PART I HOME NURSING (Part 17)

of alarming conditions developing so rapidly that operation comes too late. The patient must be kept in bed and on a strictly liquid diet. No instructions can be given for treat- ment, but it will be remembered that in any inflam- matory condition the application of heat must be used with caution. BRIGHT'S DISEASE Causes of Bright's disease Character- istic changes in the disease Acute Bright's disease or kidney trouble, present- ing albumen in the urine, may be brought on by ex- posure to cold, as a result of extensive burns, or as a sequel of some of the infectious diseases,, especially scarlet fever, typhoid, or diphtheria. It may also occur during the course of pregnancy. The most characteristic changes are indicated by the urine, which diminishes in quantity and becomes albuminous. There is usually a puffiness about the ankles and eyelids, which may spread over the entire ACUTE AND NERVOUS DISEASES 173 body. Headache and gastric disturbances are usual, and only the most easily digested foods can be taken. It is evident that in any disease of the kidneys the waste of the body is not being properly removed, Treatment and the defective work of those organs must be sup- normal plemented by increasing the activity of the skin. Hot ^"he0" baths are given and drugs to induce free perspiration Sidneys and to increase the amount of urine. The bowels should be kept freely open also. Every means must be utilized to restore the normal function of the kid- neys. Increase of the dropsical condition and failure to •secrete the normal amount of urine are discouraging Hopeful i t 1- • i Slgns symptoms, whereas the reverse conditions may be re- garded as hopeful signs. When giving the hot bath the room should be warm and entirely free from draughts, as any ex- Giving posure is particularly dangerous. The patient should be put at once after the bath between warm blankets with abundant covering and hot-water bags at feet and sides. A warm drink will also aid in producing perspiration. After half an hour the covers may be taken off gradually and the patient wiped dry with warm towels. NEURASTHENIA Neurasthenia or nerve- weakness is a condition in- dicating lack of power of the nerve centres of the cause of body. The common cause for neurasthenia is over- "^nit work combined with anxiety. Some persons having large expenditure of nervous force have little power of creating nervous energy, and wherever the daily expenditure of nerve force is greater than the in- come of nervous energy the result must plainly and inevitably be nerve-weakness or neurasthenia. There 174 HOME NURSING Symptoms of mental overwork Physical symptoms Recovering from neu- rasthenia Changing the meth- od of living may be a local or a general neurasthenia, the former often leading to the latter; hence any nervous dis- order, even when confined to a particular part of the body, must be regarded as serious because of the possi- bility of its resulting in a general nervous break- down. Some of the symptoms of mental overwork are increasing reluctance to take up daily duties, weak- ness of memory, insomnia, and a feeling of weight or constriction about the head. Sometimes for the time being there is an abnormal desire to work, ac- companied by vigorous brain activity and an almost complete inability to rest or sleep, which heralds a serious and sudden collapse of nervous energy. There is usually, though not always, great de- pression accompanying general neurasthenia, and the patient becomes increasingly morbid until his condi- tion seems to border on insanity. The feet and hands are often clammy and cold and there may be profuse perspiration following the least excitement. Short- ness of breath and rapid pulse, itching, neuralgia, and nervous headaches are symptoms of this disorder. Recovery from a condition of neurasthenia is always very gradual, and must be gained chiefly through rest and proper food. The special method of treatment adopted must depend largely upon the degree Of the nerve exhaustion. In attempting to rest an excited, worn-out brain the effort must be to re- move all anxiety and brain-work while still endeavor- ing to keep up the interest of the patient and to estab- lish the general health of the body more completely. To secure this the method of living must be en- tirely changed as far as mental atmosphere is con- cerned. All brain-work is to be excluded and fresh air and exercise in some form is to be added to ACUTE AND NERVOUS DISEASES 175 proper feeding and rest. Quiet travel when properly directed affords one of the best means of obtaining the desired change in cases where the general strength will permit. An ocean voyage which pro- vides mental qu>et, fresh air, and an escape from An ocean business or domestic activities, or camp lite, which beneficial may add the element of exercise in any amount de- sirable for the patient, are means which probably afford the shortest road to complete recovery. To persons of slender means to whom the luxury of travel must be denied it should be borne in mind that cessation from mental work is an absolute re- quirement, whereas such a modification of the method of living may be made possible as to take the place of the complete change of scenery which is desirable. For severe cases the so-called "rest-cure" which has been instituted by Dr. S. Weir Mitchell is frequently "The rest- most beneficial. The principles of this cure -are "ab- solute rest, forced feeding, and passive exercise." Complete isolation from friends and relations is usually insisted upon, and as far as possible entire rest of both body and mind is secured. Extreme care is exercised in the feeding of patients, and massage and Need of electricity are relied upon to provide the required ^e^6 amount of exercise. The daily routine is so arranged food as to take up the patient's time and attention in order that the confinement may not seem intolerable. Under the guidance of a wise physician and with the co-operation of the family and of the patient himself, an approach to this method of treatment can be made in the home by arranging a daily schedule to include stated periods of rest, exercise, and frequent regular feedings. Wherever there is a derangement of the nervous system it should be understood that the nerves them- 176 HOME NURSING Supplying selves are suffering from a lack of proper nutrition, nutrition which we can in part supplement by a judicious over- feeding, provided the waste of the body is eliminated at the same time. The proportion of fats is always increased in the food recommended for nervous pa- tients. This need is supplied by a diet of milk, butter, cream, and the fats of meat, of which bacon is the most digestible. At the present time the expense attendant upon The reduc- treatment at most sanatoria necessarily shuts out a penses in large class of patients, but as the success of the new methods gains footing in the popular mind we shall have public sanatoria as we have general hospitals for the relief of those who can not afford expensive treatment. Special rates are already made at some of the well-known sanatoria. HYSTERIA Hysteria an actual malady Those most apt to suffer from hysteria Very few people other than doctors and nurses recognize that the term hysteria stands for an actual malady. The person who exhibits hysterical fits or who is morbidly emotional and defective in will-power is suffering no less truly from a disordered state of the nervous system than is the neurasthenic or insane person, and the establishment of curative measures is equally important in both cases. Hysteria is more common among women than among men, because of their more excitable and sensi- tive nervous system. It develops more often between the ages of fifteen and twenty-five years, and the ten- dency is greater among young people whose parents belong to the nervous type or whose education and mode of life tends largely to indoor, luxurious living rather than to the more robust out-of-door life. The ACUTE AND NERVOUS DISEASES 177 disease may also follow as a result of overwork, dis- sipation, or a long period of severe pain. The manifestations of hysteria are very varied. The unnatural craving for sympathy which is one of strange the characteristics of the disease leads to such warp- JJons of* ing of moral purpose that simulation of almost every hystena known disorder is the common practice of hysterical patients. It is very difficult for one to realize that this deceit results from the fact that the emotional nature dominates and that morbid ideas have full sway — the dread of a certain disease, for instance, being so intense as to cause a patient to feign its symptoms. We may regard a person in this condition as in some measure irresponsible for her acts because of the tremendous power the imagination has over conduct. Some of the common symptoms to be observed are retention of urine or the passage of abundant and Common . 1-1 • rin symptoms light-colored urine, neuralgia, the sensation of a ball of hysteria in the* throat (globus hystericus), paralytic disturb- ances, and spasms of one kind or another. Beast mimicry, in which the sounds and movements of the lower animals are imitated, is observed among children. The treatment of hysteria is both preventive and curative. The results of inheritance may be largely Jfret^ement overcome by careful education of the child, and an difficulty effort to secure a normal physical development to- gether with a healthy and robust nervous system. Self-control must be demanded of the child, and a spirit of unselfishness cultivated which may offset in a large measure the self-centred interest which is so marked a characteristic of the disease. When the disease is once established it is often treated like neu- rasthenia, with which it is closely allied. Hysterical fits need no treatment and the less notice a patient 178 HOME NURSING Withhold- ing sym- pathy and teaching fortitude gets on such occasions the quicker will the paroxysm subside and the less frequent will they become. In general it is safe to say that sympathy must be rigidly withheld and all effort directed toward teach- ing the patient how to gain a proper self-control. If complaints do not reap sympathy they will gradually cease. Sometimes the hysterical attacks are made to result very disagreeably to the patient and are so broken up, as when a physician arrests a paroxysm by the injection of a drug which causes vomiting. It is possible by some such treatment, if wisely admin- istered, to effect a complete cure of the attacks. "Reflex epilepsy' EPILEPSY The cause of epilepsy is very little understood. The attacks are occasioned by some disturbance of the Cause of nerve force occurring irregularly without any apparent not known cause, and are attended by loss of consciousness and more or less convulsive seizures. What is known as "reflex epilepsy" manifests very similar symptoms and may follow injury to the head in which the skull has become indented, causing pres- sure upon the brain. In the latter case a certain measure of relief is sometimes gained by means of operation, if that is thought advisable after consulta- tion. Convulsions resembling epilepsy sometimes ac- company affections of the eye and ear, and may cease upon the removal of the exciting cause. Also the convulsions of hysteria may be confused with true epilepsy. In typical epilepsy the onset is abrupt and usually accompanied by a peculiar sharp cry. The pupils are widely dilated, the face livid, and the involuntary pas- sage of urine is usual. The duration of the attack is seldom more than a few minutes. In typical epilepsy ACUTE AND NERVOUS DISEASES 179 Hysterical patients rarely do themselves any in- jury, whereas an epileptic may injure himself in fall- How the big, or bite the tongue badly if not prevented. The attack"* movements of hysterical patients are more co- dlffers ordinated, the pupils never dilated, and the attack is always longer than in true epilepsy. Attacks of epilepsy occurring in the night may go long unrecognized, but should a person complain frequently of soreness of the limbs on waking, head- ache, exhaustion, and possibly wetting of the bed, such attacks would be suggestive and should be watched for. Very little can be done for a person who is having an epileptic seizure beyond loosening the clothing Care of the epilep- and placing a folded towel between the teeth to pre- tic patient vent biting of the tongue. This should be done at once, as the jaw soon closes tightly and it will then be too late to save the tongue from injury. If the person is in bed he should be rolled over to one side and the mattress protected from the involuntary passage of urine which may accompany the attack. The younger the age at which epilepsy shows it- self the greater the likelihood of serious impairment Variation of the mental system, and the more frequent and effects of severe the attacks the more speedy is the intellectual ePllePsy ruin liable to be. There are, however, notable excep- tions to this general statement, for cases are on record of patients who, though suffering from a severe form of epilepsy, have for years been able to carry on an active life in business without any noticeable mental defect. As the tendency to epilepsy is transmissible from The epi- parent to child, there can be no question as to the moral ™ moral right of epileptics to marriage, and it should m^ryto never be considered. 180 HOME NURSING INSANITY Two forms of insanity Mania Condition of mind Physical condition accom- panying this Inducing sleep by baths In the cities where people are so closely crowded into homes, the care of the mentally diseased is very naturally given over to the institutions specially de- signed for them. In the country, however, there is more effort made to attempt home treatment, and occasionally, with the aid of a good physician and untiring nurses, this can be successfully done. The two forms of insanity, mania and melancholia, demand quite different care. A patient suffering from an acute attack of either form may be regarded as a hopeful case for complete recovery. Mania is sometimes preceded by a period of de- pression varying in length of time from a few days to a few months before the true condition presents itself. The final state of mind is one of exaltation and the patient becomes so excited by his fantasies and de- lusions as to disregard his bodily wants. He becomes noisy, incoherent, Often violent, so that it may be necessary to resort to mild restraint. A maniacal patient seldom commits suicide, but his homicidal tendencies are often marked. There is almost com- plete insomnia, the bowels are constipated, and the skin dry and hot. The appetite seems good, though it is usually difficult to make the patient attend enough to eat. Bodily activity is absolutely untiring, and the care of such patients is most exhausting. A certain amount of sleep is sometimes induced by means of warm baths, particularly the prolonged warm bath at a temperature of no°, which may be continued for an hour and a half or two hours if the patient is not too restive. Rest in bed is required so ACUTE AND NERVOUS DISEASES 181 far as it is possible to secure it, and massage or electricity may be ordered. The hair, teeth, and mouth should receive careful attention, as in- the case of anv helpless patient. Nour- Careand ' * nourish- ishment is often confined to liquid overfeeding, and it mem may be necessary to resort to nasal feeding if the patient is unmanageable. If the patient becomes very violent and restraint is demanded, he should be sent at once to some good Modern ° methods institution where his needs are perfectlv understood in >.nsti- r -_ tutions and regarded. The period no longer exists when the care of the insane in institutions is conducted with cruel indifference. Modern methods of treatment aim at the recovery of the greatest possible number of cases. Restraint is now reserved for the extremely violent patients only, and when it becomes necessary to resort to it such means are used as will give the patient the least possible feeling of restraint. As the period of gradual improvement begins, every effort is made to divert the patient's mind and to give him employment which will interest him. In melancholia the condition of the patient is quite different. He is seized with persistent and torturing Jhoita dif- depression of spirits, is constantly "hearing voices," £™1 which startle him, and are doubtless very real to his man,a imagination. The skin is pallid and cold. There is continual headache and usually constipation and aver- sion to food. The feeding of patients suffering from this form Impajr. of insanity must be even more carefully regulated 5}|"s5on than in cases of mania, as the digestion is often much %£°™~g impaired. The diet should be of nourishing liquids, ™^]an- eggs, and cereals, with some further variety as the physician may allow it. Overfeeding must be very cautiously carried out. 182 HOME NURSING Careful guarding of the melan- cholia patient Do not discuss delusions with the patient In case of forced feeding Sympathy of the nurse with the patient Suicide is of frequent occurrence among patients suffering from melancholia, and it is never safe to leave one unguarded even for a moment, for while the back is turned the fatal deed may take place. Everything that could possibly be used as a means of taking life must be removed from his surround- ings. In extreme cases the "rest-cure" treatment is ad- vised, and in the milder cases it is best that half a day should be spent in