PART I HOME NURSING (Part 16)

carefully into a glass contain- ing a little lemon- juice, sprinkled with a little pepper and salt, and covered with more lemon squeezed over it. Sherry wine is sometimes used in place of lemon- juice. In conclusion let us add that the message of the Tubercu- scientific world along the line of the tuberculosis in- curable vestigation is full of cheer and confidence provided there is obedience to simple hygienic rules. This is what the sanatoria are trying, and with already a marked degree of success, to set before us. Tuber- culosis is both a preventable and a curable disease. There is no specific climate necessary for its No specific treatment, although some climates may have a better chmate influence than others upon it. There is no specific medicine which can act di- .*o specific rectly upon the germ causing the disease, or upon the poisons which that germ produces. The attitude of the medical world toward the segregation of tuber- culous patients has changed from that of indifference or even hostility to one of hearty indorsement of the methods carried out by the modern sanatoria. The principles of treatment there adopted are : Life Principles spent in the open air, the nutrition of the body main- menteat tained at the highest point, and rest suited to the patient's condition and to the stage of the disease. An arrangement for carrying out home treatment on the sanatorium basis is often practicable, when for INFECTIOUS DISEASES 163 some reason it is not advisable or necessary to send the patient away. A veranda can be built on, conven- To have ient to the patient's living-room, where *he can rest sanato- dnring the day and can often sleep during the night. rmm This should be covered by a roof or awning, and in most climates it will need to be inclosed in wire netting as a protection against mosquitoes and flies. The reclining-chair may be of willow or an ordinary steamer-chair well cushioned will answer the purpose. If the clothing is warm, and hot-water bags areDuringthe used at the feet and about the bodv, a person can live winter J ' r months ' out of doors in really cold weather. A very good arrangement for protecting one from draughts is a beach-chair with high back and sides, like the old sedan-chairs. If the seat is taken out of this and the head of the steamer-chair is drawn inside it, the head and shoulders can be effectually protected from draughts, and yet the lower part of the body may lie in the sun. This is a better arrangement than shield- ing the patient with an ordinary screen, because the chair is stable and solid and can not be blown over. It may not be necessary for a person to give up all occupation, and to become a helpless invalid. If one's occu- . . . pation in tuberculosis is recognized in its incipient stage it is case of inclined to yield quickly to treatment. If the patient los"0"" has an indoor occupation, if he is working in an atmosphere which is carrying foreign particles into his lungs with every breath he draws, his first duty is to find, another method of earning his living. Every year increases the number of persons who are fight- ing the disease, or a tendency to it, by giving the tangs a chance to expand in the fresh open air and by furnishing the tissues with the best possible nutri- ment, while at the same time the daily occupations of • life are carried on. 164 HOME NURSING It is the neglect of the premonitory symptoms that Duty of makes the disease such a menace to patients contract- to himself: ing it, and it is their lack of observance of precau- community ti°ns that makes their presence in the community an actual danger. CEREBRO-SPINAL MENINGITIS Meningitis is an infectious disease, though the infectious- specific micro-organism producing it has not been meningitis isolated. In the highly malignant form of the disease there is hardly time to recognize the nature of the trouble before the end has come, but when the attack is milder it is less often fatal, but needs untiring and intelligent care. The excessive stiffness of the muscles of neck, Character- spine, and extremities, the deafness and headache are symptoms very characteristic of the disease. Dizziness, nausea, constipation, restlessness, delirium, and double-vision are usual accompaniments, the temperature is not necessarily high, and an eruption of the skin appears frequently enough to give the disease its name of ''spotted fever." It generally occurs in epidemics, and attacks both children and adults, although it is more common during the first twenty years of life. The milder cases run for a period of from two to Conva- four weeks, convalescence being rather slow. The deafness, dizziness, and muscular stiffness last for some time and excitement and fatigue must be avoided. The different symptoms receive, individual treatment Treatment- as they occur# if the temperature is high, sponge individual baths and rubbing with alcohol are given. The pains in the spine are treated with either cold or hot applications according as the system seems to need a depressant or a stimulant, and the restlessness and INFECTIOUS DISEASES 165 delirium are often relieved by the use of an ice-bag on the head. As soon as the stomach can bear food it should be given with great regularity. Liquids will be ordered Diet while the fever continues, and during convalescence the diet should be abundant and easily digestible. All excitement should be guarded against, and every con- dition that makes for health should be secured. An inciting cause of the disease is believed to be poor food and bad air, combined with a depressed state of the system, which furnishes a favorable condition for the growth of the disease germ. One point that we must emphasize in our treatment of the disease The dis- is the fact that it is communicable from person to commu- person. The nasal and throat secretions should be mca disinfected or received in cloths which can be burned, and the utmost care should be taken in regard to per- sonal cleanliness and the care of utensils. Good health, fresh air, and suitable nourishing: food are the Necessary 0 safeg«ards best safeguards. Mild cases when neglected may leave the system in a condition of increased suscep- tibility to subsequent attacks, or a deficiency in the sense organs causing deafness, loss of the use of the vocal cords, or both. X ACUTE AND NERVOUS DISEASES Rheumatism— Tonsilitis— Bronchitis — Pleurisy — Appendicitis— Bright's Dis- ease—Neurasthenia— Hysteria— Epilegsy— Insanity Inflamma- tory na- ture of rheuma- tism Care of the clothing Precau- tion in bathing RHEUMATISM ACUTE inflammatory rheumatism is a disease characterized by pain and swelling of the joints, accompanied by high fever. Usually one joint after another becomes involved, and in severe cases the pain is extreme, so that even the weight of the sheet on the affected parts is intolerable and the slightest jarring of the bed or change of position causes ago- nizing pain. The disease is usually brought on by ex- posure to damp and cold and generally runs a course of several weeks. Profuse perspiration accompanies the disease, and the clothing must be changed as it becomes wet with the increased moisture of the body. For this reason a night-dress opening down the back which can be slipped on and off the patient with the least possible disturbance is essential for such cases. A thin flannel shirt opened down the back in the same way should be worn next the skin unless a flannel night-dress is preferred. The advisability of giving the daily bath must be left for the doctor to decide. As the perspiration is always profuse, and has a characteristically strong odor, there should be frequent sponging with warm alcohol. All bathing should be done under cover without the slightest exposure. (166) ACUTE AND NERVOUS DISEASES 167 The danger of bed-sores forming should be particu- larly kept in mind. The increased moisture, owing to The dan- profuse perspiration, and the patient's inability to turn bed-s°ores himself are exciting causes which might readily lead to bed-sores if special care is not taken to prevent their formation. Rheumatic cases are always liable to heart com- plications and care must be taken not to move a The action r of the patient suddenly or as he improves to allow him to heart make any sudden exertion. Sometimes even after convalescence seems well established the heart func- tion is still imperfect, and may remain so for some weeks or months, if, indeed, the patient is not left with a chronic weakness of that organ. On this ac- count any orders the doctor may give in regard to rest and careful exercise need not seem unreason- able. There is likely to be great irritability of the nerv- ous system and often marked mental depression. Dis- Reguia- taste for food as in all fever cases may be expected, the" diet and ingenuity and untiring patience in preventing it is demanded of the nurse in order to keep up the necessary amount. The diet in rheumatism is always carefully regulated. During the fever stage nothing but liquids in liberal quantity may be given. As the fever declines light diet is allowed, though all foods having a tendency to produce acids in the system must be eliminated. In general the following diet list may be useful during convalescence : Eggs in moderation, small A diet • • r r • r , , . , r list for a quantities of farinaceous foods, toast, stale bread of rheumatic rye or whole wheat flour, milk toast, zwieback, gra- patient ham gems, crackers, and hominy. Vegetables — fresh green varieties, celery, lettuce, watercress, sal- ads, young peas and beans, and spinach. For des- 168 HOME NURSING A bever- age list A device for relief serts — oranges, lemons, cranberries, apples, apricots, pears, peaches, cherries, jellies, blanc-mange, stewed or roasted fruit. Meat should be taken once a day only, and should be confined to the white varieties chiefly — mutton, chicken, bacon, sweetbread, pigeon, and pig's feet. Beverages will be useful during the fever to re- lieve the great thirst, and a plentiful amount of liquids assists toward recovery. Plain soda, toast-water, lime-juice, lemonade, and mineral waters may be given with the doctor's approval. Liquids should be taken through a glass drinking-tube, which it is necessary to wash at once after using in order to keep it clean, unless a small brush is used which serves to properly clean the inside of the tube. In cases of chronic rheumatism, pain may some- times be greatly relieved by wrapping the joints in cotton wool. If there is a slight rheumatic tendency and the joints feel stiff and painful in the morning, the use of cotton over the affected part frequently puts an end to the trouble. Marks of tonsilitis TONSILITIS Inflammation of the tonsils often follows exposure to cold, fatigue, or foul and poisonous air. Although not usually in itself a serious affection, it is extremely prostrating and is attended by high fever, severe headache, and general soreness of the limbs and back. The tonsils themselves become enlarged, so that talk- ing is difficult and the voice sounds thick. The glands about the neck are also more or less swollen. The white spots seen on the tonsils may be confused with the gray patches of diphtheria, though the distinction is usually recognizable to a practiced eye. No posi- tive diagnosis, however, is likely to be made if there ACUTE AND NERVOUS DISEASES 169 is any doubt in the matter until a "culture" has been taken from the throat and subjected to examination under the microscope. This is now a routine measure with many physicians whenever the throat is affected. The patient should be- kept in bed and on liquid diet, and a gargle prepared for the relief of the in- Care and , . . r i i -rr • , • treatment named tissue of the throat. If no special prescrip- of the tion is given by the physician one made of hamamelis patient 1C diluted half with water is useful because of its slightly astringent property. If the area of white patches is large in the throat a solution of peroxide of hydrogen one part in six of water will aid in cleansing the throat. Special care must be observed to keep an even temperature in the sick-room, especially when the patient begins to sit up, as relapse sometimes brings with it serious complications. All dishes used by the patient should be kept separate from those of the family. The fever in tonsilitis is of short duration, but it is often several weeks before a person regains his usual strength after an attack. BRONCHITIS Bronchitis may follow a cold or occur as a symp- tom in the progress of other diseases. There is a Signs in feeling of tightness and soreness across the chest, a of bron- hard, dry cough often coming in severe paroxysms, chltls and, as in tonsilitis, the weakness and aching of the head, back, and limbs is marked. The fever does not run as high as in tonsilitis. In an ordinary case of bronchitis the cough may be expected to loosen in three or four days, and expectoration becomes freer, giving great relief. n The bowels should be kept open and free action 8 \c\ 3 170 HOME NURSING Condition and care of the patient of the skin secured by means of the bed-bath and alcohol rubs. It is especially important that the air of the room should be kept pure and the temperature not above 70°, and that there be plenty of nourish- ing food. The patient must avoid sudden change of temperature in going from room to room when con- valescence begins, as the susceptibility to cold is in- creased. PLEURISY £? pleura OF injury The term pleurisy indicates an inflammation of what the the membrane or pleura which envelops the lungs. pleura is ^[s membrane is so arranged as to fold back, form- ing also a lining to the chest cavity. In health it secretes a certain amount of fluid which serves to lubricate the two surfaces, so that they slide easily against each other as the chest rises and falls in breathing. Inflammation often occurs as a complication of infiamma- pulmonary disease or it may follow cold, exposure, The membranes become dry and no longer rub smoothly against each other, and this causes sharp pain on inspiration. This condition may terminate in a restoration to the normal state in a few days or continue for some weeks. Counter-irritants in the form of a hot-water bag or a mustard plaster, if applied immediately upon the first indication of pain, may sometimes ward off an attack and a broad band of adhesive plaster carried entirely around the chest to constrict its movements gives considerable relief. Sometimes the temperature continues to remain Conditions high and the breathing more or less difficult, though the pain lessens or may entirely disappear. These symptoms may mean that the space between the two Counter- irritants rf the fever ACUTE AND NERVOUS DISEASES 171 surfaces of membrane is filling with fluid and their separation has caused the pain to diminish. This con- dition may subside gradually and the fluid become absorbed or pus may form and an operation become necessary. APPENDICITIS Appendicitis is an inflammation confined to a certain part of the intestines known as the vermiform ap- Causes of pendix. The disease was commonly called "inflam- citis mation of the bowels" before modern surgery showed that the origin of the trouble is in the appendix or small appendage on the right side of the intestines. Inflammation may be due to blows, falls, great physi- cal exertion, a strain, improper food, or to a small hardened mass — rarely to a foreign body — which may collect and obstruct the opening to the appendix. Sometimes it is associated with rheumatism, influ- enza, or typhoid fever. There are several forms of the disease recognized as acute, chronic, or recurrent. Sometimes it hap- Several pens that grave symptoms are obscured and the the'disease patient may not seem very ill, though in reality the condition is most serious. For this reason the advice of a physician should always be sought if there is any indication of the following symptoms : The pain may be sharp and colicky or dull and aching. It is at first diffuse, but usually becomes Grave localized on the right side of the abdomen over the symptoms region of the appendix. Nausea and vomiting is usual and constipation is more common than diarrhoea. There is apt to be tenderness over the right side, and sometimes a distinct tumor can be made out. The temperature is not a safe guide, as it may be found normal when other symptoms are grave. The charac- 172 HOME NURSING Three courses the inflam- mation may take The ques- tion of operation Cautions teristic position of the patient is to lie flat on the back with the right leg drawn up. The attack may come to an end in one of three ways — by resolution, in which ease the symptoms gradually subside so that in a week or ten days the patient is entirely recovered; by abscess formation with increased pain and more extensive tenderness over the abdomen, or with a lessening of the pain and general symptoms if the abscess has become thoroughly walled off; or there may be a rupture of the appendix followed by a general peritonitis. The question of operation must of course be left to the decision of the doctor and surgeon, but in general it may be said that unless operation is too long delayed it is rarely attended with serious results, and that however mild the attack there is always danger