a very common cause of crying in infancy and childhood. Screaming from ear-ache may be distinguished from that due to pain the bowels, another fruitful source of crying, by the former being more continuous, and by the child frequently carrying his hand to his head; again, in ear-ache the passages from the bowels are natural, while in bowel-ache they are usually altered in character and offensive.

Put into the ear, for a short distance, a small piece of absorbent cotton saturated with a little warmed olive oil containing a few drops of laudanum, or, better still, with a two per cent. solution of cocaine. At the same time dry or moist heat may be applied to the external ear.

Cold and Coughs.

A cold in the head is indicated by watery eyes, sneezing -- with a discharge of mucus from the nose -- and a nasal voice. Simple remedies are often efficacious. Frequently grease the forehead and bridge of the nose with mutton suet; insert a little vaseline in the nasal orifices, and, should the skin be hot, administer a mustard foot-bath.

An ordinary cold -- or, in medical language, a bronchial catarrh -- is usually preceded by a cold in the head, and is indicated by a hoarse cough, increased rapidity of breathing, and fever.

The methods recommended for colds in the head are also useful here. In addition, rub the chest thoroughly, three times a day, with a liniment of turpentine and sweet oil -- one part to three; keep the child in one room at a temperature of 72° F.; allow a light diet, and summon medical aid.

Vomiting.

The most healthy infant, even though it be fed at a normal breast, often expels a portion of each feeding. This is an act of regurgitation rather than vomiting, and is, in reality, a natural method of relieving an over-burdened stomach.

Vomiting proper is preceded by the sensation of nausea; is followed by lassitude, and is often attended by fever. It indicates some disorder of the stomach. For its relief, perfect rest for the whole body; several hours' starvation, or rest for the stomach, and a reduction in the quantity and strength of the food, are necessary. Bits of ice, soda-mint, lime water, annd a mixture of equal quantities of cinnamon water and lime water, in teaspoonful doses, are simple and efficient remedies; a weak mustard plaster placed upon the pit of the stomach is always useful. Should the symptom be obstinate, however, the case becomes too serious for the mother to manage on her own responsibility.

Colic.

Colic is a very common affection of infancy. It usually occurs in the period between birth and the end of the third month, and gives rise to much discomfort, both to the infant and its attendants, by causing fretfulness, crying, and wakefulness. The treatment is very much one of diet and properly prescribed drugs. Still, there are some domestic remedies which may be used safely and with success. Thus, the body should be annointed twice a day with warm olive oil and enveloped in a broad flannel binder. It is even more important to keep the feet warm, and for this purpose thick socks or long woolen stockings should be worn, and, in bad cases, artificial heat must be applied by hot water bottles. Medicines are indicated chiefly during attacks of pain. A serviceable prescription is ten drops of gin in a teaspoonful of sweetened warm water, or a small teaspoonful of hot soda mint. It is also well to administer a teaspoonful of caraway water after each nursing, or with each bottle of food.

When a paroxysm of pain is violent enough to lead to depression of the fontanelle and threaten collapse, place the infant in a warm bath for five minutes. After removing and carefully drying him, wrap him in a blanket; put a flaxseed poultice with a dash of mustard over the abdomen; apply a hot water bottle to the feet; relieve the bowels by an enema of warm water, and by the mouth, give him ten drops of gin or brandy in warm water. If the fontanelle still remain depressed, continue the stimulant in doses and at intervals proportioned to the urgency of the symptoms.

Constipation.

Habitual constipation is such a common occurrence in infancy and childhood that it warrants a somewhat detailed consideration. The methods that may safely be employed to clear the lower bowel of accumulated faeces, or, in other words, to relieve the actual state of constipation, will be first noticed, for this is always a necessary step when there is painful straining, and in case there has been no movement for a day or more. For this purpose injections are most efficient, and when given with care, are entirely free from danger.

A serviceable plan is to inject into the rectum, according to the age of the patient, from one to four teaspoonfuls of warm olive oil; allow it to remain for six hours, and then use one or more injections of castile soap and warm water; olive oil, soap and warm water, or table salt and warm water. The preliminary injection of oil softens the faeces, while the subsequent ones have the additional effect of distending the walls of the rectum, thus bringing about muscular contraction and expulsion of its contents. Should a compact faecal mass be present at the anus and be too bulky to escape -- a condition often visible during straining -- more liquid must be injected, and if this fails the mass must be broken up by the finger and its passage assisted by gentle pressure upon the parts behind the anus while expulsive efforts are being made. The process of breaking up is easy, as the anus is widely distended at such times. In obstinate cases little result may follow a single administration of the injections, though a course of one or two oil injections and purgative enemata for several successive days rarely fails to empty the bowel.

The best syringe for children is one of hard rubber with a long, smooth, nozzle, having a capacity of six fluidounces. When oil is injected, the intention being to have it remain in the rectum and act mechanically on the faeces, its retention is best secured by firmly pressing a warmed pad of flannel against the anus for five minutes after the insertion, the patient, in the meanwhile, lying upon his back. The laxative enema must vary in bulk with the age of the child, or, in other words, with the capacity of the rectum; one fluidounce (two tablespoonfuls) will be sufficient for an infant of six weeks, while from four to six fluidounces are required at the age of two years. The quantity of oil, salt, or soap to be used must depend upon the quantity of water -- two teaspoonfuls of oil or one teasoponful of salt to eight tablespoonfuls of water being a good proportion, and if soap be employed, it is sufficient to stir a bit in the water until suds begin to form. After drawing the fluid -- which must be tepid -- into the syringe, grease the nozzle well and gently insert it into the anus, driecting the point a little toward the patient's left; next, slowly force down the piston until all the liquid is expelled or complaints of pain indicate that the bowel is sufficiently distended. If it be possible to force retention for a minute or two by pressure on the anus, the movement will be freer and easier that if the fluid be allowed to flow away at once. The best positions for the child are either on his back with his legs well drawn up, or resting on his abdomen across the nurse's lap.

Injections of glycerine and glycerine suppositories are also very useful for the purpose of unloading the lower bowel. When glycerine is employed, the quantity to be injected varies from one to two teaspoonfuls, according to the age of the child, and the best instrument to use is the bulb syringe, previously recommended. See page 235.

For the prevention of further constipation the diet must be regulated according to the rules given in Chapter VIII, and besides regulating the food and hours for meals, bathing, sleep, exercise and clothing, care must be taken to estabilsh fixed habits of defecation.

In my experience the youngest infant can be taught to use a chamber, and if this vessel be presented each day at the same hour he soon falls into regular ways. Should faulty habits be established, or constipation exist, resort to injections, and abdominal massage at the same hour each day.

After the third year the best period of the day for the bowels to be moved is immediately after breakfast, and no call of duty or pleasure should be allowed to interfere. When constipation is to be overcome natural efforts must be made then. These efforts may at first be ineffectual, but much can be accomplished by perseverance in a daily, sustained effort, for about ten minutes. When this plan fails, use injections or other methods of relief, taking care to keep to a certain hour, that the formation of a habit may be encouraged.

Thorough rubbing of the abdomen is often successful in inducing a movement of the bowels. Gentle pressure should be made with the palm of a well-warmed hand, and the movements directed first, from the brim of the pelvis on the right side, upward to the rib margin, then across from the right to the left, and finally downward on the left side, from the margins of the ribs to the brim of the pelvis again. Such manipulation excites peristaltic action, and encourages the psasage of the intestinal contents along the large bowel toward the anus. Ten minutes is quite long enough to continue the rubbing. The manipulation may be rendered more effective by using warm sweet oil, or a weak ammonia or turpentine liniment as an inunctio.

With children of six years and upward, daily cold spongings of the body are very beneficial, followed by frictions with a coarse towel until the surface is red.

Manna, phosphate of sodium, and soap suppositories are among the medicines that may be safely used in the nursery.

Manna, which imparts a sweet taste, may be dissolved in the food, and given from the bottle as often as required; a piece as big as a pea, once, twice, or three times a day, will be sufficient for an infant of six months.

Phosphate of sodium -- an admirable laxative -- can also be administered with the food; five or ten grains, three times daily, is the proper dose at the same age.

Soap suppositories must vary in strength with the age. At two months one grain of soap to ten grains of cocoa-butter is the proper proportion; at one yar the quantity of soap may be increased to five grains in each suppository, and so on. A substitute for soap suppositories may be prepared in the nursery, as follows: Cut from a bar of good castile soap a piece two inches long and half an inch thick. Scrape this into a cone, pointing one end like a sharpened pencil, but with a blunter point and more gradual slope; make it quite smooth by rubbing the surface with a wet rag (see Fig. 25). When the soap stick is used anoint the pointed end with vaseline and gently insert it into the rectum and hold it there until the action begins. It is not desirable to leave any fragments of soap in the rectum.

Figure 25. Soap stick.

 

Convulsions.

Convulsions arise from so many diverse causes, that it is impossible to indicate more than what is to be done during the fit and prior to the arrival of the physician.

When the attack comes on, the child must be undressed at once and plunged into a warm bath for five minutes; this bath must contain enough mustard flour to stimulate the skin thoroughly. This usually restores consciousness and checks the muscular twitching. Should there be a distinct history of overloading of the stomach, give an emetic of ipecacuanha, and after this has operated, a purgative dose of castor oil. One or more doses of bromide of potassium, five to ten grains, according to the age, may be also safely given; this salt must always be administered in solution.

A Chill.

This is always a serious occurrence and warrants sending for the doctor. Before his arrival, put the child to bed, surround him with bottles containing hot water, place a moderately strong mustard plaster over the abdomen or over the region of the heart, and administer whiskey and hot water in small doses and at short intervals.

The ailments of children do not so frequently begin with a chill, as do those of adults, but when it does occur, it is a more decided indication of the future gravity of the attack.

Fever.

It is not my intention here to refer to the management of the essential fevers, for I hold that neither mother nor nurse is capable of managing them without professional assistance. However, the table on page 264 [below], exhibiting the features of the eruptive fevers will answer some of the questions which so frequently suggest themselves to the minds of anxious mothers.

Eruptive Fevers.

Name.

Period of Incubation.

Day of Rash.

Character of Rash.

Rash Fades.

Duration of Illness.

Duration of Contagiousness.

Measles

10 to 14 days.

4th day of fever, or after 72 hours' illness.

Small, dull, red pimples, appearing behind the ears and on face.

On 7th day of fever.

9 days.

From second day, for exactly 3 weeks.

Scarlet Fever

2 to 7 days.

2d day of fever, or after 24 hours' illness.

General rosy blush appers first about neck and shoulders.

On 5th day after fever.

8 or 9 days (this does not include sequels).

Fourth day, for 6 or 7 weeks.

Typhoid Fever

10 to 14 days.

7th to 14th day.

Rose-colored, slightly elevated spots, few in number, chiefly on abdomen.

--

14 to 21 days.

Not contagious.

Chicken-pox

8 to 16 days.

2d day of fever, or after 24 hours' illness.

Appears in crops on back and abdomen, small, red papules rapidly passing into globular vesicles.

Thin scabs form about 4th day of fever.

4 to 7 days.

First day, for two weeks.

Small-pox.

14 days.

3d day of fever, or after 48 hours' illness.

Small, hard, red pimples, becoming vesicles, then pustules, appearing first on face and neck.

Scabs form on 9th or 10th day of fever, and fall off about the 14th.

14 to 21 days.

First day, for about one month.

It may be well to give a few directions as to the management of a fever before the arrival of the physician. Every fever -- whether it be due to a poison circulating in the blood or to a passing irritation of little or no moment -- is attended by the following symptoms, namely: heat of skin, lassitude, loss of appetite, and thirst. When these features arise, the mother must be on her guard and take steps to place her charge in the best possible condition. Give the child, the first thing, a mustard foot bath; then put him to bed with only sufficient covering to keep up a normal body temperature. Reduce the diet to the simplest possible basis, milk food being the safest. A moderate quantity of pure water, or of some effervescing saline water, and of ice, may be allowed. Febrifuges, as aconite, or even sweet spirits of nitre, had best not be given without advice, and quinine or other remedies are not to be trifled with.

Should head-ache be severe, place cold compresses upon the forehead, or a weak mustard plaster (one part of mustard to six of flour) on the nape of the neck.

Free urination should be encouraged by hot compresses over the bladder, and it is well to secure a free action of the bowels by a mild saline laxative.

Contagious Diseases and Disinfection.

There are certain points connected with the nursing of contagious diseases and the subject of disinfection that are worthy of mention.

In every case of contagious disease, allow in the room only those who are necessary to nurse the sick. The nurse must avoid over-fatigue, have regular meals of digestible and nourishing food, and fixed hours for sleep and relaxation. The chamber selected for the sick room should be large, well-ventilated, and as near the top floor of the house as possible. Upholstered and stuffed furniture, curtains, hangings, carpet and other articles capable of holding disease germs, are difficult to disinfect, and should be removed before the entrance of the patient; in fact, to put this matter in a nutshell, the sick room should contain only such furniture as will be absolutely needed by the patient and nurse. Scrupulous clealiness is essential. Remove dirty dishes, vessels with discharges, soiled napkins, and the like, at once.

Disinfectants are substances that destroy the infective power of contagious materials, and must be confounded with neither antiseptics or arrestives of putrefaction, nor with deodorizers or neutralizers of bad smells.

In the case of disinfectants, it is important to bear in mind that contagious virus must be destroyed at its source. As this, of course, is the body of the sick, all discharges must have their power for evil destroyed as soon as possible. Receive discharges from the mouth and nose, especially in cases of scarlet fever and diphtheria, in bits of rags, and burn them immediately after use. When the skin is affected, as in scarlet fever, for example, the flakes that fall away are highly infective. To prevent these becoming disseminated, the surface should be anointed several times a day with vaseline, lard or cocoa-butter, either of which substance will be rendered more efficient by the addition of carbolic acid (one part to forty).

Articles used about the patient, such as sheets, pillow-cases, blankets and clothes, should not be removed from the chamber until they have been soaked for at least an hour in the following disinfecting fluid:--

Sulphate of zinc, 8 ounces
Carbolic acid, 1 ounce
Water, 3 gallons

Place, after this, the soiled articles in boiling water for washing.

Articles not requiring to be frequently changed, such as pillows and mattresses, need fumigation. This may be accomplished at the termination of the case.

Keep a small quantity of the above fluid or of a solution of corrosive sublimate (1 to 500) in all vessels used for receiving the discharges of the patient, and, after these are used, empty quickly and clean with boiling water. Water closets or privy wells into which these discharges are poured must also be disinfected each day with a solution of copperas (one pound to the gallon).

Fumigate the sick room itself as soon as the patient leaves it. To do this, tightly close the room and stuff all apertures, such as keyholes, loose window sashes, spaces under doors and so on, with cotton or rags. Then place a quantity of roll sulphur [the quantity of sulphur required is three pounds for every thousand cubic feet of space], broken into small fragments, in a saucer, standing either in a large iron kettle or supported by two bricks set in a tub partially filled with water. Next, sprinkle a little alcohol over the sulphur and apply a live coal, and as soon as combustion begins, leave the room, shutting the door of exit. The room must remain closed for at least twelve hours and then be thoroughly aired.

Wood-work and walls, if painted, should be wiped down with a solution of chloride of lime (one ounce to the pint) or carbolic acid (one drachm to the pint), and then scrubbed with soap and hot water. Re-papering and fresh painting are necessary in cases of scarlet fever or smallpox.

The person of the patient or nurse may be disinfected by washing with a two per cent. solution of carbolic acid.

Both milk and water will carry disease germs, and hence both must be thoroughly boiled when there is any danger of their being contaminated. Never give delicacies or articles of food that have stood in the sick room to other members of the household.

Various Dressings.

Poultices.

Pultices may be made with Indian meal, bread, starch, ground slippery elm, flax-seed meal, or, in fact, any material that will retain heat and moisture. Flax-seed meal is usually selected because it is bland and non-irritating; because it contains considerable oil, which gives it great heat retaining properties, and because it is cheap.

All poultices should be large, from half an inch to an inch thick; applied as hot as can be borne, and renewed as soon as cold. A covering of oil-silk or thin rubber cloth is useful to prevent rapid cooling.

Flax-Seed Poultice.

Take a perfectly clean bowl, pour in the requisite quantity of boiling water, then add the flax-seed meal slowly, stirring continually with a large spoon to prevent the formation of lumps, until it becomes stiff enough not to run freely. Spread between two layers of old muslin, folding the edges over so as to avoid soiling the part to which it is applied.

The Jacket Poultice.

The jacket poultice, so often employed in cases of pneumonia, requires some skill in preparation.

For a child from one to three years old, use about a pound of flax-seed meal in each poultice.

Take a piece of muslin or a large towel long enough to go all around the patient's chest, and of sufficient width, when folded on itself, to extend from the collar bone to a few inches below the lower end of the breast bone. After the meal is properly mixed, spread it evenly over one entire half, lengthwise, of the cloth, which should then be folded over. Place this around the chest, with the open edge upward, and fasten behind. It should be held up by a tape passing over each shoulder.

Put this poultice on as hot as the nurse can tolerate it against her cheek; cover with oil-silk and renew every five or six hours. When the cool poultice is to be removed have a hot fresh one ready for immediate application.

Bread Poultice.

Make a bread poultice by soaking a muslin bag filled with bread crumbs, for a few moments in boiling water, then squeeze it gently between two towels until it does not drip.

Charcoal Poultice.

The charcoal poultice is useful in foul and sloughing sores, and is prepared by incorporating some powdered charcoal with a flaxseed, an Indian meal or a bread poultice, and then sprinkling the surface with more charcoal.

Plasters.

Mustard Plaster.

These plasters are used for the purpose of making counter-irritation, and must be graduated in strength according to the tenderness of the skin and the end to be accomplished. Pure mustard is very irritating and will quickly blister the tender skin of a child. Flour is the ordinary diluent, and the strength of the plaster usually ranges from one part of mustard to three, six or even more parts of flour.

In making the plaster, take one teaspoonful of mustard flour and add to it three teaspoonfuls of wheat flour; mix them together thoroughly on a plate, and put on as much hot water (never vinegar) as may be necessary to make a soft mass. Spread evenly over a piece of muslin. To prevent the mustard from adhering to the skin, place a piece of gauze or thin muslin over the surface of the plsater; turn down the edges as in poultices.

Remove the plaster after the surface becomes quite red.

Spice Plaster.

Take equal parts of ground ginger, cloves, cinnamon, and allspice, and one-fourth part of cayenne pepper; mix the ingredients together on a plate, and put the whole into a flannel bag about as large as the hand, and wet with hot whiskey or alcohol.

After the bag is filled it is better to quilt it; otherwise, as it is usually worn some length of time, the ingredients are apt to fall together in a lump.

Dry, Heated Applications.

Make a bag of thick flannel, somewhat larger than the part to be covered. Half fill it with hot bran, hops, chamomile flowers, or whatever is to be used. Apply to the part on which it is intended to act. Retain it there by a bandage. When the bag and contents become cooled, quickly remove, substituting a few thicknesses of hot flannel until the bag can again be heated by placing it on a tin plate in the oven, or by holding it over burning coals, being careful, of course, not to scorch it.

Cold Water Dressing.

Take a piece of old linen or muslin large enough to cover the affected part. Thoroughly wet with cold water. Keep constantly wet by re-dipping in the cold water, or by gently squeezing out a wet sponge on the cloth, so as to keep it wet without dripping. The latter plan is the better, as it causes no disturbance of the parts beneath -- an important consideration in many cases.

Hot Water Dressing.

The hot water dressing is prepared in the same way as above, substituting hot for cold water, and covering with oil-silk.

Flannel Dipped in Spirits.

Take a piece of old, soft flannel. Heat it before the fire. Then fold it into the size and shape required. Dip into hot water and wring it dry. While this is being done by one person, some one else should put some common whiskey into a shallow dish over the fire, and heat it, being careful that the whiskey does not take fire. As soon as thoroughly heated, dip the flannel into it and squeeze out any excess of spirits, which would merely drip away, to the annoyance of the patient. Have the surface exposed, and rapidly apply the flannels as hot as can be borne. Over this place another piece of dry flannel which has been heated quite hot and folded like the first one. If desirable, a bandage may be brought around to secure them in position. As soon as the inner flannel, which was dipped in the whiskey, has become somewhat dry, another one should be prepared at once and applied in its stead.

Turpentine Stupe.

A turpentine stupe is made by wringing a piece of old flannel out of hot water and sprinkling a few drops of warm spirits of turpentine on it. It should be covered with oil-silk while applied, and removed when sufficient irritation of the surface is produced.

Administration of Medicine.

The administration of medicine often requires considerable skill, and is a task in which more clumsiness than tact is often exhibited. Teach the nurse that a child cannot swallow so long as the spoon is between the teeth, but that it is advisable to depress the tongue a brief moment and withdraw the sppon as soon as emptied.

Should the child rebel, there are many ways by which he can be diverted, so that he shall swallow his medicine before he knows it. Also, should he have a fondness for any special thing, such as sugar, jelly, etc., the taste of the medicine may be quite hidden by mixing it with the thing he loves.

 

Footnotes 

[1] Hot and cold act in the same way upon the blood vessels, contracting them and preventing the transudation of blood. It is the changes occurring in the blood after leaving the vessels that produce the discoloration.


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