CHAPTER XV. ILLS OF BABY. (Part 2)

both eyes are infected, it is more convenient to place the baby on a table, treat one side, and then turn the baby on the other side and give it the same treatment. The eyes should be irrigated every two hours while there is any discharge ; little cotton balls should always be made and ready for use, to wipe off all discharge between irrigations. Pro- torgal, one drop in each eye, if both eyes are affected, every four hours, is prescribed by most physicians in addition to the irrigation. If only one eye is affected the other must be inspected from time to time for evi- dence of infection. Precaution to Prevent Infection.- — During the treat- ment and care of such a case the nurse must use the greatest care to prevent others becoming infected as well as herself. All dressings and the cotton used on the infant's eyes must be deposited in paper bags, and burned. This the nurse must attend to herself. The pillow slips and little dress or gown and all that comes in immediate contact with the discharge from baby's eyes, should be placed, as soon as removed or soiled, in a one to one-thousandth bichloride solution or a one to twenty carbolic acid solution, and should re- main in it at least twelve hours. If there are other children in the house they must not be allowed to go in the nursery. All articles used on and about the baby must be kept in the nursery and the nurse must take care of them herself. And the nurse must not neglect herself. Be careful that the discharge does not soil her dress. She should wear a large obstetrical gown when irrigating and treating the eyes, this to be 222 worn only during the treatment. Then she must be very careful of her hands. Wash them well, disinfect them thoroughly after each treatment and whenever they are soiled by the discharge. The best disinfect- ant is a one to five-thousandth bichloride solution, the hand to remain in it several minutes. Bichloride solution is hard on the hand and carbolic acid is pref- erable when the treatment must be kept up for some time. Sterilized rubber gloves are excellent, but are a little awkward. The nurse should avoid her own eyes and face as much as. possible ; there is always a pos- sibility of contamination. Difficulty in Nursing. — The causes of difficulty in nursing are several, but the two most common are first, ignorance on the part of the baby ; it does not know how to take hold and suck, and secondly, neglecting to teach it how during the first two or three days of life and allowing the breast to become so ingorged that the infant can not take hold, and thirdly, trying to force a crying baby to take the nip- ple the first time. The nipple should be pulled out and the child taught to suck before the milk appears. Take the baby when partly awake, lay it in a comfort- able position near the mother, flat on the bed on the. same angle as the nipple, rub its little head so as to rouse it and in a short time baby will usually take hold. Sometimes it is necessary to put a little sweet- ened water on the nipple, or a little milk squeezed out of the breast in a spoon, and while baby is trying to nurse allow it to run on the nipple and into baby's mouth as it is nursing. This will encourage it to try. If difficulty is experienced and the breast or nipple are not at fault, examine the child's mouth and see if the conditions are normal. See if the tongue is tied or 223 the mouth sore, and if conditions are abnormal report same to the physician immediately. If conditions are normal a little perseverance is all that is necessary to overcome the difficulty. Vomiting. — "When vomiting occurs a few minutes after baby takes its food, bottle or nursing, it is either because it has taken more than the specified amount, the quantity is too large, or the food has been taken too rapidly. This is especially true in bottle- fed babies where the hole in the nipple is large. It is sometimes due to the binder being on too tight and presses on its stomach, and sometimes because there is too much fat, the milk is too rich. At the time of birth the stomach of a baby is simply the dilation of the gullet running from the throat to the stomach, and holds about one ounce. At the end of four weeks it has attained the capacity of two ounces and con- tinues to grow and develop slowly and at twenty weeks or rive months reaches the capacity of little over five ounces. To this condition is due the fact that babies can eject the contents of their stomachs very easily. A slight movement or pressure is all that is necessary to cause baby to throw off a surplus of milk. A baby vomits without effort and with comfort. This is a wise provision of nature to pro- tect the child. For these reasons a baby should never be played with or moved about immediately after nursing. If vomiting takes place an hour after feed- ing it is a symptom of indigestion. In bottle-fed children the formula should be made weaker and in breast-fed babies the mother's diet should exclude all fats and she should eat principally cereals and starches. Should baby vomit anything but milk the physician should be notified. 224 Indigestion. — This is most common of all ills baby is heir to. More frequently found in artificially-fed babies than breast-fed children, yet both may suffer with this complaint unless there is regularity in feed- ing the child. Symptoms. — The symptoms are vomiting, colic, restlessness. The stools are green, containing much mucus and large particles of undigested milk curds. Treatment. — The treatment consists in the remov- ing of the cause. The child's food should be diluted or if the case is severe, it is best to take the food away for a day or two and the infant fed on barley water or albumen water until the stomach has rested and vomiting- ceased. With regularity in regard to amount and interval of time between the feedings this difficulty may be avoided. Colic. — This is one of the symptoms of indigestion, '/:>,,; "l,kJ--t fc'', mm m Fig-. 70 — Infant's syringe for rectal injection. although it may rarely occur when the stomach and bowels seem to be in perfect condition. Symptoms. — The symptoms of colic are a sharp cry with a drawing up of the feet. The little one will often awaken from sleep, utter a sharp cry, there is a rumb- ling of the bowels and gas is passed by rectum. Treatment. — For colic the best thing I have ever used, one that seldom fails, and also one that is harm- [15] 225 less, is a high saline enema, using for this purpose a soft velvet eye catheter. Place a piece of rubber sheet- ing or oil cloth on the bed or several layers of newspa- pers will do, over this one of the baby's little pads or napkins. The baby's napkin is then removed and it is laid on its side,, its little clothes folded back well out of the way. Immediately under the buttocks a large pad of absorbent cotton is placed to catch the water and feces that will be expelled. The catheter is oiled and inserted as high as possible and the enema given slowly. From two to four ounces is given at a time, repeated several times until the bowels are emptied. In expelling the enema the gas is also ex- pelled and the baby usually goes quietly to sleep. The room should be well heated and the infant not exposed to draughts. Do not give peppermint or brandy water. These upset the stomach and cause indigestion and do more harm than good. See that the infant's feet are warm; if not apply a warm water bag to them. Be sure the water in the bag is not too hot. Baby's skin is very sensitive. Infection of the Umbilicus. — It must be remembered that the umbilicus is a surgical wound and subject like any other wound to infection. The same care that is exercised regarding the hands of the nurse and dressing of surgical wounds must be observed in dressing and handling the stump of the umbilicus cord. Direction for the treatment and dressing of same has already been given. Tetanus. — Tetanus is caused by infection, usually of the umbilicus cord. A lack of asepsis in tying, cut- ting or the after-care of the umbilicus cord. It is always fatal. 226 Hernia. — Umbilicus hernia is not uncommon and is due to imperfection of the Avails of the abdomen in early fetal life and not to improper tying of the cord. The treatment has already been described in a previous chapter on "The Care of the Cord.'" Hiccoughs. — Hiccoughs are very annoying to the baby. A few grains of granulated sugar placed on the tongue will dissolve and trickle down the throat and usually relieves this distressing condition. Thursh. — Thursh is an infection of the mouth and is caused by uncleanliness. and should not occur. It is always due to neglect. If baby's mouth is washed carefully after each feeding, with a solution of boric acid or a little bicarbonate of soda solution, this con- dition would never occur. Engorgement of the Breast. — A peculiar condition which sometimes affects children during the first three weeks of life, is an assumption of a function similar to lactation in the mother. The secretion closely re- sembles colostrum, and may be found in the mammary glands of babies of either sex. The nurse should not attempt to squeeze the milk out. as any existing in- flammation would be aggravated by so doing. Treatment. — For such a condition dress the glands with a little camphorated oil. over this a pad of ab- sorbent cotton : a little bandage is placed around over the pads to prevent them from slipping, or simply hold them in place by pinning them with a small safety pin to the little shirt. This is usually all the treatment that is necessary. The condition disappears in a few days. Vaginal Discharge. — Little girl babies sometimes have a little whitish mucus discharge from the vagina. This is of little importance ; the only treatment is cleanliness. Menstruation. — In rare cases the female child has a discharge resembling menstruation. It usually has no significance, yet should be reported to the physician. Size and Weight at Birth. — The average weight of a girl baby is seven and a half pounds to eight pounds, a boy from eight to nine pounds. The average length of a girl baby is from nineteen to twenty inches, and a boy from twenty to twenty-one inches. Teething — This is inserted simply for completness, and it may be a suggestion to some inexperienced nurse in caring- for such an infant. Keep the stomach and bowels in a good condition and there will be no cause for alarm. Should fever occur, it is usually caused by indigestion. The child swallows a great deal of mucus ; this is especially true of children that do not drool. Watch the bowels and character of the stools. If slimy, containing mucus and curds and are green, give a teaspoonful of castor oil or laxsol, and omit the food (if a bottle baby) for twenty-four hours and give barley water or albumen water. Where the teeth are very broad and thick and the gum tissue hard, it is better to have them lanced; it saves the little one much suffering. Do not allow the baby to suck its thumb ; it spoils the shape of its mouth, in- creases the flow of saliva, which causes indigestion and predisposes to adenoids. There are twenty teeth in the first set. The two central lower teeth are usually the first to appear. They are cut between the fifth and eighth month. Next are the four central upper teeth, which are cut between the eighth and tenth month. The other two lower central teeth and the .228 four front double teeth between the twelfth and eighteenth month. Then the four canine teeth ; the two upper ones are known as eye teeth and the lower ones as the stomach teeth ; these usually come be- tween the eighteenth and twenty-fourth month. The four back double teeth, which complete the first set, come between the twenty-fourth and thirtieth month. The time of appearance of the teeth varies. In some families they come very early, in others late. Symptoms. — The symptoms of teething are fretful- ness, restlessness, loss of appetitie, drooling, indiges- tion, sucking or biting of the thumb or ringer and fever. Sometimes the teeth are large and the gum tissue very tough and hard, and the gums are lanced to assist nature, thus relieving the child of much suf- fering. During teething children frequently have convulsions. Convulsions. — The first thing noticed usually is a jerking and twitching of the limbs, the infant is restless and does not care for food. The first thing to be done is to keep the infant and surroundings quiet and notify the physician at once should a convulsion take place. While waiting for the physician, the nurse should give an enema of saline, to empty the baby's bowels, and two drops of syrup of epecac every twenty min- utes until vomiting is produced. Often convulsions are caused by indigestion. Place the baby in a hot mustard bath. The temperature of the bath for a baby in a convulsion is ninety-nine and a half. You can not reduce the temperature of the water below the normal temperature of the body. The baby is easily supported in the water by placing the hand under the back. The baby should remain in the water ten to fifteen minutes. Ice should be kept constantly 229 on its little head. There should be a tablespoonful of mustard to each gallon of water. When the convul- sion ceases add a little cold water. Have plenty of hot water for the physician when he arrives. 230 APPENDIX. The Life of the Nurse. "Oh may I join the choir invisible Of those immortal dead who live again In minds made better by their presence-live. In pulses stirred to generosity, In deeds of daring rectitude, in scorn For miserable aims that end with self. In thoughts sublime that pierce the night-like stars, And with their mild persistence urge men's search To vaster issues. . . . May I reach That purest heaven, be to other souls The cup of strength in some great agon}-. Enkindle generous ardour, feed pure love. Beget the smiles that have no cruelty — Be the sweet presence of a good diffused. And in diffusion ever more intense. So shall I join the choir invisible, Whose music is the gladness of the world." ''Every noble life leaves the fibers of it interwoven into the frabic of the world." — Ruskin. The life of a trained nurse is one rilled with awe. hope and great responsibilities, yet a privileged and sacred calling. There is no more useful or nobler profession than the "trained nurse." She who cares tenderly and lovingly for the sick, suffering and dying, tills the noblest trust of woman. The good she has in 231 her power to do, the aching hearts and brows that she may soothe, the pain-stricken and mangled forms that she may handle gently and tenderly ; to her, indeed, is given a rare opportunity, a great privilege. The life and ministrations of a kind, gentle, sympathetic and conscientious nurse is a great blessing to suffer- ing humanity. She has many sacrifices to make, and many trials to contend with ; she will meet with many discouragements in serving the sick and suffering; her efforts and devotion to duty will not always be appreciated as they deserve, but she can be kind, faithful, true and attentive and know the peace and joy that comes with the knowledge of duty well done. This is , and should be, her true and real compensation. For gold or honor can never repay a nurse for the services she renders, the sacrifices she makes or the dangers she braves in serving suffering humanity. But should she meet with ingratitude, let it not deter her on her upward march, let it not cause her to hesi- tate or falter, but rather stimulate and strengthen her to walk faithfully and honorably in the noble profes- sion she has chosen and be an ornament thereto. Let her, too, recall all those big brown and blue eyes that have looked up to her from their ivhite pillow of pain with love, gratitude and hope and she will feel she is more than compensated for any ingratitude she may meet, and finally what a rich reward in heaven will be the lot of the faithful nurse. God is faithful to His promises. If He has promised to reward even a cup of cold water given in His name, what will be the re- ward of those who have spent their whole life in min- istering to the sick and suffering". The whole life of such a nurse has been one of continual sacrifice. But every step she has taken, every word of consolation 232 she has spoken, every service she has rendered, every wound she has dressed, every pain she has soothed all have been registered in the book of life by the record- ing angel, a true member of the "Choir invisible, a cup