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CARE OF THE SICK.

NURSING.

The sick room should have two windows so that it can be easily aired. A narrow, high bed is better than a broad, low one. The sheets should be put on without wrinkles and should be frequently changed. A rubber sheet should be placed under the lower sheet if there is danger of soiling the mattress. When it is desired to put a sheet under a patient, it should be rolled up to half its width, the roll tucked under the patient, the latter turned over on the unrolled portion, and the sheet spread out. A folded sheet called a drawsheet is often placed under the patient's hips. The nurse should wear clothes that can be laundered and she should keep herself scrupulously clean. It is well for her to have a pair of rubber gloves to put on when handling the bedpan or urinal. After performing duty of this sort she should immediately wash her hands and disinfect them with a bichloride solution 1 to 5,000 (one bichloride of mercury tablet, 7 grains, dissolved in 5 pints of water). The patient should be given a sponge bath once a day for cleanliness, and his mouth should be frequently washed with a 4 per cent solution of boric acid (5 teaspoonfuls of boric acid dissolved in a pint of warm water). Cold baths are sometimes used to lower the patient's temperature. The bedclothes are thrown off and cloths wrung out of cold water are applied to his body, or he may be wrapped in a sheet wrung out of cold water. A fan may be employed to further cool the patient or ice may be rubbed over his skin. When the temperature has been reduced the bedclothes are again drawn over the patient. In some cases of kidney disease the hot pack is efficacious; a sheet is wrung out of hot water, the patient wrapped in it and the bedclothes immediately tucked around him. A hot foot bath is sometimes of service. A foot tub filled with hot water is put beside the bed, add a couple of tablespoonfuls of mustard previously stirred to a uniform cream in a cupful of hot water, place the patient's feet in the bath and keep them there about 20 minutes. The bath may be put in the bed if the patient is too sick to sit up. Hot-water bottles should never be more than half filled and should always be wrapped in a piece of flannel or blanket

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and never allowed to come in contact with the patient's skin. Great care should be taken not to burn the patient, a thing which may easily happen if he is unconscious.

The nurse should see that the patient's bowels move daily, and that he passes his urine. If he goes over 24 hours without urinating, a catheter should be passed. The method of doing this is described on page 157. A history should be kept showing the temperature, pulse, and respiration taken at least three times a day, the number of bowel movements and times urine was voided, baths given, and nourishment administered.

The normal pulse rates is 72 to the minute, in a woman 80 a minute, in a child less than 1 year old from 105 to 120, 6 years old 90, over 10 years 80 per minute. Considerable variation from this standard may, however, be compatible with health. It should be taken by laying the fingers gently on a superficial artery, preferably at the point where the radial artery passes over the wrist. The normal temperature taken with a Fahrenheit thermometer is 98.6°, with a centigrade 37°. A temperature from 99° to 101° is called a slight fever, from 101° to 103° a moderate fever, 103° to 105° a high fever, 105° to 106° a very high, extremely dangerous, fever. In taking the temperature the following directions should be observed:

Place bulb of mercury in mouth under tongue for five minutes. If it registers over 101°, send for physician. Stay in bed until he arrives. See that it registers less than 97 before using. This may be brought about by shaking it. Grasp the thermometer at the middle between the index finger and the thumb of the right hand, hold the bulb downward and hit the lower edge of the right hand against the upper edge of the left hand; the column of mercury will be lowered by the shock.

The normal respirations occur at the rate of 18 to the minute. In disease there are marked variations in the frequency and character of the respirations. They should be taken without the patient's knowledge, as they are in a measure under the control of the will. This is done by laying the arm across the chest in taking the pulse, and then without removing the fingers from the wrist taking the respiration while appearing to take the pulse.

In all acute diseases, especially those attended with fever, the question of diet is a very important one, and the main reliance may be placed on such food as eggs and milk. Thin soups may be used, but they contain very little nutrition and can not be depended upon to maintain the strength of the sick.

A patient sick of a communicable disease should be isolated and some one detailed for his care and comfort, who, if practicable, should be immune to the disease.

Communication between the patient or his nurse and other persons should be reduced to a minimum.

Used clothing, body linen, and bedding of the patient and nurse should be immersed in boiling water or in a 3 per cent solution of carbolic acid before removal from room, and should be kept so immersed for 1 hour.

Eating and drinking utensils, after being used by the patient, should be washed in boiling water. They should not be used by others until they have been sterilized by boiling.

The room from which the patient was removed should be disinfected and thoroughly cleansed.

Formulas for disinfecting solutions recommended for use.

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DOSES.-Unless otherwise stated, the doses mentioned in this book are intended for adults. To determine the dose for children, add 12 to the age of the child and divide the age of the child by this sum. This fraction will represent the size of dose compared with that of an adult. For example, a child 6 years 6 6 old will require or one-third of the adult dose. 6+12 18

CAUTION.-Preparations containing opium, such as laudanum, paregoric, camphor and opium pills, Sun Cholera Mixture tablets, etc., should not be used except where absolutely necessary, as their continued use is liable to produce the drug habit.

Typhoid fever is caused by a germ known as the bacillus typhosus. This bacillus is found in the discharges of persons sick with the disease and sometimes for a considerable time after their recovery. When the food or drink of well persons becomes contaminated with these discharges, typhoid fever is apt to result. This contamination may be brought about by means of flies which convey small particles of fecal matter containing the bacillus of typhoid fever from privies to kitchens and dining rooms and soil the food by lighting upon it. Drinking water may become infected through the drainage of a cess

1 Poisonous solutions should be colored blue with a little laundry bluing in order to distinguish them from nonpoisonous solutions.

pool into a well or near-by stream. Milk may carry the disease through the washing of milk cans with such water. Persons caring for typhoid-fever cases may infect themselves or others if they are not careful. Finally, there are patients who have recovered from the disease but who still have typhoid bacilli in their stools. These individuals are called "carriers" and may cause sickness among many other persons. This is especially the case if they are employed in milking cows or in the preparation of food.

Symptoms. Typhoid fever begins with headache, diarrhea, cramps in the abdomen, nosebleed, loss of appetite, coated tongue, dry mouth, and fever, which is higher each day than on the day previous. The stools are foul smelling and of the color and consistency of pea soup. In mild cases some of these symptoms may be absent. As a general thing the patient has been feeling badly for several days before the attack begins. At the end of the first week the patient is dull and apathetic, twitches his fingers, and picks at the bedclothes. There may be a low muttering delirium. The abdomen is distended with gas, and small rose-colored spots appear here and there on the body. Later on there may be hemorrhage due to ulceration of the bowel. Sometimes an ulcer will perforate the intestine and allow its contents to enter the general abdominal cavity; this usually causes death in a few hours. When hemorrhage or perforation occurs there is severe pain and the signs of shock are present. The pulse is weak and thready, the face is pale, the skin damp, and the temperature falls to normal. Typhoid fever lasts from 4 to 7 weeks. Convalescence is slow.

Abscesses and boils may form in various parts of the body, and bedsores are not uncommon. In persons who have used stimulants freely delirium tremens may be a prominent symptom. Pneumonia and meningitis are occasional complications.

Prevention. Wells suspected of being infected with sewage should be closed until it is proved that contamination has not taken place. Water that is suspicious, if it is necessary to use, should first be boiled or treated with bleaching powder, 1 teaspoonful to every 500 gallons of water. The powder should be dry and only that taken from a freshly opened can should be used. During a typhoid epidemic milk should be pasteurized. This is done by heating the milk to 150° F. and keeping it at that temperature for half an hour. (See p. 90.)

No person caring for a typhoid-fever patient should prepare food for others. The nurse should wash her hands carefully after waiting upon the patient and before she eats her meals. After washing they should be immersed in a solution of bichloride of mercury (two 7-grain tablets of bichloride of mercury to the quart of water), or

a solution of bleaching powder, one-half teaspoonful to a quart of water, for a few minutes. The wearing of rubber gloves by those handling the patient is a good additional safeguard. Thorough scrubbing of the hands with soap and water only will do much toward removing the infection from the hands.

All water used for bathing the patient should be disinfected by adding 1 teaspoonful of bleaching powder to each gallon of water. The dishes and utensils used in caring for the patient should be immersed in bleaching-powder solution of the same strength as that employed for the hands. The urine and stools should be boiled or completely covered and thoroughly mixed with a bleaching-powder solution made by adding 1 pound of bleaching powder to 4 gallons of water. The mixture should be allowed to stand at least one-half hour before emptying into the water-closet. If there is no watercloset or sanitary privy about the residence, the discharges should be buried in the ground about 1 foot deep at a point remote from wells, springs, and other sources of water supply. The excreta, if deposited in the ground, should be thoroughly covered with earth to prevent chickens and other animals from having access to it. All towels, sheets, and other cloths used about the patient should be boiled or disinfected with bleaching-powder solution. Persons who have had typhoid fever should not be permitted to handle food until they have been proved free of typhoid germs by a microscopical examination.

Typhoid prophylaxis.—When typhoid fever is prevalent everyone should be inoculated with antityphoid vaccine to prevent taking the disease. This vaccine has practically eliminated this disease from the Army. During the fiscal year 1916 there were 220 cases of typhoid fever among seamen, of whom 31 died; if this vaccine had been administered to these men before they were taken sick, it is safe to say none of them would have had the fever. An attack of typhoid fever usually lasts two months, and the patient is as a rule too weak to do much work for another month, so that at least 75 days are lost by each attack of this disease. From the above calculation it will be seen that this would amount to 16,500 days' sickness for those that survived.

Treatment. Place the patient in bed and do not let him get up. When he desires to have an action of the bowels, the bedpan should be used. He should have a liquid diet, plenty of water, milk, and thin soups, which should be given in liberal quantities, a cupful every two hours; no solid food should be allowed until 10 days after the fever has subsided. The temperature should be watched and the patient bathed with cold water whenever the fever rises above 39° C. (102.2° F.). Ice bags, if obtainable, applied to his abdomen and chest will assist in keeping the temperature down. One should also

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