,,american ,,red ,,cross ,,text-,,book ,,on ,,home ,,care ,,of ,,the ,,sick 999999 ,,delano ,,american ,,red ,,cross ,,text-,,book ,,on ,,home ,,hygiene ,,and ,,care ,,of ,,the ,,sick ,,by ,,jane ,a4 ,,delano1 ,r4 ,n4 ,chairman of the ,national ,committee1 ,red ,cross ,nursing ,service2 ,director1 ,department of ,nursing1 ,american ,red ,cross2 ,late ,superintendent of the ,nurse ,corps1 ,u4 ,s4 ,a42 of the ,training ,schools for ,nurses1 ,bellevue ,hospital1 ,new ,york ,city2 and of the ,training ,school for ,nurses1 ,hospital of the ,university of ,pennsylvania1 ,philadelphia ,,revised ,,and ,,rewritten ,,by ,,anne ,,hervey ,,strong1 ,r4 ,n4 ,professor of ,public ,health ,nursing1 ,simmons ,college1 ,boston ,this is the ,second ,edition of the ,american ,red ,cross ,text-book in ,elementary ,hygiene and ,home ,care of the ,sick by ,jane ,a4 ,delano and ,isabel ,mc,isaac4 ,,prepared ,,for ,,and ,,endorsed ,,by ,,the ,,american ,,red ,,cross ,,philadelphia ,p4 ,,blakiston',s ,,son ,,co4 #ajab ,,walnut ,,street ,,copyright1 #aiah1 ,,by ,,american ,,red ,,cross ,,the ,,maple ,,press ,,york ,,pa ,,preface ,to the woman who wishes to protect her family from preventable diseases and is anxious to fit herself in the absence of a trained nurse to give intelligent care to those who are sick1 this revision of the ,red ,cross text-book on ,elementary ,hygiene and ,home ,care of the ,sick is particularly directed4 ,it should appeal to men and to women who are interested in maintaining the health of their neighborhoods and communities and in affording effective coperation to the public health authorities4 ,to teachers wishing to impart protective health information to high school pupils1 the book also should be useful as a class text as well as a guide4 ,the war1 which has caused the withdrawal from private practice of thousands of physicians and graduate nurses1 makes it peculiarly important to the nation for every adult to have sound knowledge as to how to prevent contagion and epidemics1 especially by precautionary attention to home and local sanitation4 ,with nurses becoming more difficult to secure1 the safety of the family demands that some member in each household know enough about elementary nursing to make a patient comfortable and to carry out accurately the instructions of the physician4 ,the work of revision1 based upon the latest knowledge of hygiene1 sanitation and methods of home-nursing has been done by ,miss ,anne ,hervey ,strong1 ,professor of ,public ,health ,nursing1 ,simmons ,college1 under the personal direction of the author and the ,national ,committee on ,red ,cross ,nursing ,service4 ,the material has been painstakingly read by ,dr4 ,h4 ,w4 ,rucker and ,dr4 ,taliaferro ,clarke of the ,united ,states ,public ,health ,service1 and ,lieutenant ,colonel ,clarence ,h4 ,connor1 ,medical ,corps1 ,united ,states ,army4 ,indebtedness to ,dr4 ,h4 ,m4 ,mc,cracken1 ,president of ,vassar ,college and ,director of the ,red ,cross ,junior ,membership1 for his valuable suggestion as to adapting the book for high school use as well as for the assistance rendered by his ,department1 also is gladly acknowledged4 ,j4 ,a4 ,d4 ,,acknowledgment ,i wish to express my gratitude to those who have so kindly helped in the work of preparing the present edition4 ,thanks are especially due to ,professor ,isabel ,stewart1 ,miss ,anna ,c4 ,jamme1 ,professor ,curtis ,m4 ,hilliard1 ,professor ,maurice ,bigelow1 ,miss ,katharine ,lord1 ,miss ,josephine ,goldmark1 and ,miss ,evelyn ,walker4 ,a4 ,h4 ,s4 ,,contents ,,preface v ,,introduction xi ,,chapter ,i ,,page ,,causes ,,and ,,prevention ,,of ,,sickness #a ,communicable diseases1 #a4 ,micro-organisms and bacteria1 #a4 ,parasites1 #c4 ,structure and development of parasites1 #d4 ,bacteria1 #d4 ,shape1 #d4 ,size1 #e4 ,motion1 #e4 ,multiplication1 #e4 ,spores1 #g4 ,distribution1 #h4 ,protozoa1 #h4 ,visible parasites1 #h4 ,transmission of pathogenic organisms1 #i4 ,defenses of the body1 #ab4 ,immunity1 #ac4 ,vaccination and inoculation1 #ae4 ,carriers1 #ag4 ,non-communicable diseases1 #bj4 ,physical examinations1 #bb4 ,,chapter ,,ii ,,health ,,and ,,the ,,home #bg ,heredity1 #bg4 ,hygiene of environment and person1 #bh4 ,ventilation1 #bi4 ,lighting1 #cb4 ,cleanliness of houses1 #cc4 ,garbage1 #cg4 ,insects1 #ch4 ,sewage1 #ci4 ,personal cleanliness1 #da4 ,oral hygiene1 #dd4 ,treatment of teeth1 #df4 ,clothing1 #dg4 ,food1 #dh4 ,elimination1 #eb4 ,rest and fatigue1 #ec4 ,sleep1 #ee4 ,recreation1 #ee4 ,,chapter ,,iii ,,babies ,,and ,,their ,,care #fj ,growth and development1 #fd4 ,average size1 #fd4 ,muscular development1 #fe4 ,development of special senses1 of speech1 of teeth1 #ff4 ,normal excretions1 #fg4 ,clothing1 #fh4 ,sleep1 #gj4 ,fresh air1 #gb4 ,diet1 #gb4 ,intervals of feeding1 #gc4 ,water1 #ge4 ,weaning1 #ge4 ,nursing bottles and nipples1 #ge4 ,tables of diet1 #gh4 ,bathing1 #gh4 ,eyes1 #hj4 ,mouth1 #ha4 ,nostrils1 #ha4 ,genital organs1 #ha4 ,development of habits1 #hb4 ,exercise1 #hc4 ,play and toys1 #he4 ,,chapter ,,iv ,,indications ,,of ,,sickness #hh ,objective symptoms1 #ib4 ,temperature1 #ib4 ,pulse1 #if4 ,respiration1 #ii4 ,general appearance1 #ajj4 ,special senses1 #aja4 ,voice1 tongue1 throat1 gums1 #ajb4 ,cough1 #ajc4 ,appetite1 #ajc4 ,excretions1 #ajc4 ,loss of weight1 #ajd4 ,sleep1 #ajd4 ,mental conditions1 #ajd4 ,subjective symptoms1 #aje4 ,pain1 #aje4 ,records1 #ajg4 ,tuberculosis1 cancer and mental illness1 #ajg4 ,tuberculosis1 #aji4 ,cancer1 #aaa4 ,mental illness1 #aab4 ,,chapter ,v ,,equipment ,,and ,,care ,,of ,,the ,,sick ,,room #aag ,choice of a sick room1 #aah4 ,furnishing1 #abj4 ,ventilation1 #abc4 ,heating1 #abd4 ,lighting1 #abd4 ,cleaning1 #abf4 ,the attendant1 #abg4 ,,chapter ,,vi ,,beds ,,and ,,bedmaking #acb ,bedsteads1 #acc4 ,mattresses1 #ace4 ,care of the mattress1 #acf4 ,pillows1 #acf4 ,protection of the mattress and pillows1 #acg4 ,rubber sheets and pillow-cases1 #ach4 ,sheets1 #aci4 ,draw sheets1 #aci4 ,pillow covers1 #adj4 ,blankets1 #adj4 ,comforters and quilts1 #ada4 ,counterpanes1 #ada4 ,bedmaking1 #ada4 ,to make an unoccupied bed1 #adc4 ,to change a patient's pillows1 #adf4 ,lifting a patient in bed1 #adf4 ,to turn a patient in bed1 #adg4 ,to change sheets while patient is in bed1 #adg4 ,to move patient from one bed to another1 #aej4 ,,chapter ,,vii ,,baths ,,and ,,bathing #aed ,cleansing baths1 #aed4 ,bed bath1 #aef4 ,care of the mouth and teeth1 #afj4 ,care of the hair1 #afc4 ,to wash the hair of a bed patient1 #afd4 ,hot foot-baths1 #afe4 ,cool sponge bath1 #aff4 ,,chapter ,,viii ,,appliances ,,and ,,methods ,,for ,,the ,,sick-,,room #afi ,devices to give support1 #agb4 ,bedpans1 #agf4 ,daily routine in the sick-room1 #agi4 ,time for visitors1 #ahb4 ,,chapter ,,ix ,,feeding ,,the ,,sick #ahg ,the digestive process1 #ahh4 ,feeding the sick1 #aia4 ,liquid diet1 #aib4 ,semi-solid diet1 #aib4 ,light or convalescent diet1 #aic4 ,full diet1 #aic4 ,serving food for the sick1 #aie4 ,to feed a helpless patient1 #aig4 ,,chapter ,x ,,medicines ,,and ,,other ,,remedies #bjj ,action of drugs1 #bjj4 ,amateur dosing1 #bjb4 ,patent remedies1 #bje4 ,administration of medicine1 #bjf4 ,suppositories1 #bji4 ,enemata1 #baj4 ,sprays and gargles1 #bac4 ,inhalation1 #bac4 ,inunction1 #bad4 ,household medicine cupboard1 #bae4 ,,chapter ,,xi ,,application ,,of ,,heat1 ,,cold ,,and ,,counter-,,irritants #bbj ,inflammation1 #bbj4 ,hot applications1 #bbe4 ,dry heat1 #bbe4 ,moist heat1 #bbg4 ,stupes or hot fomentations1 #bbi4 ,cold applications1 #bca4 ,dry cold1 #bca4 ,moist cold1 #bcb4 ,cold compresses for the eyes1 #bcb4 ,counter-irritants1 #bcc4 ,mustard paste1 #bcc4 ,mustard leaves1 #bcd4 ,,chapter ,,xii ,,care ,,of ,,patients ,,with ,,communicable ,,diseases #bcf ,incubation period1 #bch4 ,care of patients with colds or other slight infections1 #bch4 ,care during more serious infections1 #bdb4 ,children's diseases1 #bdf4 ,rules for isolation and exclusion from school1 #bdg4 ,disinfection1 #bdh4 ,care of nose and throat discharges1 #bdi4 ,care of discharges from the bowels and bladder1 #bdi4 ,bath water1 #bej4 ,care of the hands1 #bej4 ,care of utensils1 #bea4 ,care of linen1 #bea4 ,disinfection of the person1 #beb4 ,termination of quarantine1 #beb4 ,terminal disinfection1 #bec4 ,fumigation1 #bed4 ,,chapter ,,xiii ,,common ,,ailments ,,and ,,emergencies #beg ,conditions in which the nervous system is involved1 #beg4 ,headache1 #beg4 ,sleeplessness1 #beh4 ,fainting1 #bei4 ,convulsions1 #bfj4 ,shock1 #bfa4 ,stimulants1 #bfc4 ,sunstroke and heat exhaustion1 #bfd4 ,conditions in which the digestive tract is affected1 #bfe4 ,nausea and vomiting1 #bfe4 ,hiccough1 #bfe4 ,diarrha1 #bff4 ,constipation1 #bff4 ,colic1 #bff4 ,conditions in which the eyes or ears are affected1 #bfg4 ,styes1 #bfg4 ,foreign bodies in the eye1 #bfg4 ,disorders affecting the ears1 #bfh4 ,conditions in which the skin is affected1 #bfi4 ,prickly heat1 #bfi4 ,insect bites and stings1 #bgj4 ,ivy poisoning1 #bgj4 ,other emergencies1 #bgj4 ,chills1 #bgj4 ,croup1 #bga4 ,bleeding1 #bgb4 ,treatment of slight wounds1 #bgb4 ,nose bleed1 #bgd4 ,profuse menstruation1 #bge4 ,other injuries1 #bge4 ,sprains1 #bge4 ,bruises1 #bgf4 ,burns and scalds1 #bgg4 ,brush burn1 #bgh4 ,,chapter ,,xiv ,,special ,,points ,,in ,,the ,,care ,,of ,,children1 ,,convalescents1 ,,chronics1 ,,and ,,the ,,aged #bhj ,children1 #bha4 ,physical defects1 #bhc4 ,eye-strain1 #bhd4 ,enlarged tonsils and adenoids1 #bhd4 ,defective hearing1 #bhe4 ,defective teeth1 #bhf4 ,posture1 #bhf4 ,predisposition to nervousness1 #bib4 ,convalescent patients1 #bid4 ,chronic patients1 #bii4 ,care of the aged1 #cjc4 ,,chapter ,,xv ,,questions ,,for ,,review #cab ,,appendix #cai ,circulars of information issued by ,division of ,child ,hygiene1 ,new ,york ,department of ,health4 ,,glossary #cbf ,,index #cca ,,introduction ,health and sickness1 at all times momentous factors in the welfare of our nation1 now as never before are matters of vital importance4 ,to win its victories both in peace and in war1 the nation needs all its citizens with all their powers1 and it is a matter of more than passing interest that1 as conservative estimates show1 at least three persons out of every hundred living in the ,united ,states are constantly incapacitated by serious sickness4 ,in #aiaj these seriously sick persons numbered more than #c1jjj1jjj4 ,even more significant1 perhaps1 is the fact that at least half of our national sickness could be prevented if knowledge and resources that we now possess were fully utilized4 ,the problem of sickness is by no means peculiar to our own day and generation4 ,it has been a medical1 a religious1 and a social problem in every age4 ,from the time of ,job its meaning has baffled philosophers2 from his day to ours thoughtful men have devoted their lives to searching for causes and cures4 ,yet before the middle of the last century little progress was made1 either in scientific treatment or in prevention of disease4 ,the invention of the microscope first made possible a real understanding of sickness4 ,through the microscope a new world was revealed1--a world of the infinitely small1 swarming with tiny forms of animal and vegetable life4 ,no one1 however1 appreciated the significance of these hitherto invisible plants and animals until the latter part of the #aith century1 when the great ,french savant1 ,pasteur1 proved that little vegetable forms1 now called bacteria1 cause putrefaction and fermentation1 and also certain diseases of animals and man4 ,pasteur's discoveries were carried still further by other scientists1 with the result that bacteriology has revolutionized medicine1 agriculture1 and many industries1 and has made possible the brilliant achievements of modern sanitary science4 ,for the first time in history the prevention of epidemics has become possible1 and sickness is no longer regarded as a punishment for sin4 ,actual care of the sick1 both in homes and in hospitals1 has always been one of the responsibilities of women4 ,the first general public hospital was built in ,rome in the #dth century after ,christ by ,fabiola1 a patrician lady4 ,there she nursed the sick with her own hands1 and from her day to ours extends an unbroken line of devoted women1 handing down through the centuries their tradition of compassionate nursing service4 ,it remained for ,florence ,nightingale1 however1 to give to the training its technical and scientific foundation1 and thus to found the profession of nursing4 ,as a result of her work1 effectiveness was added to the spirit of service1 that spirit which inspires the modern nurse no less than in an earlier day it inspired the ,sisters of ,charity who died nursing the wounded on the battlefields of ,poland4 ,but different generations have different needs1 and to meet them the spirit of service must manifest itself in widely varying ways4 ,the sick need care today no less than they did when ,st4 ,elizabeth bathed the feet of the lepers2 but such limited service1 however beautiful1 is no longer enough4 ,today we serve best by preventing sickness4 ,cure of sickness and alleviation of suffering must never be neglected2 not in cure1 however1 but in prevention lies the hope of modern sanitary science1 of modern medicine1 and of modern nursing4 ,nearly every woman at some time in her life is called upon to assist in caring for the sick4 ,indeed1 approximately #ij of all sick persons in the ,united ,states are cared for at home1 even in cities where hospital facilities are good4 ,moreover1 every woman is largely responsible for maintaining her own health1 and few escape responsibility at some time for maintaining the health of others4 ,for such responsibility most women are poorly prepared4 ,every year in our own country thousands of persons1 many of them babies and children1 die merely because someone1 in many cases a woman1 is fatally ignorant of the laws governing sickness and health4 ,only prolonged and careful training1 such as good hospital training-schools afford1 can furnish the skill and judgment required in nursing persons who are seriously ill4 ,upon the trained nurse the modern practice of medicine makes great and ever-increasing demands3 a nurse must perform complicated duties1 meet critical situations1 and carry out a wide variety of measures based on scientific principles which she must understand4 ,good will and sympathy are no longer enough2 amateur nursing1 even when performed with the best intentions1 may involve grave dangers for those who are seriously ill4 ,on the other hand1 although it is true that a little knowledge is a dangerous thing1 it is no less true that total ignorance may be more dangerous still4 ,for instance1 in cases of incipient1 slight1 or chronic illness1 and in certain emergencies a little knowledge may be safer far than no knowledge at all2 and no one1 surely1 should be ignorant of the principles of hygiene4 ,the ,american ,red ,cross1 recognizing the part that women can and should play in preventing sickness and in building up the health and vigor of the nation1 has added to its larger patriotic services this elementary course of instruction in hygiene and home care of the sick4 ,the lessons are not intended to take the place of a nurse's training1 and procedures requiring technical skill are necessarily omitted4 ,the object of the book is to supply a little knowledge of sickness1 which though limited may yet be safe4 ,the book is also designed to set forth some general laws of health2 to make possible earlier recognition of symptoms2 to teach greater care in guarding against communicable disease2 and to describe some elementary methods of caring for the sick1 which1 however simple1 are essential to comfort1 and sometimes indeed to ultimate recovery4 ,,for ,,further ,,reading ,a ,history of ,nursing--,dock and ,nutting1 ,volume ,i4 ,the ,life of ,florence ,nightingale--,cook4 ,the ,life of ,pasteur--,vallery-,radot4 ,the ,house on ,henry ,street--,wald4 ,public ,health ,nursing--,gardner1 ,part ,i1 ,chapters ,i-,,iii4 ,origin and ,growth of the ,healing ,art--,berdoe4 ,medical ,history from the ,earliest ,times--,withington4 ,under the ,red ,cross ,flag--,boardman4 ,report on ,national ,vitality--,fisher1 7,bulletin #cj of the ,committee of ,one ,hundred on ,national ,health4 ,government ,printing ,office1 ,washington74 ,,chapter ,i ,,causes ,,and ,,prevention ,,of ,,sickness ,diseases of two kinds have long been recognized3 first1 those transmitted directly or indirectly from person to person1 like smallpox1 measles1 and typhoid fever2 and second1 diseases like heart disease and apoplexy1 which are not so transmitted4 ,these two classes are popularly called catching and not catching2 the former are the infectious or communicable diseases1 and the latter the non-infectious or non-communicable4 ,the term contagious1 formerly applied to diseases supposed to be spread only by direct contact1 is no longer an accurate or useful term4 ,,the ,,communicable ,,diseases ,the invention of the microscope1 as we have seen1 revealed the existence of innumerable little plants and animals1 so small that even many millions crowded together are invisible to the naked eye4 ,these tiny living creatures are called micro-organisms or germs4 ,the plant forms are called bacteria 7singular1 bacterium71 and the animal forms protozoa 7singular1 protozon74 ,the common belief that all or even most bacteria are harmful is quite unfounded4 ,as a matter of fact1 while not less than #aejj different kinds of micro-organisms or germs are known1 only about #ge varieties are known to produce disease4 ,most bacteria belong to the class of micro-organisms called saprophytes1 which find their food in dead organic matter1 both animal and vegetable1 and cannot flourish in living tissues4 ,these saprophytes act upon the tissues of dead animals and vegetables1 and resolve them into simpler substances1 which are then ready to serve as nourishment for plants higher in the vegetable kingdom4 ,thus the processes which we know as fermentation and putrefaction are due to the action of saprophytes4 ,higher plants in turn furnish food for men and animals1 and so the food supply is used over and over in different forms1 making what is known as the food cycle4 ,if it were not for bacterial activities vegetation would be robbed of its supply of nourishment1 and plant life would speedily end2 destruction of plant life would deprive the animal kingdom of food and thus all life would become extinct4 ,the saprophytes are consequently essential to the existence of both animals and vegetables4 ,there are1 however1 other organisms called parasites1 which can exist in living tissues of animals or vegetables4 ,the organisms at whose expense the parasites live are called their hosts4 ,parasites not only contribute nothing to their hosts1 but generally harm them by producing poisonous substances or depriving them of food4 ,some parasites are able to lead a saprophytic existence also1 but as a rule they live at the expense of animal or plant life4 ,pathogenic1 or disease-producing1 germs belong to the group of parasites4 ,the pathogenic germs which find favorable soil in the body produce poisons called toxins4 ,these poisons or toxins interfere with the bodily functions1 and thus cause what we know as communicable disease4 ,communicable diseases are caused by specific germs only3 that is1 a certain disease cannot develop unless its particular germs are present2 the germs of typhoid for instance1 can cause typhoid fever only1 and not tuberculosis or other disease4 ,a number of diseases are caused by micro-organisms that are now well known4 ,chief among these diseases are colds1 septicmia 7blood poisoning71 influenza1 pneumonia1 diphtheria1 typhoid fever1 tuberculosis1 whooping cough1 ,asiatic cholera1 bubonic plague1 meningitis1 tetanus 7lock jaw71 leprosy1 gonorrha1 syphilis1 relapsing fever1 typhus fever1 glanders1 and anthrax4 ,micro-organisms not yet identified probably cause the communicable diseases whose origin is not known with certainty4 ,these include infantile paralysis1 smallpox1 scarlet fever1 measles1 mumps1 chicken-pox1 ,rocky ,mountain spotted fever1 yellow fever1 hydrophobia 7rabies71 foot-and-mouth disease4 ,we can hardly doubt that the intensive laboratory research now in progress will reveal in the near future the specific germs of these diseases also4 ,,structure ,,and ,,development ,,of ,,parasites ,the group of parasites consists of two general classes1 the vegetable1 and the animal4 ,in the former class belong the bacteria1 and in the latter the protozoa4 ,the two classes are not sharply differentiated1 but in general the vegetable parasites are less highly organized than the animal4 ,,bacteria ,,shape4--,bacteria are composed of single cells and are consequently called unicellular organisms4 ,under the microscope individual cells are seen to differ in size1 shape1 and structure4 ,in shape bacteria show three different types2 the rod-shaped 7bacillus71 the spherical 7coccus71 and the spiral 7spirillum74 ,the organisms causing typhoid fever for example are a variety of bacilli1 those causing pneumonia are cocci1 while those causing ,asiatic cholera are spirilla4 ,illustration3 ,,fig4 #a4--;,,bacilli ,,of ,,various ,,forms4 7,williams47 ,,size4--,bacteria vary greatly in size4 ,average rod-shaped bacteria are about #a_/bejjj of an inch long1 but there are undoubtedly organisms so small that they cannot be seen1 even by means of the strongest microscopes we now possess4 ,illustration3 ,,staphylococci4 ,,streptococci4 ,,diplococci4 ,,tetrads4 ,,sarcin4 ,,fig4 #b4--7,williams47 ,,motion4--,the power of motion in certain species of bacteria is due to hair-like appendages called flagella4 ,these flagella by a lashing movement somewhat resembling the action of oars enable the organisms to move through fluids4 ,,multiplication4--,after bacteria have fully developed1 each cell divides into two equal parts2 the process of division is called fission4 ,each of these two parts rapidly grows into a full-sized organism4 ,then fission again takes place1 so that four bacteria replace the original one4 ,in each of the four1 fission occurs again1 and so the process of multiplication continues4 ,as bacteria develop they group themselves in characteristic ways4 ,some1 like the streptococci1 arrange themselves in chains2 the diplococci1 in pairs2 the tetrads1 in groups of four2 others in packets called sarcin1 and still others1 the staphylococci1 form masses supposed to resemble bunches of grapes4 ,illustration3 ,,fig4 #c4--,,spirilla ,,of ,,various ,,forms4 7,williams47 ,illustration3 ,,fig4 #d4--;,,bacteria ,,showing ,,flagella4 7,williams47 ,under favorable conditions fission occurs rapidly2 in some types a new generation may appear as often as every #ae minutes4 ,enormous multiplication would result if nothing occurred to check the process4 ,but in nature such increase never continues unhindered1 and bacteria1 acting upon their food substances1 produce acids and other materials injurious to themselves4 ,furthermore1 lack of proper food1 moisture1 or favorable temperature1 and competition with other organisms tend to prevent their unrestricted growth and multiplication4 ,illustration3 ,,fig4 #e4--;,,bacteria ,,with ,,spores4 7,williams47 ,,spores4--,most bacteria die if conditions become unfavorable to their growth1 but some enter into a resting stage4 ,this stage is characterized by the development of round or oval glistening bodies called spores1 which are of dense structure and possess an extraordinary power to withstand heat1 chemicals1 and unfavorable surroundings4 ,except in rare instances a single cell produces but one spore4 ,as soon as favorable conditions of temperature1 moisture1 and food supply are restored1 the spore develops into the active form of the germ2 it may1 however1 remain dormant for months or years4 ,spore formation1 however1 occurs in only a very few varieties of pathogenic bacteria4 ,,distribution4--,bacteria are very widely distributed in nature2 they are in fact found practically everywhere on the surface of the earth4 ,they are present in plants and water and food2 on fabrics and furniture1 walls and floors2 and they are found in great numbers on the skin1 hair1 many mucous surfaces1 and other tissues of the body4 ,,protozoa ,the protozoa are the lowest group of the animal kingdom4 ,like bacteria they are composed of single cells so small as to be visible only under the microscope4 ,they play an important part in causing certain diseases of man1 especially in the tropics4 ,among the well-known human diseases of protozoan origin are malaria1 amoebic dysentery1 and sleeping-sickness4 ,protozoa also cause several wide-spread and serious plagues of domestic animals4 ,,visible ,,parasites ,a few diseases are caused by parasites large enough to be seen with the naked eye4 ,one of the most important is hookworm disease4 ,this disease is caused by a tiny worm which penetrates the victim's skin and ultimately finds its way into the intestine4 ,other diseases also are caused by parasitic worms1 such as tapeworms1 pinworms1 and trichin4 ,the latter are acquired as a result of eating infected meat1 particularly infected pork that has not been thoroughly cooked4 ,,transmission ,,of ,,pathogenic ,,organisms ,pathogenic or disease producing organisms need for their development food1 moisture1 darkness1 and warmth1 conditions that exist within the human body4 ,when one or more of these factors is unfavorable1 development of germs is checked2 if unfavorable conditions are extreme or long continued1 the organisms begin to die4 ,it is difficult to say at exactly what moment they will die if deprived of moisture or exposed to extremes of temperature or other unfavorable conditions1 just as it would be impossible to state at exactly what moment a collection of house plants would all be dead if water were withheld1 or if the room temperature were greatly reduced4 ,most pathogenic organisms1 however1 do not flourish long outside the body1 and owe their continued existence to a fairly direct transfer from person to person4 ,they gain access to the body through mucous surfaces such as the respiratory and digestive tracts1 and through breaks in the skin1 such as cuts1 abrasions1 and the bites of certain insects4 ,they leave the body chiefly in the nasal and mouth discharges1 as in coughing1 sneezing1 and spitting1 in the urine and bowel discharges1 and in pus or matter4 ,illustration3 ,,fig4 #f4 7,l4 ,h4 ,wilder47 ,the problem of controlling communicable diseases1 consequently1 lies in preventing the bodily discharges of one person from travelling directly into the body of another4 ,if a person is not expelling pathogenic germs1 it is clear that he cannot pass diseases on to others4 ,but both pathogenic and harmless germs follow the same routes from person to person1 so that safety as well as decency lies in preventing so far as possible all exchanges of bodily discharges4 ,there are five routes by which the bodily discharges most frequently travel from one person to another4 ,four of these routes of infection are called public1 because in most cases efforts of individuals alone are not sufficient to control them4 ,the public routes are water1 milk1 food1 and insects4 ,the fifth1 or private route1 includes all means by which fresh discharges of one person are passed to another1 as when nose and mouth discharges are carried in coughing1 sneezing1 and kissing1 or when bowel and bladder discharges are carried by the hands4 ,these five routes in a given case differ greatly in relative importance1 but the fifth1 or direct route plays an immense part1 although its importance in causing sickness has only lately been recognized4 ,it cannot be too strongly emphasized that the chief agent in the spread of human diseases is man himself1 and the human hand is the great carrier of disease germs both to and from the body4 ,if unclean hands could be kept away from the orifices of the body1 particularly the mouth1 many diseases would soon cease to exist4 ,defenses of the ,body ,in view of all the dangers from disease-producing germs it may seem surprising that the human race has not long ago succumbed to its invisible enemies4 ,but the body has various defenses by means of which it may prevent invasion1 or successfully combat its enemies in case they do gain access4 ,the unbroken skin is usually impassable to bacteria4 ,virulent organisms are often found upon the skin of perfectly healthy persons1 where they appear to be harmless unless an abrasion occurs which affords entrance into the deeper tissues4 ,most bacteria breathed in with the air cling to the moist surfaces of the air-passages and never reach the lungs4 ,mucous membranes lining the mouth and other cavities of the body would prove favorable sites for the growth of bacteria if the mucus secreted by them were not frequently removed4 ,the mouth of a healthy person may contain bacteria of many kinds1 but the saliva has a slight disinfectant power and serves as a constant wash to the membranes4 ,the normal gastric 7stomach7 juice is decidedly unfavorable to the growth of bacteria1 although it does not always kill them2 they often pass through the stomach and are found in large numbers in the intestines4 ,other bodily secretions1 such as the tears and perspiration1 tend to discourage bacterial growth4 ,tissues of the body vary greatly in their power to resist invading germs1 so that the route by which germs enter influences the severity of their effects4 ,typhoid bacilli and the spirilla of ,asiatic cholera when taken with food or water produce far more serious disturbances than when injected under the skin2 infections from pus germs through an abrasion of the skin may result in a slight local disturbance1 while the same amount introduced into a deeper wound might cause a fatal infection4 ,certain germs nourish in certain tissues only2 even tuberculosis1 which attacks practically all tissues1 has its favorite locations4 ,,immunity4--,in addition to its mechanical defenses against disease1 the body shows a varying degree of immunity1 or the power possessed by living organisms to resist infections4 ,immunity or resistance is the opposite of susceptibility4 ,it is exceedingly variable1 being greater or less in different people and under different conditions1 but the exact ways in which it is brought about are still in many cases far from clear4 ,immunity may be natural or acquired4 ,by natural immunity is meant an inherited characteristic by which all individuals of a species are immune to a certain disease4 ,the natural immunity of certain species of animals to the diseases of other animals is well known4 ,man is immune to many diseases of lower animals1 and they in turn are immune to many diseases of man4 ,cattle1 for instance1 are immune to typhoid and yellow fever1 while man shows high resistance to rinderpest and ,texas fever2 both1 however1 are susceptible to tuberculosis1 to which goats are immune4 ,there are all gradations of immunity within the same species4 ,moreover1 certain individuals have a personal immunity against diseases to which others of the same race or species are susceptible4 ,immunity may be acquired in several ways4 ,it is commonly known that one attack of certain communicable diseases renders the individual immune for a varying length of time1 and sometimes for life4 ,among these diseases are smallpox1 measles1 whooping-cough1 scarlet fever1 infantile paralysis1 typhoid fever1 chicken-pox1 and mumps2 erysipelas and pneumonia on the other hand appear to diminish resistance and to leave a person more susceptible to later attacks4 ,again1 in some cases immunity may be artificially acquired by introducing certain substances into the body to increase its resistance4 ,examples of this method include the use of antitoxin as a protection against diphtheria1 of sera in pneumonia and other infections1 and vaccination against smallpox and typhoid fever whereby a slight form of the disease is artificially induced4 ,laboratory research goes on constantly1 and doubtless many more substances will eventually be discovered that will reduce human misery as vaccines and antitoxin have already reduced it4 ,vaccination and inoculation have saved thousands of lives4 ,smallpox1 once more prevalent than measles1 was the scourge of ,europe until vaccination was introduced4 ,during the #ahth century it was estimated that #fj1jjj1jjj people died of it1 and at the beginning of the #aith century one-fifth of all children born died of smallpox before they were #aj years old4 ,in countries where vaccination is not practised the disease is as serious as ever2 in ,russia during the five years from #ahic-ig1 #bge1ejb persons died of smallpox1 while in ,germany where vaccination is compulsory1 only #h people died of it during the year #ahig4 ,death rates from diphtheria and typhoid fever have been greatly reduced by the use of antitoxin and antityphoid vaccine4 ,thus in ,new ,york ,state in #ahid1 before antitoxin was generally used1 #ii out of every #ajj1jjj of the population died of diphtheria1 while only #bj out of #ajj1jjj died of it in #aiad4 ,in #aiaa a ,united ,states ,army ,division of more than #ab1jjj men camped at ,san ,antonio1 ,texas1 for four months4 ,all of these men were vaccinated against typhoid fever and only a single case occurred during the summer1 although conditions of camp life always tend to spread the disease4 ,while many and various factors tend to lower resistance rather than to increase it1 the idea that these factors act equally in all kinds of infection is erroneous4 ,the principal causes which diminish resistance to infection are3 wet and cold1 fatigue1 insufficient or unsuitable food1 vitiated atmosphere1 insufficient sleep and rest1 worry1 and excesses of all kinds4 ,the mechanism by which these varying conditions lower our immunity must receive our attention1 for they are of the greatest importance in preventive medicine4 ,it is a matter of common observation that exposure to wet and cold or sudden changes of temperature1 overwork1 worry1 stale air1 poor food1 etc41 make us more liable to contract certain diseases4 ,the tuberculosis propaganda that has been spread broadcast with such energy and good effect has taught the value of fresh air and sunshine1 good food1 and rest in increasing our resistance to this infection4 ,there is1 however1 a wrong impression abroad that because a lowering of the general vitality favors certain diseases1 such as tuberculosis1 common colds1 pneumonia1 septic and other infections1 it plays a similar rle in all communicable diseases4 ,many infections1 such as smallpox1 measles1 yellow fever1 tetanus1 whooping-cough1 typhoid fever1 cholera1 plague1 scarlet fever1 and other diseases1 have no particular relation whatever to bodily vigor4 ,these diseases often strike down the young and vigorous in the prime of life4 ,the most robust will succumb quickly to tuberculosis if he receives a sufficient dose of the virulent micro-organisms4 ,a good physical condition does not always temper the virulence of the disease2 on the contrary1 many infections run a particularly severe course in strong and healthy subjects1 and1 contrariwise1 may be mild and benign in the feeble4 ,physical weakness1 therefore1 is not necessarily synonymous with increased susceptibility to all infections1 although true for some of them4 ,in other words1 'general debility' lowers resistance in a specific1 rather than in a general1 sense4--7,rosenau3 ,preventive ,medicine and ,hygiene1 pp4 #djc and #djd47 ,,carriers ,well persons who carry in their bodies pathogenic germs but who themselves have no symptoms of disease are called carriers4 ,thus typhoid carriers have typhoid bacilli in the intestinal tract1 while they themselves show no symptoms of typhoid fever2 diphtheria carriers have bacilli of diphtheria in the throat or nose1 but have themselves no symptoms of diphtheria1 and so on4 ,it has now been proved that many patients harbor bacteria for weeks1 months1 or even years following an infection1 and are dangerous distributors of disease2 also1 some healthy individuals without a history of illness harbor living bacteria which may infect susceptible persons in the usual ways4 ,transmission by healthy carriers goes far to explain the occurrence of diseases among persons who have apparently not been exposed4 ,this explanation has greatly clarified the whole problem of the spread of communicable diseases4 ,carriers1 unfortunately1 exist in large numbers1 and render the ultimate control of disease exceedingly difficult4 ,they can usually be identified by bacteriological tests4 ,to some extent they can be supervised2 food handlers at least should be legally obliged to submit to physical examinations1 and should be licensed only when proved free from communicable disease4 ,diseases are also spread by persons suffering from them in a form so mild or so unusual that they pass unrecognized4 ,these persons are known as missed cases4 ,carriers of disease and missed cases go freely about the community1 handling food1 using common drinking cups1 travelling in crowded street cars1 standing in crowded shops2 in various ways coming into close contact with other people1 coughing and sneezing and kissing their friends no less often than normal individuals4 ,it is consequently clear that the bodily discharges of supposedly normal persons may be hardly less a menace than those of persons known to be infected4 ,diseases that depend for transmission upon milk1 water1 food1 and insects may be controlled by public action1 that is1 by specific measures taken by a large group of people in order to protect the individual4 ,such action constitutes public sanitation4 ,there is1 however1 a large group of diseases1 chiefly sputum-borne1 that cannot be controlled except by individual action4 ,such individual action constitutes a large part of personal hygiene4 ,the whole problem of controlling infections sounds simple1 depending as it does for the most part upon unpolluted water1 milk1 and food1 extermination of certain insects1 and cleanliness in personal behaviour4 ,in practice the problem is not so easy4 ,public sanitation has performed miracles in the past1 and will do much in the future2 behaviour1 however1 will continue to be influenced by many factors1 social and economic as well as personal4 ,ignorance of the laws of health is an obstacle to progress1 but in modern conditions even the instructed may be unable to control their ways of living and working4 ,indeed1 such control is at present limited to the privileged few4 ,on the ignorant and the poor1 those least able to bear it1 society loads the heaviest burden of sickness4 ,only when ignorance and poverty are abolished1 as one day they will be1 can the final stage be reached in the fight for public health4 ,,the ,,non-,,communicable ,,diseases ,in this group is included a great variety of maladies4 ,of some the causes are known1 while in the case of others1 origin1 prevention1 and remedy are still obscure4 ,here belong defects in structure of the body1 both hereditary and acquired2 insanity and other nervous diseases2 new growths1 like tumors and cancer2 disturbances of bodily processes1 as malnutrition and gout2 and the important class of degenerative diseases1 like arteriosclerosis1 in which tissues become hardened and fibrous and hence less able to perform their normal functions4 ,the degenerative diseases are playing a menacing part in national health4 ,the average length of life in the ,united ,states has shown a marked increase it is true1 during the last #dj years4 ,but this gain represents chiefly the saving of life through prevention of communicable diseases1 especially among babies and children2 among people who have passed the #cjth year on the other hand1 death rates are actually increasing4 ,this increase is most marked after the age of #de1 and is caused chiefly by the increase of cancer1 and of degenerative diseases of the heart1 blood vessels1 and kidneys4 ,degeneration of tissues is normally a condition typical of old age1 and in aged persons it may occur in any tissue4 ,there is no elixir of youth1 and for old age there is no cure4 ,but the important facts in this connection are that degenerative changes now occur prematurely1 and that among a vast number of people1 in various classes of society and various occupations1 the vital organs show a marked tendency to break down after the age of #de4 ,this condition is not inevitable4 ,before the beginning of the present war1 death rates at all ages were decreasing in ,england1 ,sweden1 and other ,european countries4 ,in ,america also degenerative diseases can be checked or prevented to a large extent1 and it is highly important that their causes should be generally understood4 ,the two groups following include some of the probable causes3 #a4 ,conditions of life which result in continued overwork1 and mental overwork in particular2 worry1 excitement1 insufficient recreation and exercise1 and other kinds of nervous strain typical of modern life1 especially in cities4 #b4 ,irritating substances in the body1 including poisonous substances resulting from infectious diseases1 and from syphilis in particular2 poisons from chronic infections1 alcohol1 and industrial poisons such as lead and other metals2 overeating and improper eating1 especially of meat and other proteins1 and rich or highly seasoned food2 faulty digestion1 constipation1 and imperfect elimination through the kidneys4--7,see ,dr4 ,a4 ,e4 ,shipley1 in bulletin of the ,n4 ,y4 ,city ,dept4 of ,health1 ,feb41 #aiae47 ,the importance of early recognition cannot be overemphasized4 ,in many of these troubles the symptoms are not pronounced1 and the victims have no knowledge of their condition until they happen to be examined for life insurance1 or until the disease is far advanced4 ,and even when they realize that trouble exists1 as for example constipation or overwork1 most people absolutely fail to realize how serious the consequences may be4 ,the first step toward remedy is periodic complete physical examination by a competent physician1 in order to learn in time how to prevent these degenerative diseases1 if present1 from growing worse4 ,the custom of undergoing an annual physical examination is becoming more common1 and such a course1 conservatively estimated1 would add #e years to the average life of persons between #de and #ej4--7,winslow47 ,recently1 we have been making examinations of the employees of whole institutions1 large banks and other industrial concerns in ,new ,york ,city1 and we find almost the same conditions there4 ,out of #bjjj such examinations among young men and women of an average age of #cc1 just in the early prime of life1 men and women supposedly picked because of their especial fitness for work1 only #c4ad were found free of impairment or of habits of living which are obviously leading to impairment4 ,of the remaining persons1 #if4fi were unaware of impairment2 #e4ch of the total number examined were affected with chronic heart trouble2 #ac4aj with arteriosclerosis2 #be4ha with high or low blood pressure2 #ce4fe with sugar1 casts or albumen in the urine2 #ab4gg with combination of both heart and kidney disease2 #bb4bb with decayed teeth or infected gums2 #af4jc with faulty vision uncorrected4444 ,the fact of greatest import1 however1 was that impairment1 sufficiently serious to justify the examiner in referring the examinee to his family physician for medical treatment1 was found in #ei of the total number of cases1 while #cg4hf were on the road to impairment because of the use of too much alcohol1 or too much tobacco1 constipation1 eye-strain1 overweight1 diseased mouths1 errors of diet1 and so forth4444 ,and what is the cause of this appalling increase1 in the ,united ,states1 of these and other degenerative diseases8 ,i believe it can be shown to the satisfaction of any reasonable person that the increase is largely due to the neglect of individual hygiene in ,united ,states4444 ,if a man were suddenly afflicted with smallpox or typhoid fever or any other acute malady1 he would lose no time in getting expert advice and applying every known means to save his life4 ,but his life may be threatened just as seriously1 though possibly not so imminently1 by arteriosclerosis1 heart disease1 or ,bright's disease1 and he will do nothing to prevent the encroachment of these diseases until it is too late1 but will continue to eat as he pleases1 drink as he pleases1 smoke as he pleases1 or overwork1 and worry himself into a premature grave4--7,conservation of ,life at ,middle ,age1 ,prof4 ,irving ,fisher1 ,am4 ,journal of ,public ,health1 ,july1 #aiae47 ,periodic physical examinations are as necessary for children as for adults1 in order to detect physical defects4 ,these defects are known to have such an immense bearing upon health that routine examinations of all children have become an integral part of the work of enlightened public schools4 ,prevention of degenerative disease1 then1 as well as of the enormous numbers of preventable accidents and injuries1 depends in large measure upon proper living conditions and proper personal habits4 ,the infectious diseases1 according to ,dr4 ,hill1 cost us annually at least #aj billion dollars in addition to the loss of life1 and he adds3 ,the infectious diseases in general radiate from and are kept going by women4--7,hill-- ,new ,public ,health1 p4 #cj47 ,women1 it is true1 can prevent many of the infections1 but they can do still more1 for hygienic habits to be effective must be acquired early1 and mothers and teachers1 because they have practically the entire control of children1 have the power to prevent many cases of degenerative as well as of communicable disease4 ,,exercises #a4 ,distinguish between communicable and non-communicable disease4 #b4 ,describe the part played by micro-organisms in causing disease4 #c4 ,describe the structure of bacteria and their method of multiplication4 #d4 ,in what ways are pathogenic germs transmitted from person to person8 #e4 ,upon what preventive measures does the control of communicable diseases depend8 #f4 ,what is meant by immunity8 #g4 ,against what diseases may immunity be acquired artificially8 ,how has the practice of immunizing affected death rates from communicable diseases8 #h4 ,what factors tend to lower resistance8 ,do they act equally in the case of all diseases8 #i4 ,define a carrier1 and explain the importance of carriers in the spread of disease4 #aj4 ,name some of the characteristics and causes of degenerative diseases4 #aa4 ,whom do the degenerative diseases most commonly affect8 #ab4 ,describe methods that should be employed to prevent degenerative diseases4 ,,for ,,further ,,reading ,the ,new ,public ,health--,hill1 ,chapters ,i-,,ix4 ,health and ,disease--,roger ,i4 ,lee1 ,chapters ,,xv-,,xxiv4 ,principles of ,sanitary ,science and the ,public ,health--,sedgwick1 ,chapters ,i1 ,,ii1 ,,iii4 ,scientific ,features of ,modern ,medicine--,frederic ,s4 ,lee1 ,chapters ,,ii1 ,,iv-,,vi4 ,disease and ,its ,causes--,councilman1 ,chapter ,i4 ,preventive ,medicine and ,hygiene--,rosenau4 ,publications of the ,life ,extension ,institute--#be ,west #deth ,street1 ,new ,york ,city4 ,,chapter ,,ii ,,health ,,and ,,the ,,home ,of all the considerations that determine health1 heredity is the one unalterable factor4 ,although certain characteristics are obviously hereditary1--complexion1 height1 and mental and physical traits in great variety1--yet in the past heredity has been little understood4 ,in consequence it has served too often as a scape goat for faults and failings not beyond an individual's control4 ,our first clear understanding of the principles underlying heredity resulted from experiments made by ,mendel1 an ,austrian monk1 during the last century1 and it is now possible to predict with a high degree of accuracy the inheritance of certain characteristics4 ,many diseases1 formerly considered hereditary because their actual causes were unknown1 are now known to be communicable4 ,thus1 it is now understood that tuberculosis is not hereditary1 although little children may be infected by tuberculous parents4 ,no germ diseases are inherited in the strict sense of the word2 but a baby may be infected with syphilis before birth if his father or his mother has the disease4 ,it is true1 however1 that certain tissue weaknesses of the body seem to be hereditary1 and in consequence one family is more susceptible to digestive disorders1 another to diseases of the lungs1 a third to deafness1 and so on4 ,moreover1 general low vitality may be inherited4 ,it should be emphasized1 however1 that hereditary weakness does not inevitably lead to disease4 ,many persons have succeeded in preventing the development of active disease by guarding against strain in directions where they are weak by inheritance4 ,of all tissue weaknesses that may be inherited1 defects of the nervous system are the most serious4 ,nervous disorders of every degree of severity1 from slight nervous instability even to insanity1 may result when these tissues are defective2 but it is now a recognized fact that nervous disorders in many cases can be prevented from developing4 ,feeblemindedness1 another condition due to defective tissue1 is known to be inherited in the majority of cases1 and in all cases it is incurable4 ,,hygiene ,,of ,,environment ,,and ,,person ,by environment is meant everything outside the body that affects it2 taken in its complete meaning the word might include everything that is or ever was in the whole universe4 ,it is possible to consider here a few only of the many environmental and personal factors affecting the health of individuals4 ,the home constitutes the important part of environment for most persons1 and for children in particular1 since they spend the greater part of their time in or about it1 and get there the foundation on which their health in later years depends4 ,for persons employed away from home1 industrial and occupational hygiene is hardly less important2 but those subjects are too extensive to be considered here4 ,most people live where they must1 and few have any part in planning the construction of their own houses4 ,in choosing a house1 however1 one should remember that rooms where sunshine never enters are unfit for continued occupation4 ,for children in particular fresh air and sunshine are essential1 and it may be economy in the end to pay a comparatively high rent for an apartment having sunshine during at least a part of the day4 ,ignorance and carelessness1 unfortunately1 can spoil the best living conditions1 and sometimes even in the country fresh air and sunshine are excluded from sleeping and living rooms4 ,,ventilation4--,ventilation has a direct bearing on health1 although1 contrary to former belief1 the actual amount of oxygen in the air is not ordinarily the most important factor2 even badly ventilated rooms contain more than enough oxygen to support life4 ,the factors of prime importance in ventilation are temperature1 humidity1 air movement1 and the number of persons in a given space since the greater the distance from one another the less is the probability that diseases will be spread4 ,room temperature should not be above #gj ,f4 and1 except for the aged or sick1 it is better to be between #fj and #fe4 ,some moisture in the air is desirable2 the amount needed is from #ej to #ee of the total moisture that the air can hold at a given temperature4 ,we have no apparatus to decrease humidity in the air of houses1 and in summer we are obliged to endure humidity1 if excessive1 no matter how uncomfortable we may be4 ,but in winter the air in most houses is too dry1 so that the mucous membranes of the nose and throat often become irritated and susceptible to infection4 ,most heating systems1 particularly in small buildings1 make no provision for supplying moisture4 ,keeping water in open dishes on or near radiators is often recommended1 and would greatly improve the condition of the air1 if people remembered to keep the dishes filled4 ,the following is a simple but effective device to increase humidity3 ,roll an ordinary desk blotter into a cone about #h inches in diameter at the base1 and keep it constantly submerged for about one inch in a dish of water4 ,the water rises to the top of the blotter and a large surface for evaporation is thus afforded4 ,illustration3 ,,fig4 #g4 ,stagnant air is harmful4 ,air should be in constant though not necessarily perceptible motion4 ,air about the body1 if motionless1 acts like a warm moist blanket1 preventing the passage of heat from the body4 ,the three factors1 heating1 humidity1 and air motion1 must be considered together4 ,every person requires each hour about #cjjj cubic feet of air1 and the problem of heating and ventilating is that of providing this amount in gentle motion1 at a temperature of about #fe ,f41 and of humidity from #ej-ee4 ,higher temperatures and stagnant air cause disinclination to work1 headache1 nausea1 restlessness1 or sleepiness1 and if continued are likely to result in loss of appetite1 and anemia4 ,the tuberculosis movement has clearly shown the benefits both for the sick and the well of living in the open air1 and has caused great and beneficial changes within a generation4 ,the more time spent in the open air the better2 since however most persons who work must spend the greater part of the day indoors1 ventilation is a matter of great importance4 ,although fresh air enthusiasts are still too few1 yet some go to the extreme and think that because cool air in motion is good1 the colder the air and more violent the motion the better4 ,on the contrary1 chilling the whole body or a part of the body lowers resistance4 ,draughts of air have no bad effects upon persons in good health1 particularly those accustomed to changes in temperature4 ,but draughts are likely to be injurious to aged or sick persons and babies1 by diminishing their resistance to such infections as common colds and pneumonia4 ,it should be remembered that draughts or cold alone cannot cause colds2 the specific germs must be present4 ,,lighting4--,amount and direction of light are physiologically important4 ,defects of the eyes1 too prolonged use1 and insufficient light are the commonest causes of eye strain4 ,most eye defects can be relieved by glasses4 ,children's eyes should be examined upon entering school1 and as often afterward as the oculist advises4 ,prolonged use causes fatigue of the eyes1 especially when the illumination is poor2 within limits1 the amount of light needed depends on the nature of the work4 ,light should come from the left side of right handed people2 never from the front4 ,light reflected from snow1 sand1 glazed white paper of books1 or other bright surfaces is fatiguing from its intensity1 and from the unusual angle at which it enters the eyes4 ,too much light is harmful1 and probably causes some of the effects1 such as nausea and headache1 commonly attributed to poor ventilation4 ,almost all blindness is preventable1 and blindness due to industrial accidents and processes is no exception to this rule4 ,surely no individual precautions or legal measures are too great in order to guard against this saddest of all physical defects4 ,,cleanliness ,,of ,,houses4--,a clean1 well-cared for house is desirable from every point of view1 but certain kinds of cleanliness affect health more than others4 ,the most scrupulous care should be exercised wherever food is stored or prepared4 ,the kitchen is in reality a laboratory2 in it either intelligently or ignorantly are formed chemical compounds which have a far-reaching effect upon family health4 ,from the standpoint of health no other room in the house is so important4 ,it should be bright1 airy1 and easy to clean4 ,in cleaning kitchen tables and woodwork water should not be allowed to soak into cracks and dark corners1 carrying with it particles of food for the nourishment of bacteria and insects4 ,linoleum1 if used to cover the floor1 should be well fitted at the edges to prevent water from running underneath4 ,there should be neither cracks nor crevices in wall or floor1 and no dark corners or out-of-the-way cupboards in which dust1 food particles1 and moisture can accumulate4 ,such conditions not only attract mice and roaches1 but furnish favorable soil for the development of moulds and fungi which by their growth affect food deleteriously4 ,waging a constant warfare against the development of bacteria constitutes a large part of good housekeeping4 ,all cooking utensils should be thoroughly washed1 scalded1 and dried before they are put away2 the use of carelessly washed dishes is bad4 ,enameled or agate ware which has begun to chip should be discarded4 ,dish-cloths and towels should be washed and boiled after using1 and if possible dried in the sun4 ,every place in which food is kept should have constant care4 ,the refrigerator is particularly important4 ,its linings should be water-tight1 and the drain freely open at all times2 otherwise the surrounding wood will become foul and saturated with drainings4 ,at least once a week it should be entirely emptied and cleaned in the following way3 ,the racks should be thoroughly washed in hot soapsuds to which a small amount of washing soda has been added1 rinsed in boiling water1 dried and placed in the sun and air4 ,all parts of the refrigerator should be washed in the same manner1 especially grooves and projections where food or dirt may lodge4 ,the drainpipe should be flushed1 the whole interior rinsed again with plain hot water1 thoroughly dried with a clean cloth1 and left to air for at least an hour4 ,the drainage pan should be washed and scalded frequently4 ,food showing the slightest evidence of spoiling should be removed from the refrigerator at once4 ,even more attention should be paid to the hands of the cook4 ,they should be washed always before handling food1 and always after visiting the toilet1 using the handkerchief1 or otherwise coming in contact with nose1 mouth1 or other bodily secretions4 ,theoretically coughing and sneezing ought not to occur in the neighborhood of food1 especially of food to be eaten raw2 and persons with coughs1 colds1 or other communicable disease1 however slight1 ought not to handle food4 ,if this rule were observed in practice1 more persons would go hungry1 but fewer would be sick4 ,thorough cleaning of rooms involves soap1 water1 sunshine1 air1 and elbow grease1 just as it did before germs were discovered4 ,cleaning means actually removing dirt and dust1 not merely stirring it up to settle again2 consequently dry sweeping and dusting are ineffectual4 ,vacuum cleaning1 and sweeping and dusting with damp or dustless mops and dusters are good4 ,deodorants and disinfectants do not take the place of ordinary cleanliness4 ,dust does not carry living disease germs to an appreciable extent2 the fact is now well established that diseases formerly thought to be transmitted by dust or even supposed to travel directly through the air1 are carried on tiny particles of moisture and mucus expelled in coughing and sneezing4 ,this mode of transmission is called droplet or spray infection2 it is one of the most active agents in spreading certain kinds of communicable diseases4 ,nevertheless dust in motion is harmful2 it irritates the lining membranes of the nose1 throat1 bronchial tubes1 and lungs1 even causing tiny wounds through which disease germs enter4 ,thus tuberculosis is especially prevalent among stone cutters1 felt workers1 and others engaged in dusty trades4 ,metallic dust is especially harmful1 because it is harder and sharper than dust from organic substances like wool and cotton4 ,furthermore1 presence of dust indicates a low standard of cleanliness4 ,people who tolerate it generally tolerate uncleanliness in other forms1 more serious though less apparent4 ,cleaning would not be so great a problem if most houses were not littered with such dust catchers as carpets1 so-called ornaments1 carved and upholstered furniture1 banners1 draperies1 and a vast collection of articles that can only be classified as ,christmas presents4 ,in actual practice things that are difficult or expensive to clean seldom are cleaned2 carpets for example are considered unhygienic1 not because they cannot be cleaned1 but because they are not4 ,william ,morris' advice to exclude from houses all articles not known to be useful or believed to be beautiful would1 if followed1 add years to the lives of housekeepers4 ,,garbage1 has little bearing on health1 except in so far as it affords a breeding place for flies4 ,if it contains disease germs it may be dangerous1 but statistics show that garbage handlers1 although they can hardly be called especially careful1 are not more subject to sickness than other men of their class4 ,garbage disposal is chiefly a question of preventing a public nuisance2 it is a matter of cleanliness and public decency4 ,,insects4--,flies1 cockroaches1 and other scavenging insects may carry disease germs on their feet and thus infect food on which they walk4 ,typhoid1 cholera1 dysentery1 and other diseases have been carried by flies4 ,flies are always a menace1 and should not be tolerated2 moreover1 the thought of their coming to food directly from manure piles and privy vaults is disgusting4 ,houses should be thoroughly screened in the fly season1 but it is better to destroy the nuisance at its source4 ,the chief breeding places of flies are garbage cans and manure piles4 ,if the garbage can is water tight1 closely covered1 frequently emptied1 and thoroughly cleaned1 flies will not develop in it2 about ten days must elapse from the time when the egg is laid until the insect is ready to fly4 ,fly traps to fit on the garbage can are useful4 ,manure should be screened and removed frequently1 or it can be treated chemically4 ,methods for treating it are given in ,preventive ,medicine and ,hygiene4--,rosenau1 p4 #bee1 and in ,bulletin ,no4 #aah1 of the ,u4 ,s4 ,dept4 of ,agriculture1 ,july #ad1 #aiad4 ,illustration3 ,,fig4 #h4--;,a ,,fly ,,with ,,germs 7,,greatly ,,magnified7 ,,on ,,its ,,legs4 7,u4 ,s4 ,dept4 ,agri47 ,other diseases carried by insects are malaria and yellow fever1 each by a special species of mosquito2 typhus fever1 by lice2 and bubonic plague1 by rat fleas4 ,various diseases less common in this country are carried by other insects4 ,even when mosquitoes are not carrying disease germs their bites may be harmful since they are often rubbed1 especially by children1 until the skin is broken1 and various infections may enter through the wounds4 ,insects of every kind1 rats1 mice1 and vermin should be excluded from houses4 ,,sewage4--,discharges from the bowels and bladder contain various germs1 and constitute one of the most important routes by which germs of typhoid fever1 cholera and certain other diseases travel from person to person4 ,keeping sewage out of the water supply is consequently of great importance4 ,where a system of sewage disposal exists1 the responsibility of making the system adequate and thus safeguarding public health rests upon the community as a whole4 ,communities ordinarily get just as much1 or just as little typhoid fever as they are willing to endure4 ,illustration3 ,,fig4 #i4--;,,how ,a ,,well ,,may ,,be ,,polluted4 7,from ,the ,human ,mechanism4 ,copyright by ,theodore ,hough and ,william ,t4 ,sedgwick4 ,ginn and ,company1 publishers4 ,used by permission47 ,in places having no system of drainage privies must be used4 ,they can be made harmless1 as army camps prove1 but they require scrupulous care4 ,fecal matter must be prevented from draining into wells and other water supplies1 and must be screened from flies4 ,the privy should be located at a distance from the well4 ,the minimum distance that is safe depends in each case upon the nature of the soil and the direction of the natural drainage4 ,even when the privy is situated below the well on sloping ground1 drainage may still occur from the privy to the well2 however1 a well-made1 properly located pit privy is safe unless it is near a limestone formation4 ,the dry earth system is satisfactory in places having an efficient public scavenger system2 in this system pails or cans are used to receive the discharges1 which are then covered with sand1 ashes1 earth or1 preferably1 chloride of lime4 ,the buckets are frequently emptied and the contents buried at least one foot below the surface of the ground4 ,the objection to this method for more extended use is that proper care of the cans is a disagreeable duty of which most households soon tire4 ,,personal ,,cleanliness4--,the main functions of the skin are three3 to protect underlying tissues1 to excrete waste matter1 and to regulate bodily heat by checking or allowing the evaporation of perspiration4 ,after perspiration has evaporated solid matter is left upon the skin1 and oily matter also is deposited on it by the glands that keep the skin lubricated4 ,removing these and other materials at least once a day is desirable to improve the bodily tone and sense of well-being4 ,real cleanliness is impossible without frequent use of warm water and soap4 ,cold baths are stimulating1 though not very efficacious for cleansing purposes4 ,they are valuable tonics if properly used1 but delicate or elderly persons should use them only by a physician's advice4 ,chilly feelings or depression following should be the signal for any person to discontinue cold bathing or swimming in cold water4 ,warm baths are soothing in their effects1 and are appropriate at bed time1 particularly for persons inclined to sleeplessness4 ,very hot baths1 especially if prolonged1 may be harmful1 and should not be taken often4 ,there is no clear connection between general cleanliness and disease4 ,frequent bathing does not protect a person from any particular disease1 except in so far as bathing necessarily includes washing the hands4 ,if typhoid germs for example have actually been swallowed1 a clean bodily exterior is of no avail in preventing typhoid fever or in diminishing its severity4 ,the same is true of other diseases4 ,but it is impossible to emphasize unduly the importance of clean hands4 ,hands are prime offenders in distributing fresh bodily secretions1 and germs both innocent and harmful4 ,all health authorities agree on this point4 ,perhaps #ij of all infections are taken into the body through the mouth4 ,they reach the mouth in water1 food1 fingers1 dust1 and upon the innumerable objects that are sometimes placed in the mouth4 ,the fact that the great majority of infections are taken by way of the mouth gives scientific direction to personal hygiene4 ,sanitary habits demand that the hands should be washed after defecation and again before eating1 and fingers should be kept away from the mouth and nose1 and that no unnecessary objects should be mouthed4 ,all food and drink should be clean or thoroughly cooked4 ,these simple precautions alone would prevent many a case of infection4--7,rosenau3 ,preventive ,medicine and ,hygiene1 p4 #cff47 ,as ,dr4 ,chapin says3 ,probably the chief vehicle for the conveyance of nasal and oral secretion from one to another is the fingers4 ,if one takes the trouble to watch for a short time his neighbors1 or even himself1 unless he has been particularly trained in such matters1 he will be surprised to note the number of times that the fingers go to the mouth and the nose4 ,not only is the saliva made use of for a great variety of purposes1 and numberless articles are for one reason or another placed in the mouth1 but for no reason whatever1 and all unconsciously1 the fingers are with great frequency raised to the lips or the nose4 ,who can doubt that if the salivary glands secreted indigo the fingers would continually be stained a deep blue1 and who can doubt that if the nasal and oral secretions contain the germs of disease these germs will be almost as constantly found upon the fingers8 ,all successful commerce is reciprocal1 and in this universal trade in human saliva the fingers not only bring foreign secretions to the mouth of their owner1 but there exchanging them for his own1 distribute the latter to everything that the hand touches4 ,this happens not once1 but scores and hundreds of times during the day's round of the individual4 ,the cook spreads his saliva on the muffins and rolls1 the waitress infects the glasses and spoons1 the moistened fingers of the peddler arrange his fruit1 the thumb of the milkman is in his measure1 the reader moistens the pages of his book1 the conductor his transfer tickets1 the lady the fingers of her glove4 ,every one is busily engaged in this distribution of saliva1 so that the end of each day finds this secretion freely distributed on the doors1 window sills1 furniture and playthings in the home1 the straps of trolley cars1 the rails and counter and desks of shops and public buildings1 and indeed upon everything that the hands of man touch4 ,what avails it if the pathogens do die quickly8 ,a fresh supply is furnished each day4--7,chapin3 ,the ,sources and ,modes of ,infection1 p4 #ahh47 ,,oral ,,hygiene4--,cleanliness and proper care of the mouth and teeth can hardly be over emphasized4 ,their bearing upon health is direct4 ,long ago it was recognized that persons with decayed or missing teeth frequently suffered from dyspepsia1 a natural result of inability to masticate properly1 but only within recent years has it been realized that decayed teeth give rise to many other diseased conditions4 ,bacteria are constantly present in the mouth4 ,if the mucus of the mouth is not removed1 it forms a sticky coat upon the surfaces of the teeth and gums4 ,in this bacteria collect1 and pus or matter may also be formed1 which1 if carried by the blood to other parts of the body1 may cause digestive troubles1 rheumatism1 and diseases of heart and kidneys4 7,see ,dr4 ,t4 ,b4 ,hartzell1 ,health ,news1 ,oct41 #aiae1 ,the ,importance of ,mouth ,hygiene and ,how to ,practise it47 ,to keep the mouth and teeth healthy they must have3 #a4 ,proper use4 #b4 ,proper care4 #c4 ,proper treatment4 #a4 ,teeth1 like other parts of the body1 need exercise4 ,foods that require a considerable amount of chewing should be included in the diet4 ,such food is needed by children as soon as their first teeth have come1 but care must be exercised to see that the food is actually chewed before it is swallowed4 #b4 ,a good brush should be provided4 ,the stiffness of the bristles should be regulated according to the individual4 ,the brush should be thoroughly rinsed after using1 and discarded as soon as it is worn4 ,dental floss is generally needed to remove particles that have lodged between the teeth4 ,brushing the teeth by passing the bristles across them is not efficacious4 ,they should be brushed not across but with the cracks1 as a good housewife sweeps a floor4 ,in the light of recent investigation conducted by some of the leading students of mouth hygiene1 the most effective way to use the toothbrush is to place the bristles of the brush firmly against the teeth1 applying firm pressure1 as though trying to force the bristles between the teeth1 using a slight rotary or scrubbing motion4444 ,after a little practice the user of this method will be surprised at the results obtained4 ,care should be used to go over all the surfaces of the teeth in this manner4--7,see ,dr4 ,w4 ,g4 ,ebersole4 ,the ,importance of ,mouth ,hygiene and ,how to ,practice it1 ,health ,news1 ,oct41 #aiae47 ,after brushing the teeth1 the mouth should be rinsed by forcing lukewarm water about the teeth1 using all the force that can be brought to bear by the cheeks1 lips1 and tongue4 #c4 ,,treatment4--,the teeth1 including the first teeth of children1 should be inspected by a competent dentist at least twice a year4 ,periodic cleansing by a dentist1 and early attention to small cavities1 may prevent serious ill health and impairment of the body1 as well as the acute suffering generally accompanying treatment of advanced dental defects4 ,,clothing4--,clothing was originally used for purposes of ornament4 ,desire for protection from cold and dampness came later4 ,the amount of clothing required varies greatly according to individual needs and habits1 but it is increasingly recognized that light clothing is best1 provided that the wearer is really protected from cold4 ,clothing should be porous in order to allow ventilation of the body1 supported so far as possible from the shoulders1 and clean and well aired4 ,dampness favors the growth of germs which may cause irritation of the skin4 ,clothing should not constrict the body or hamper its movements4 ,perhaps the worst health menace for which clothing is to blame comes from the high heeled shoes on which many women prefer to limp through life4 ,from the health standpoint shoes are of great importance4 ,bad shoes are responsible for many cases of flat feet1 whose muscles have degenerated through non-use1 and for much so-called rheumatism1 which is merely the protest of abused muscles4 ,bad shoes also1 by distorting the feet1 prevent comfortable walking1 which is the only out-of-door exercise readily available for the vast majority of people2 and still worse1 the resulting unnatural position of the body sometimes has serious consequences by bringing injurious strains on other muscles and organs4 ,,food4--,two distinct problems are encountered here3 the problem of nutrition1 and the problem of preventing sickness4 ,nutrition1 or proper feeding1 is a subject beyond the scope of this book2 it is nevertheless one of the most important1 if not the most important1 factor in maintaining health4 ,food preparation and care of children1 the two most important functions of the home1 are unfortunately relegated to the least intelligent and least interested members of most households in which servants are employed4 ,most ,american families eat too much protein food1 such as meat and eggs4 ,excess of protein probably leads to degeneration of tissues1 and plays a part in causing the degenerative diseases already mentioned4 ,habit is important here as in other ways of living1 but cereals and vegetables should in large measure make up the diet of sedentary persons and indeed of everyone in warm weather4 ,the amount of food required in #bd hours depends on many factors3 age1 height1 weight1 occupation1 season1 and habit4 ,underweight and overweight are both abnormal conditions2 probably the latter is the more easily remedied4 ,both require the advice of a physician4 ,rapid reduction of weight involves certain dangers1 especially for persons with weak hearts4 ,food may cause sickness either because it is in itself harmful1 or because it carries disease germs4 ,meat from diseased animals should be destroyed before it reaches the market1 but bacterial activities in food originally wholesome may form in it poisonous substances4 ,the chief diseases known to be carried by food1 water1 or milk are typhoid fever1 paratyphoid1 dysentery and other diarrhal diseases1 scarlet fever1 diphtheria1 septic sore throat1 and tuberculosis4 ,the sole problem here is to keep human and animal excretions out of food1 water1 and milk4 ,since thorough cooking kills disease germs1 danger arises chiefly from raw foods4 ,all fruits and vegetables eaten raw should first be thoroughly washed4 ,water is essential to health4 ,at least three pints should be taken daily1 the amount varying somewhat according to diet1 exercise1 temperature1 and so forth4 ,most persons drink too little water4 ,cities and towns should of course have public supplies of pure water4 ,contamination of water1 when it occurs1 is caused chiefly by sewage from cesspools1 privies1 and drains4 ,all well or spring water must be constantly watched and ,boards of ,health are always ready to examine samples of water and to report whether it is safe to drink4 ,at the present time a porcelain filter is the only satisfactory kind for a household1 but many domestic filters are so badly cared for that in actual practice they are worse than none4 ,danger from a filter containing an accumulation of impurities is greater than the danger from most ordinary water supplies4 ,boiling water for ten minutes kills all pathogenic germs1 but this method is inconvenient on a large scale and is not practical for continued family use4 ,every effort should be made to insure a regular supply of pure water in every house4 ,it is not satisfactory to have two kinds1 one for drinking and one for other purposes1 since mistakes are sure to be made1 especially by children4 ,some families who use only bottled or filtered water for drinking purposes habitually run the risk involved in using impure water from the tap for cleaning the teeth4 ,freezing destroys most germs1 but ice is not necessarily free from bacterial life1 and should be used in drinking water only when known to be free from impurities4 ,neither does freezing milk or cream necessarily kill germs that may be contained in it4 ,raw milk plays so important a part in the spread of disease that its fitness for human consumption is open to serious question4 ,certified milk1 where obtainable1 is safe but expensive4 ,boiled milk is safe1 but changed in taste and to some extent in quality4 ,if milk is heated to #adb-ade ,f4 and kept at that temperature for #cj minutes all disease germs in it are killed4 ,this process1 called pasteurization1 renders milk safe4 ,the objection is sometimes made that continued use of pasteurized milk for infants causes scurvy1 but in ,new ,york ,city where over #ij per cent4 of the milk is pasteurized no increase in scurvy has been noticed1 while a large diminution in deaths of infants from diarrhal diseases has resulted1 as in all cities where pasteurization is required4 ,the following is a simple method for pasteurizing a quart bottle of milk4 ,if the directions are exactly followed the milk will be pasteurized at the end of the process2 no thermometer need be used4 ,to prevent the bottle from breaking1 it is first warmed by placing it for a few minutes in a pail of warm water4 ,from the results of the experiments it was concluded that any housewife can pasteurize a one quart bottle of milk by3 #a4 ,boiling #b quarts of water in a large agate saucepan2 or better #b4 ,boiling #b quarts of water in a #aj pound tin lard pail1 placing the slightly warmed bottle from the ice chest in it1 covering with a cloth and setting in a warm place4 ,at the end of one hour the bottle of milk should be removed and chilled promptly4 ,the water must be boiled in the container in which the pasteurization is to be done4--7,ruth ,vories1 in ,health ,news1 ,sept41 #aiaf47 ,,elimination4--,careful attention should be paid to elimination through the bowels and kidneys4 ,constipation is responsible for many common ailments2 among them are headache1 disinclination to work1 irritable temper1 and lowered resistance4 ,if long continued1 constipation becomes serious both from congestion and displacement of pelvic organs1 and from absorption over a considerable time of even small amounts of the poisonous substances resulting from decomposition of food in the large intestine4 ,the bowels can best be regulated by diet1 water1 exercise1 and habit4 ,the habitual use of cathartic and laxative drugs is most unwise1 because they tend to aggravate the trouble4 ,moreover the habitual and continued use of injections and internal baths is harmful1 and would not be considered necessary if bran and coarse flour and vegetables were substituted for concentrated foods4 ,greed1 laziness1 and lack of intelligence lead most persons suffering with constipation to prefer pills to the restraints demanded by hygienic living4 ,the habit of evacuating the bowels at a regular time1 if established in early childhood and rigidly adhered to1 will prevent constipation among most healthy people4 ,any person who thinks drugs necessary should consult a physician1 and be prepared to follow the rgime he advises over a considerable period of time and at the cost of some self-denial4 ,for healthy people1 voiding urine presents no difficulty if a sufficient amount of water is taken2 but some persons reduce the amount of liquid taken in order to escape the inconvenience of urination4 ,this practice is harmful1 and may involve insufficient cleansing of the entire system4 ,if frequent urination disturbs sleep1 liquids may be withheld during the evening2 but the total amount of water taken in #bd hours should not be diminished4 ,,rest ,,and ,,fatigue4--,a fatigued person is a poisoned person4 ,muscular exertion burns the fuel constituents of the body1 as we recognize by the greater heat generated within us during muscular exertion4 ,waste products1 resulting from this burning process1 accumulate if not removed1 and clog the body in somewhat the same way that ashes and cinders clog a furnace4 ,the fatigued person remains fatigued1 consequently1 until the accumulations of waste matter are removed by the normal action of the lungs1 skin1 and kidneys4 ,fatigue is caused by both mental and physical work1 and when excessive1 affects the nervous system most disastrously4 ,the body can and should respond to occasional extra drafts on strength and endurance2 its flexibility and power of adjusting to varying conditions may even be stimulated thereby4 ,but even slight fatigue1 if continued and especially if associated with anxiety or worry1 has caused many nervous and mental breakdowns4 ,work carried beyond the point of normal fatigue requires a proportionately longer time for recovery4 ,for example1 if the point of fatigue has been reached by a certain finger muscle after #ae contractions1 and if half an hour is required to rest it completely1 one might suppose that one hour would rest it after #cj contractions4 ,this is not so1 however2 after #cj contractions #b hours are required1 or #d times as much rest for twice the amount of work1 if continued beyond the point of fatigue4 ,laboratory experiments and experience alike show that this principle holds true in other forms of fatigue4 ,thus the output of factories has been shown in many instances to be greater1 other things being equal1 when operatives work #h hours a day than when they work longer4 ,excessive hours in any kind of work are the poorest economy4 ,fatigue is increased in direct proportion not only to muscular exertion but also to the amount of speed1 complexity1 responsibility1 monotony1 noise1 and confusion involved in an occupation4 ,ability to bear fatigue differs greatly with different people1 as ability varies to bear other kinds of strain4 ,rest at night and on ,sunday1 and the annual vacation should be enough to keep a person in good condition4 ,if not1 there is probably something wrong with the worker's health1 the nature of his work1 or his adaptation to his particular kind of work4 ,this statement is not only true of persons regularly employed1 but of those living at home1 including children in school1 women in society1 and especially mothers of families4 ,,sleep4--,a sufficient amount of sleep is essential to health1 but individual requirements vary widely4 ,each person should know and regard his own need1 and children and young people should be obliged to go to bed early4 ,ability to sleep is largely habit2 good habits should be formed and continued4 ,sleep-producing drugs should never be taken1 except by a doctor's prescription4 ,,recreation4--,owing to the speed1 complexity1 and worry of modern life among all classes1 and to the monotony of work in industry1 recreation has become a matter of vital importance for everyone4 ,some muscular activity1 preferably in the open air1 is needed by every healthy person4 ,recreation should be as unlike the regular occupation as possible3 going to the theatre1 for example1 is not the best exercise for sedentary workers employed all day in artificially lighted offices4 ,the element of pleasure is essential4 ,hoisting dumb-bells purely from conscientious motives is seldom beneficial1 and is generally soon abandoned4 ,the part played by habit in matters of health is often overlooked4 ,although the body adjusts itself to widely varying conditions and even to unfavorable ones1 the importance of forming desirable habits cannot be overemphasized4 ,sudden or radical changes in living1 however1 particularly among people no longer young1 may play havoc4 ,new and violent systems of exercise1 weight reduction1 and food fads forced on families by enthusiastic discoverers involve considerable risk4 ,many elements enter into health2 in no single one is found hygienic salvation4 ,temptation always exists to emphasize one element at the expense of others4 ,for instance1 people who insist upon overventilating rooms regardless of others' comfort may themselves be utterly careless in regard to necessary sleep1 and more than one fastidiously clean person has disregarded the highly unclean condition of constipation4 ,to maintain sound health only a rational program will suffice3 properly balanced work and play1 sleep and food and all other elements must be included in due proportion4 ,and over-anxious health seekers might well remember that health is not so much an end in itself1 as a means to a happy and productive life2 even in concern over health1 it is possible for him that saveth his life to lose it4 ,,exercises #a4 ,explain the difference between an hereditary disease and hereditary susceptibility to a disease4 ,how may hereditary susceptibility to a disease be combatted8 #b4 ,what are the essentials of good ventilation8 #c4 ,what is the proper temperature for a living room8 ,what are the effects of higher temperatures8 ,of lower temperatures8 #d4 ,describe methods for maintaining household cleanliness4 #e4 ,discuss the importance from the point of view of health1 of dust2 of insects2 of garbage2 of sewage4 #f4 ,what principles should guide one in deciding whether a certain water supply is safe to use for drinking purposes8 ,what are the dangers of impure water8 ,how can impure water be rendered safe8 #g4 ,what diseases may be carried by milk8 ,how can milk be rendered safe8 #h4 ,explain the health aspects of personal cleanliness4 #i4 ,what care should be given the teeth and mouth8 ,why8 #aj4 ,what bad results frequently follow constipation8 ,how should constipation be remedied8 #aa4 ,name seven factors that are important in causing fatigue4 ,why is it uneconomical to continue work1 either physical or mental1 beyond the point of fatigue8 #ab4 ,what facilities for recreation1 especially in the open air1 does your community provide for little children8 ,for school children8 ,for working boys and girls8 ,for grown people8 ,,for ,,further ,,reading ,health and ,disease--,roger ,i4 ,lee1 ,introduction and ,chapters ,i1 ,,iii-,v1 ,,vii-,,ix4 ,how to ,live--,fisher and ,fisk1 ,chapters ,i1 ,,iii-,v4 ,the ,human ,mechanism--,hough and ,sedgwick1 ,chapters ,v1 ,,xxii-,,xxix4 ,disease and ,its ,causes--,councilman1 ,chapters ,x1 ,,xii4 ,fatigue and ,efficiency--,goldmark1 ,chapters ,,ii1 ,,iii4 ,preventive ,medicine and ,hygiene--,rosenau4 ,a ,manual of ,personal ,hygiene--#fth ,edition1 ,edited by ,walter ,l4 ,pyle4 ,four ,epochs of a ,woman's ,life--,galbraith4 ,hygiene and ,physical ,culture for ,women--,galbraith4 ,the ,home and ,its ,management--,kittredge4 ,exercise and ,health--,f4 ,c4 ,smith1 ,supplement #bd to the ,public ,health ,reports1 ,government ,printing ,office1 ,washington4 ,the ,sanitary ,privy--,farmers' ,bulletin #dfc1 ,united ,states ,department of ,agriculture1 ,government ,printing ,office1 ,washington4 ,safe ,disposal of ,human ,excreta at ,unsewered ,homes--,lumsden1 ,stiles and ,freeman1 ,bulletin #fh1 ,public ,health ,reports1 ,government ,printing ,office1 ,washington4 ,the ,disposal of ,human ,excreta and ,sewage of the ,country ,home--,new ,york ,state ,department of ,health1 ,albany4 ,milk and ,its ,relation to ,public ,health--,bulletin #ef1 ,hygienic ,laboratory1 ,government ,printing ,office1 ,washington4 ,milk and ,its ,relation to ,health--,new ,york ,state ,department of ,health1 ,albany4 ,other ,publications of the ,united ,states ,public ,health ,service and of the ,departments of ,health of the different states and cities4 ,,chapter ,,iii ,,babies ,,and ,,their ,,care ,the principles of hygiene are fundamentally the same for young and old4 ,the applications1 however1 differ at different ages4 ,from the time when physical growth and development are complete until changes due to old age appear1 an individual commonly has greater resistance than at other ages1 and is able in consequence to endure unfavorable conditions of life with more success4 ,babies1 on the other hand1 are exceedingly sensitive to their environment4 ,surroundings that are even slightly unfavorable are likely to make babies sick4 ,in order to remain healthy1 they must have exactly the right kind of food1 in the right quantities and at the right times2 their sleep1 exercise1 and clothing must be carefully regulated2 they must be protected from careless handling1 from nervous strain1 and above all1 from the many kinds of infection to which they are peculiarly susceptible4 ,the life of a baby fortunately can be controlled almost completely2 when properly regulated it offers1 therefore1 an unequalled opportunity to see how hygienic principles work out in actual practice4 ,the primitive mother's instinct to nourish and protect and succor her helpless child was the original form of nursing4 ,instinct alone1 unfortunately1 has never accomplished much in preserving health4 ,the human race has now had an experience in the care of infants that extends over thousands of years4 ,yet today we are still1 on the whole1 less successful in keeping babies alive than we are in raising domestic animals2 we still allow society to continue1 like a modern ,herod1 in its ruthless career of slaughtering the innocents4 ,about #ad babies out of every #ajj born in the registration area#a of the ,united ,states die before reaching the age of one year1 while in some of our industrial cities as many as #be out of every #ajj born die before they are a year old4 ,most of these deaths are preventable4 ,thus1 in a few ,american cities1 the death rates have been so reduced that fewer than #aj babies out of every #ajj die before completing the first year2 while in ,dunedin1 ,new ,zealand1 as a result of the work of the ,society for the ,health of ,women and ,children1 the infant death rate has been so reduced that in #aiab only about #d out of every #ajj babies died before they were a year old4 ,while ignorant mothers1 who may or may not be uneducated women1 and contaminated milk1 are as a matter of fact1 chiefly responsible for our high infant death rates1 yet as we have already seen1 every factor in the environment has its effect upon a baby4 ,this fact has led ,sir ,arthur ,newsholme1 an eminent ,english authority1 to say3 ,infant ,mortality is the most sensitive index we possess of social welfare4 ,if babies were well born and well cared for1 their mortality would be negligible4 ,the infant death rate measures the intelligence1 health1 and right living of fathers and mothers1 the standards of morals and sanitation of communities and governments1 the efficiency of physicians1 nurses1 health officers1 and educators4 ,care of the child should begin at the earliest possible moment3 that is1 nearly nine months before he is born4 ,care before birth1 for want of a better name1 is called prenatal care of the mother4 ,every woman who thinks that she is pregnant should put herself at once under the care of a competent physician1 so that he can make the necessary examinations as early as possible4 ,if she follows his advice in regard to hygiene and proper regulation of her life1 she may be free from anxiety1 and may justly expect that her delivery will be a safe and normal process4 ,a demonstration of the value of prenatal care was recently made by the ,boston ,district ,nursing ,association4 ,during the year #aiae prenatal care was given to #gea expectant mothers in #e wards of the city2 each woman attended a pregnancy clinic1 where she was under the care of an experienced obstetrician1 and was visited at intervals by a nurse who kept careful watch of her general condition and gave necessary advice and encouragement4 ,in consequence the death rate among the babies whose mothers had prenatal care was only half as great1 through the whole first year of life1 as the death rate of babies in the same wards whose mothers had not had prenatal care4 ,moreover1 the rate of still-births was only half as great as the rate among the general population of ,boston4 ,if prenatal care can save so many lives1 surely it ought to be available for every pregnant woman in the land1 including even that generally neglected class of people who are neither very rich nor very poor4 ,each baby's birth should be recorded by the registrar of births1 and parents should make sure that registration has been attended to in the city or town where they live4 ,in some states birth registration is already obligatory1 but in any case it is required by the child's own interest4 ,for instance1 in later life it may be necessary for him to prove the date and place of birth in order to establish1 among other things1 his right to vote and to inherit property1 and to settle the question of his liability to military service4 ,moreover1 complete and accurate birth registration is needed by every community because it is essential to such reforms as reducing infant mortality and abolishing child labor4 ,,growth ,,and ,,development ,statements in regard to growth and development are based on observations of many children4 ,it should be remembered that the following figures represent averages only1 and that healthy children may vary from them considerably without giving cause for alarm4 ,,average ,,size4--,the average weight of a baby at birth is from #g to #g lbs4 and the average length is about #bj inches1 but it is not unusual for a child to weigh anywhere from #e to #aj pounds at birth and to measure from #af to #bb inches in length4 ,during the first week of life a baby loses slightly in weight4 ,after the first week a healthy baby should gain from #d to #h ounces a week until he is six months old2 after that time the weekly gain is less4 ,the weight at birth will usually double during the first five months1 and treble during the first year4 ,consequently1 a baby weighing #g pounds at birth may be expected to weigh #ad pounds when five months old1 and #ba pounds when a year old4 ,weight is one of the most important indications of a baby's condition4 ,he should be weighed every week during the first #f months1 once in two weeks during the second #f months1 and once a month throughout the #bnd year4 ,,muscular ,,development4--,a baby at birth is helpless1 and during the first few months he has little muscular control4 ,during the third month he ordinarily begins to lift his head1 and he can usually hold it up without support by the time he is #c months old2 when #g to #h months old he sits erect and begins to play with toys4 ,from this time a baby makes rapid progress2 he attempts to stand on his feet1 begins to creep1 and by the time he is #ad months old he is usually able to stand alone1 or even to walk a few steps4 ,he is usually running about without difficulty when fifteen or sixteen months old4 ,babies should never be urged to walk or to bear their weight on their feet4 ,if healthy they are generally eager to go about unaided1 and like to investigate their surroundings without assistance4 ,if walking is unusually delayed1 a physician should be consulted4 ,,development ,,of ,,special ,,senses4--,a new-born baby is unable to distinguish objects1 but the eyes are sensitive to light and need careful protection4 ,hearing1 although undeveloped at birth1 soon becomes acute2 consequently the child should stay in a quiet room4 ,when six or eight weeks old he notices objects1 and at three months old he welcomes his mother when he is hungry4 ,a month or two later he begins to distinguish between familiar and unfamiliar faces1 and to show approval or disapproval4 ,,development ,,of ,,speech4--,a baby six or seven months old begins consciously to utter sounds1 and usually can say a few unconnected words by the time he is a year old4 ,the average child1 however1 does not begin to form sentences of more than two or three words until he is about two years old4 ,,development ,,of ,,teeth4--,the so-called milk teeth are twenty in number2 they are followed by thirty-two permanent teeth4 ,the two lower front teeth 7central incisors7 generally appear when a child is from five to nine months old1 and in from one to three months later the four upper front teeth 7upper incisors7 appear4 ,all the first or milk teeth should have come through by the time a child is two and a half years old1 but wide variations occur both in the time and order of appearance and should occasion no uneasiness if the child seems well4 ,unusual conditions of any sort should be referred to the physician2 it is a great mistake to attribute all illness at this time to teething4 ,the first of the permanent teeth appear when a child is about six years old4 ,mothers sometimes mistake the first permanent molars for temporary teeth1 a mistake that frequently leads to neglect and even extraction of highly important teeth4 ,all but the last four molars1 sometimes called wisdom teeth1 should be through by the time a child is fifteen4 ,the wisdom teeth may not appear before the #bjth or even the #beth year4 ,,normal ,,excretions4--,a new-born baby should have one or two bowel movements during the first twenty-four hours2 the first bowel movements are sticky and almost black in color4 ,after the baby begins to nurse1 three to four movements a day are not unusual1 and throughout infancy and childhood as well as adult life there should be one or two evacuations of the bowels daily4 ,the character of the stools is more important than the number4 ,while the baby is taking milk only1 the movements should be soft1 yellow in color1 and nearly odorless4 ,change in frequency of the movements1 or appearance of undigested food or curds of milk in the stool1 should be carefully noted and if continued1 reported to a physician2 they may be the first signs of serious digestive trouble4 ,the urine of an infant should be odorless and colorless4 ,it should be voided at least once during the first twenty-four hours1 and much more frequently after the baby begins to nurse4 ,marked diminution in the amount of urine should be reported to a doctor4 ,efforts should be made early to develop habits of regularity in the evacuation of the bladder and bowels4 ,if taken up regularly most children learn to use a chamber for bowel movements by the time they are three months old4 ,normal children1 if properly trained1 usually have no bladder discharge during the night after they are #ah months old1 and they learn even earlier to indicate a desire to urinate during the day time4 ,,clothing4--,the amount and weight of a baby's clothing should depend upon the season2 but garments worn next to the skin1 except the diaper1 should be wholly or partly of wool1 the lightest weight in summer and heavier weight in winter4 ,during the first few weeks a baby's abdomen should be supported by a flannel binder about six inches wide1 applied snugly but not tightly enough to restrict either the abdomen or chest walls4 ,it may be replaced later by a loosely fitting knitted band worn for warmth only4 ,such a band is especially necessary if there is tendency to diarrha1 but in no case should it be discarded before the #ahth month4 ,all garments except the diaper and first flannel binder should hang from the shoulders1 and should fit loosely but well4 ,clothing for babies should be of soft materials and should be simply made4 ,even the first clothes should not be very long4 ,the weight of very long clothing is an unnecessary burden1 and prevents free movements of the legs4 ,at night an entire change of clothing should be made1 and a nightgown of warmer material substituted for the petticoat and slip4 ,most children are dressed too warmly indoors1 but in low temperatures they need to be well protected4 ,diapers should be soft and absorbent4 ,it may be necessary to wash new diapers several times before using in order to make them soft enough4 ,care should be taken not to apply them too tightly1 or in such a way as to cause pressure on the genitals4 ,they should be changed during the day whenever wet or soiled1 and at night when the baby is taken up to be fed4 ,proper care of diapers is highly important1 however laborious4 ,they should be well washed1 boiled1 and thoroughly dried before they are used a second time4 ,diapers that have been wet but not soiled should not be dried and used again before being washed4 ,much work can be saved if pads of loosely woven absorbent material are used inside the diaper to receive discharges4 ,the pads can be burned1 but even if washed the labor is less than washing full sized diapers4 ,like all other infant's garments1 diapers should be washed with pure white soap and without starch4 ,waterproof material used to cover the diaper is almost sure to irritate the baby's skin1 and is consequently harmful4 ,,sleep4--,during his first few weeks a normal baby sleeps about nine-tenths of the time1 and should be left undisturbed except for necessary care4 ,he should sleep in a crib1 bassinet or basket protected from light and drafts2 in no circumstances should a baby sleep in the bed with his mother or any other person4 ,pillows are unnecessary for babies1 and indeed for older children1 but if used they should be thin and firm4 ,the amount of sleep necessary gradually diminishes1 but during all the years of growth a child needs more sleep than an adult4 ,the amount of sleep required daily is approximately as follows3 ,first month #ah to #bj hours ,second to sixth month #af to #ah hours ,sixth month to one year #ad to #ae hours ,one to two years #ac to #ad hours ,two to four years #aa to #ab hours ,after this time a child should sleep at least ten hours out of the twenty-four4 ,during the first year a nap in the middle of the forenoon and another in the afternoon are desirable4 ,a child who is inclined to sleep so long that his nap interferes with his night's sleep1 should be waked from his nap1 but at the same hour every day4 ,when a child is a year old1 one nap during the day is often sufficient1 if he is doing well1 but the habit of taking a nap at some time during the day should be continued through the fifth year if possible1 or even later4 ,babies should not be rocked or otherwise coaxed to go to sleep2 they should be made comfortable and then left alone4 ,they learn to go to sleep by themselves as soon as they are convinced that sleep is expected of them1 and that no unfounded objections on their part will be regarded4 ,continued inability to sleep normally usually indicates discomfort or poor general condition1 and should be taken up with the doctor4 ,pacifiers and thumb-sucking should not be allowed1 since they lead to changes in the shape of the jaw with resulting imperfect adjustment of the teeth4 ,soothing syrup and like medicines should never be given to a baby2 death or permanent injury has resulted from their use4 ,it is impossible to emphasize too strongly the danger of giving them even a single time4 ,,fresh ,,air4--,all that has been said about the importance of fresh air for adults applies with even greater force to infants and children4 ,during his first month especially a baby is susceptible to draughts2 nevertheless1 the room should be well ventilated and its temperature kept between #fh and #gj ,f4 during the day1 and at about #fe ,f4 at night4 ,even in cold weather the room should be well aired two or three times a day2 the baby should be removed to another room while the windows are open4 ,after the baby is three or four months old the windows may be left open at night provided the outside temperature does not fall below freezing4 ,a healthy baby two or three weeks old may be taken out-of-doors for a short time in mild weather2 when he is three months old he may be taken out-of-doors even in winter on bright sunny days4 ,the time spent out-of-doors should be gradually increased until the baby stays out the greater part of the day2 but he should not be exposed to storms1 wind1 flying dust1 dampness1 extremes of temperature1 or insects4 ,the eyes should not be covered by veils1 but they should be shielded from the direct rays of the sun at all times4 ,,diet4--,a baby1 in order to thrive1 must have suitable food1 given at regular intervals4 ,during the first few months of life no other food can take the place of mother's milk4 ,breast-fed babies are more robust than bottle-fed babies2 more than this1 they are less likely to contract infectious diseases or to suffer from digestive disorders4 ,the number of bottle-fed babies who die every year is three times as great as the number of breast-fed babies who die4 ,many mothers do not understand the risk involved in weaning small babies2 and so every year many little lives are lost1 and lost needlessly4 ,when poverty forces nursing mothers to wean their babies and seek work outside their homes1 one can only say that a society which tolerates such a waste of infant life is indeed regardless of its own welfare4 ,special conditions1 of course1 may make it undesirable for a mother to nurse her baby4 ,no one but the physician is competent to decide this2 not even neighbors1 grandmothers1 other members of the family1 or the mother herself4 ,where artificial feeding must be used1 it should be carefully adapted to the individual child1 and in consequence it must be prescribed by the doctor4 ,patent foods1 notwithstanding the claims on their printed labels1 should be used only under his advice4 ,,intervals ,,of ,,feeding4--,little milk is secreted during the first two days after the birth of a child4 ,the baby should1 nevertheless1 be put to the breast as soon as he has had his first bath1 if the mother is sufficiently rested4 ,always before and after nursing the mother's nipples should be washed in water that has been boiled4 ,nursing should be repeated at intervals of six hours during the first two days4 ,the following schedule for the feeding of healthy babies is given by ,holt in ,care and ,feeding of ,infants4 7#aiag47 ,,schedule ,,for ,,healthy ,,infants ,,for ,,the ,,first ,,year ---------------------------------------- ------------------------- ,interval ,night ,no4 of ,quantity ,quantity ,age between feedings1 feedings1 for one for #bd meals by #f p4m4 in #bd feeding hours day to hours #f a4m4 ---------------------------------------- ------------------------- ,hours ,ounces ,ounces #b;d to #gth day #c #b #g #a-b #a-ad #b;d and #c;d weeks #c #b #g #b-c #ad-bd #dth to #fth week #c #b #g #c-d #ba-bh #gth week to #c mos4 #c #b #g #c-e #be-ce #c to #e months #c #a #f #d-f #bg-cf #e to #g months #c #a #f #e-f #cc-ci #g to #ab months #d #a #e #g-h #ce-dc ---------------------------------------- ------------------------- ,during the period when seven feedings are given in #bd hours the following hours will be found convenient3 #f a4m41 #i a4m41 #ab m41 #c p4m41 #f p4m41 #aj p4m4 and #b a4m4 ,the #b a4m4 feeding is the one omitted when the number of feedings is reduced from seven to six4 ,food should be given on exact schedule time2 the baby if asleep should be waked for any meal except the one due at #b a4m4 ,,water4--,pure boiled water should be given regularly even to a young baby4 ,he is often satisfied with a little warm water if he is fretful between the hours of nursing4 ,water may be given from a cup1 a spoon1 or a bottle2 it is desirable1 however1 for the baby to learn to drink from a cup before the period of weaning begins4 ,,weaning4--,ordinarily1 a baby should be fed from the breast until he is seven months old1 either exclusively or with the exception after the second month of one bottle-feeding in twenty-four hours4 ,this exception will do the baby no harm and may be a great relief to his mother4 ,partial breast-feeding should continue if possible through the ninth month1 but every baby should be entirely weaned by the time he is one year old4 ,it may be necessary1 if either the baby or the mother is not thriving1 to change the food before the ninth month2 but it is desirable not to make the change in hot weather4 ,healthy babies1 it should be remembered1 increase in weight constantly1 and steady gain in weight is the best indication that a baby's food is suitable4 ,,nursing ,,bottles ,,and ,,nipples4--,nursing bottles should be of heavy glass1 cylindrical in shape1 without angles or corners to make cleaning difficult4 ,the number of bottles provided should be two or three more than the number of feedings given in #bd hours4 ,short black rubber nipples which slip over the neck of the bottles should be selected4 ,they should be of such a shape that they can easily be turned inside out2 a nipple turner costs little1 and is well worth the price4 ,nipples should be discarded when they become soft or when the opening grows so large that the milk runs in a stream rather than drop by drop4 ,as soon as the baby has finished his meal1 the bottle should be removed from his mouth1 rinsed in clear hot water1 and left standing filled with cold water until a convenient time for boiling all the bottles to be used during the next #bd hours4 ,sufficient time must be allowed for the bottles to cool thoroughly between the time when they are boiled and the time when they are refilled4 ,when it is time to boil the bottles they should be placed in an agate or other suitable kettle1 covered with water1 and boiled vigorously for three minutes4 ,a cloth placed in the bottom of the kettle will help to prevent the bottles from breaking4 ,after the bottles have been removed from the boiling water1 they should be stoppered at once1 either with rubber stoppers or plugs of sterile cotton4 ,the stoppers1 if used1 should be boiled with the bottles2 sterile cotton may be purchased by the package4 ,an easy and satisfactory method to care for rubber nipples is the following3 ,provide as many nipples as the number of feedings given in #bd hours1 and another1 if desired1 to be used in case of accident2 provide also two cups of ordinary white enamel1 each one large enough to hold all the nipples at once4 ,one cup should have a cover2 the other should not4 ,to avoid mistakes it is well to have the cups different in shape4 ,as soon as each feeding is finished the nipple should be thoroughly cleansed under running water by scrubbing it inside and out with a nipple brush4 ,the nipple thus cleansed is placed in the cup without a cover4 ,when all the nipples have been used1 cleansed1 and collected in the uncovered cup1 they are transferred into the other cup2 water is added1 the cup is covered and its contents are boiled for three minutes4 ,the nipples remain covered in the boiled water until needed2 they are removed one by one for the successive feedings4 ,care must be used in removing a nipple to take it by the rim1 not to touch other nipples during the process and not to dip the fingers into the water4 ,the best way is to remove them by means of a glass rod1 which is boiled with the nipples and kept with them in the cup when not in use4 ,there are several advantages of this method of caring for nipples3 it is easy2 it reduces to a minimum the necessary handling of the nipples after boiling2 and it reduces the probability of using the wrong nipple1 since boiled nipples are always in one kind of receptacle and used nipples in another4 ,it also prevents the too common practice of continuing to keep nipples in a supposedly antiseptic solution long after the solution has become badly soiled4 ,,tables of diet for children over one year of age may be found in the ,appendix1 page #cbb4 ,,bathing4--,usually the cord has separated and the navel has entirely healed by the time a baby is #aj days old4 ,after this time a daily tub bath should be given2 it should be given not less than one hour after feeding4 ,the temperature of the room should be from #gj-gb1 measured by a thermometer placed in the part of the room where the bath is to take place4 ,in order to avoid chilling or tiring the baby the bath should be given quickly1 without confusion or interruption2 success can be achieved by using even a moderate amount of foresight4 ,before undressing the baby everything to be used should be collected and placed within easy reach1--clean clothing1 soft towels1 #b wash cloths1 pure white soap1 powder1 absorbent cotton1 etc4 ,the bath tub should last of all be filled with water1 and its temperature tested by means of a bath thermometer4 ,the temperature of the water should be from #ih to #ajj4 ,after the baby is three months old slightly cooler water should be splashed over his chest1 back1 neck1 and arms just after he is removed from the tub1 and as he grows older the temperature of his cool splash can be reduced4 ,children who become accustomed to cool water in this way take kindly to their cold showers later4 ,the baby's face should be washed first and dried carefully1 while his body is still covered4 ,next the head should be washed2 a little soap should be used1 but it must on no account enter the eyes4 ,next the entire body should be soaped with the hand2 and then the baby should be placed gently in the bath1 his head and shoulders supported by the attendant's left hand and forearm4 ,care should be taken to rinse off all the soap4 ,the baby should not stay in the tub more than #b or #c minutes2 after he has been removed from the tub he should be wrapped at once in a soft bath towel4 ,he should be dried gently but thoroughly by patting with soft1 warm towels rather than by rubbing4 ,folds of the skin should be dried with special care4 ,a little powder may be applied1 but a baby who is kept both clean and dry will not need much powder1 if any4 ,the baby should next be quickly dressed1 with as little turning and moving as possible4 ,clothing should be drawn on over the feet instead of over the head1 and the petticoat should be placed inside the slip so that the two garments may go on simultaneously4 ,,eyes4--,secretion accumulating in the corners of a baby's eyes should be removed by means of a bit of absorbent cotton moistened in boiled water4 ,the secretion should be wiped away gently2 a different piece of cotton should be used for each eye1 and a piece that has been used should not be put back into the water4 ,further than this1 eyes in a normal condition do not need cleansing4 ,every person who handles a baby should be very sure that her hands are clean2 she should be doubly sure before she touches his eyes1 since a baby's eyes are peculiarly susceptible to infection from any source4 ,more than a quarter of all totally blind persons in the ,united ,states became blind by infection of the eyes at birth4 ,blindness of the new born can be prevented in practically all cases if the doctor uses a preparation of silver in the baby's eyes immediately after birth4 ,this treatment is effective and entirely safe4 ,if at any time the eyelids look red or swollen1 or if a drop of matter appears between the lids1 the physician should be summoned at once4 ,total blindness may result if treatment is delayed even a few hours4 ,,mouth4--,the mouth should be rinsed after feeding by giving the baby a teaspoonful of boiled water4 ,until the teeth come it does not require other cleansing1 and attempts to clean it may injure the delicate membranes that line it4 ,indeed1 except in an emergency1 fingers should not be inserted into a baby's mouth4 ,the teeth when they appear should be cleaned by means of a soft tooth-brush4 ,,nostrils4--,the nostrils need no cleaning other than removal of mucus that can easily be reached by means of a piece of cotton4 ,if a little vaseline is placed in the nostrils on a small piece of absorbent cotton in the early morning1 collections of mucus will usually be softened so that they can be removed easily at bath time4 ,,genital ,,organs4--,the genital organs of girl babies should be gently washed twice a day1 using absorbent cotton1 and tepid water4 ,treatment other than cleanliness is ordinarily unnecessary4 ,vaseline may be applied if the genitals are slightly reddened2 any discharge or abnormal appearance should be reported to the doctor4 ,in the case of boy babies the foreskin should be gently drawn back twice a week after immersion in the tub2 after the parts have been gently washed with absorbent cotton1 it should be drawn forward again4 ,no force should be employed in retracting the foreskin2 the physician should be consulted if it cannot be retracted easily4 ,,the ,,development ,,of ,,habits4--,during his first few months crying is a child's only means of expression1 and he quickly learns to make effective use of his limited opportunities4 ,it is important for the mother to distinguish between crying caused by pain1 illness1 or hunger1 and crying caused by temper4 ,these cries are more or less distinctive1 but no one can be sure in every case just what a crying baby is attempting to express4 ,a cry caused by hunger is fretful and often interrupted by sucking the thumb2 it ceases when the child is fed4 ,a cry caused by indigestion is similar2 the child is relieved for a short time by feeding1 but soon begins to cry again4 ,if he has acute pain1 such as earache1 the cry is sharp1 repeated at frequent intervals and accompanied by other symptoms of distress1 such as restlessness1 contraction of the features1 and drawing up the legs4 ,in serious illness the cry is usually feeble1 fairly constant except when the child is asleep1 and exaggerated by slight causes4 ,a limited amount of crying is useful exercise for a baby1 and should not distress his mother unduly4 ,moreover1 crying may be merely the expression of a wish to be taken up1 to be played with1 carried about or otherwise amused1 to be given a pacifier1 or to be indulged in other bad habits4 ,if not indulged in these ways he may cry from temper4 ,the cry of temper is loud and violent1 accompanied by vigorous kicking or by holding the body rigid4 ,proper treatment of the baby may prevent many months of discomfort1 and spare him the formation of his first bad habit4 ,all other possible causes for crying should be eliminated4 ,if the child continues to cry when he is warm and dry and comfortable1 ,it should simply be allowed to cry it out4 ,this often requires an hour and in extreme cases two or three hours4 ,a second struggle will seldom last more than ten or fifteen minutes and a third will rarely be necessary 7,holt74 ,gas may form in the child's stomach during prolonged crying4 ,it is consequently permissible to take him up after #ae minutes1 and hold him erect2 he generally expels gas at once1 and immediately experiences relief4 ,as soon as he is relieved1 he should go back to his crib4 ,,exercise4--,exercise is essential to the development of the body1 but during the first few weeks warmth and quiet are so important that a baby should not be disturbed except for necessary care4 ,his position1 however1 should be changed occasionally2 if he lies on the same side constantly the soft bones of the head may become misshapen from pressure4 ,as the baby grows older he needs more exercise1 and he may be given an opportunity for it by removing his outer clothing and placing him on a bed in a warm room for a short time each day4 ,unnecessary handling is not good for a baby at any age4 ,after he becomes more active1 he may play on a mattress or thick blanket placed on the floor4 ,the blanket should be covered with a washable pad or rubber cloth and clean sheet1 and the whole should be surrounded by a fence at least two feet high4 ,in such an enclosure a baby may safely be left to play if protected from draughts and cold4 ,elevated pens that can be folded when not in use are more convenient but more expensive than the home-made arrangement4 ,as soon as a child begins to run about he takes ample exercise1 and he may even need to be guarded from too great fatigue1 especially toward bedtime4 ,games and play should be adapted to the age of the child and sufficiently varied to exercise all portions of the body2 but they should not be too violent nor too prolonged4 ,some supervision of children's play is necessary1 but they should be given as much freedom as possible and allowed to develop their own initiative4 ,,play ,,and ,,toys4--,the desire for play does not develop until a child is about six months old4 ,at this age toys that can be washed1 such as those of hard or soft rubber1 should be selected4 ,a baby instinctively carries everything to his mouth1--first his thumb1 then playthings1 and later whatever he may find1 no matter how unsuitable4 ,for his safety and protection this habit should be overcome as soon as possible1 and he must learn to put nothing in his mouth except food and drink4 ,relatives are nearly always tempted to give too many and too fragile toys2 they merely teach a child to be destructive and constantly to expect something new4 ,toys are the first possessions of which a child is conscious1 and through them many desirable qualities may be developed3 neatness and order1 gentleness and a feeling of protection toward the helpless doll or ,teddy bear1 and unselfishness in sharing special treasures with playmates4 ,later the child may be given pets and made responsible for their care2 but animals should not be subjected to unintentional cruelties from small children4 ,,exercises #a4 ,what two factors are chiefly responsible for the deaths of babies under a year old8 ,what other factors contribute8 ,in your city or town what is the number of deaths per #ajjj births of babies under one year old8 #b4 ,why is birth registration important to an individual8 to a community8 ,is it required by law in your city8 #c4 ,what is the average weight of babies at birth8 ,describe the rate at which they should gain4 #d4 ,at what age may a normal child be expected to sit erect8 to stand8 to walk8 to speak8 ,when should his first teeth appear8 his permanent teeth8 #e4 ,describe normal bowel movements of a baby4 #f4 ,how should a young baby be dressed8 #g4 ,describe a baby's bath and toilet4 #h4 ,describe the surroundings that are suitable for a baby4 #i4 ,what is the best food for a healthy baby8 ,why8 #aj4 ,describe in detail a good daily program for a healthy baby four months old4 #aa4 ,what habits are desirable for a baby to form1 and how may he be trained so that he will form them8 #ab4 ,name all the indications that would tell you when a baby was not thriving1 and in each case tell what you would do about it4 ,,for ,,further ,,reading ,the ,care and ,feeding of ,children--,holt4 ,the ,care and ,feeding of the ,baby--,truby ,king4 ,the ,baby's ,first ,two ,years--,r4 ,m4 ,smith4 ,the ,care and ,feeding of ,children--,j4 ,l4 ,morse4 ,preventive ,medicine and ,hygiene--,rosenau1 ,section ,,iii1 ,chapter ,,ii4 ,pamphlets3 ,prenatal ,care1 ,mrs4 ,max ,west4 ,infant ,care1 ,mrs4 ,max ,west4 ,child ,care1 ,mrs4 ,max ,west4 ,published by the ,children's ,bureau1 ,united ,states ,department of ,labor1 ,washington1 ,d4 ,c4 7,free on request47 ,the ,care of the ,baby--,supplement ,no4 #aj to the ,public ,health ,reports1 #aiac1 ,government ,printing ,office1 ,washington1 ,d4 ,c4 ,your ,baby3 ,how to ,keep ,it ,well--,new ,york ,state ,department of ,health1 ,albany4 ,publications of the ,american ,association for the ,study and ,prevention of ,infant ,mortality--#abaa ,cathedral ,street1 ,baltimore1 ,md4 7,free on request47 ,publications of the ,national ,committee for the ,prevention of ,blindness--#acj ,east #bb;d ,street1 ,new ,york ,city4 7,free on request47 ,,footnotes3 #a ,an area including about two-thirds of the population of the ,united ,states4 ,,chapter ,,iv ,,indications ,,of ,,sickness ,by indications of sickness we mean all evidences of deviation from a normal physical condition4 ,they may be apparent only to the person in whom they occur1 or to a second person only1 or to both4 ,these deviations1 commonly called the symptoms of sickness1 are always important to notice1 whether the conditions they indicate are serious or not4 ,early symptoms of sickness are often slight2 hence they easily pass unnoticed4 ,yet a slight trouble1 easily checked in its early stages1 may1 if neglected1 grow into a serious or even fatal disorder3 just as a burning match1 which anyone could extinguish instantly1 may kindle a fire beyond the power of an entire city to control4 ,it is important1 then1 to notice even slight symptoms of sickness1 first1 in order to determine the nature of the trouble1 and second1 in order to institute treatment as early as possible4 ,it is1 however1 hardly less important to observe symptoms accurately during the entire course of an illness4 ,a patient's progress can be determined only by careful comparison between present and past conditions4 ,many symptoms can be detected only by methods requiring scientific apparatus as well as the knowledge and skill of a physician1 but very pronounced symptoms are generally evident to anyone4 ,the neighbors do not need to be told when a person has advanced tuberculosis2 neither is an expert required to see that something ails a man with a broken leg4 ,furthermore less pronounced symptoms may often be clearly seen by any observant person1 even by those not specially trained4 ,accordingly it is important for every woman who has charge of others1 sick or well1 to form the habit of noticing unusual appearances of any kind4 ,this habit is one that most people must take pains to acquire1 because people generally see only the things that their own experience in life has taught them to see4 ,an added difficulty is the fact that when illness begins it is not a trained observer1 but the untrained sufferer or untrained member of his family who decides whether to send for the doctor and thus to set in motion the machinery for treatment and cure4 ,all the training and experience of a physician are required in order to decide what symptoms indicate1 and to prescribe proper remedies4 ,diagnosis1 or the process of determining the nature of illness from the symptoms observed1 is often exceedingly difficult2 it must take into consideration not one symptom only but the presence or absence of a number of symptoms4 ,untrained persons who attempt to make diagnoses are frequently led astray by the fact that actual causes of trouble may be situated far from the places where symptoms are felt or observed4 ,for instance1 the real cause of headache may lie in a region far removed from the head2 and so-called heart-burn1 which is caused by disordered digestion1 has nothing to do with the heart4 ,again1 an early symptom of tuberculosis of the hip joint is pain under the knee2 a mother is clearly not doing the best thing when she assumes that any pain in a joint means rheumatism1 and therefore doses her suffering child with the medicine that helped his rheumatic grandfather4 ,no untrained person is equipped to make a diagnosis1 and still less to prescribe medicine or treatment4 ,symptoms1 like all other forms of discomfort1 tend to trouble a patient in proportion to the amount of attention that he gives them4 ,hence1 in order to avoid calling his attention to them unnecessarily they should be observed so far as possible without his knowledge2 when it is unavoidable for him to realize what is going on1 observation should be made a matter of routine1 so that his interest may not be especially excited4 ,for instance1 everyone who has seen the routine medical inspection of school children realizes how little attention the children themselves give to the process1 apparently regarding it merely as one of the many inexplicable proceedings of grown people4 ,on the other hand1 children who know their symptoms are over-anxiously watched soon learn to watch themselves and to exaggerate every little ache and pain4 ,symptoms may be divided into two classes3 first1 objective symptoms1 or those that can be noted by an observer1 like cough1 pulse rate1 or color of the skin2 and second1 the subjective symptoms1 which are apparent only to the person affected1 like pain and fatigue4 ,the success of any woman who cares for the sick depends to a large extent upon her quickness and accuracy in noticing and reporting these symptoms and their variations4 ,it should be remembered that pronounced symptoms are not the only ones of importance3 even slight symptoms that continue over an appreciable length of time may be of very great importance4 ,a brief description of some important symptoms follows1 in order to help persons without technical training to describe the symptoms as well as to observe them4 ,,objective ,,symptoms ,,temperature4--,bodily heat is produced by slow burning of food materials1 which goes on for the most part in actively working muscles and glands4 ,heat thus generated is distributed by the blood to all parts of the body1 but the surface of the body is generally cooler than the interior4 ,in health the body temperature varies only a few degrees1 no matter how much the temperature of its surroundings varies2 consequently a temperature is abnormal if it is higher or lower than the usual temperature of a healthy person4 ,the temperature is taken by means of a clinical thermometer placed either in the mouth1 the rectum1 or the armpit 7axilla74 ,illustration3 ,,fig4 #aj4--;,,clinical ,,thermometer4 ,to take the mouth temperature1 first wash the thermometer1 using cold water and absorbent cotton or clean soft cloth4 ,next shake it until the mercury thread registers #if or below4 ,it is well before purchasing a thermometer to see whether it can be shaken down easily4 ,next place the thermometer in the patient's mouth1 with its bulb under his tongue2 he must then keep his lips closed until it is removed4 ,leave the thermometer in his mouth for two minutes4 ,then remove the thermometer1 read the temperature and record the result4 ,clean the thermometer at once1 using first cold water and soap1 and then alcohol1 #gj4 ,the mouth temperature of a healthy person is about #ih4f ,f4 ,this statement holds true if the person has been sitting with his mouth shut for a little while before his temperature is taken2 but a hot bath1 breathing through the mouth1 eating or drinking1 and so forth may cause marked temporary changes4 ,the temperature in the rectum generally varies less than the temperature in the mouth unless it is taken when the rectum contains fecal matter4 ,the temperature should be taken by rectum in babies and young children1 restless1 drowsy1 or delirious patients1 patients who cannot be trusted to keep the thermometer under the tongue1 mouth breathers1 and in any patients who have difficulty in keeping the mouth shut4 ,the temperature is normally about half a degree higher in the rectum than in the mouth4 ,in order to take a temperature by rectum1 adults generally find it more convenient to lie on the side and prefer1 if they are able1 to insert and hold the thermometer themselves2 but the attendant should be certain that they can do so without breaking the thermometer4 ,rectal thermometers should be lubricated with oil or vaseline before using2 they should be inserted about two inches1 left in three minutes1 and cleansed in the same way as the mouth thermometer4 ,a thermometer used to take rectal temperatures should never be used in the mouth4 ,in taking the temperature of a baby place him on his back1 hold him firmly with his legs elevated1 and carefully insert the bulb of the thermometer1 well oiled1 for about one inch4 ,keep the child quiet1 and hold the thermometer in place three minutes4 ,great importance should not be attached to a slight fever of short duration4 ,the temperature of a child is much more easily affected by slight causes than that of an adult1 and rectal temperatures between #ig4e and #ajj4e should not cause anxiety unless continued4 ,temperatures taken in the axilla are less accurate than those taken by mouth or rectum4 ,consequently the method is less often used4 ,the axilla should first be wiped2 then the thermometer should be inserted and held for #e minutes by pressing the arm tightly against the chest wall4 ,the temperature in the axilla is normally about half a degree lower than in the mouth4 ,the temperature varies somewhat according to the time of day4 ,it is not unusual for the mouth temperature of persons who are entirely healthy to be as low as #ig in the early morning1 or as high as #ii in the late afternoon1 and probably most people's temperatures vary as much as a degree during the twenty-four hours4 ,even greater variations that are not long continued have little if any significance in people who feel well4 ,decided variations either above or below normal are highly important symptoms4 ,a temperature below #ih is called subnormal1 and one above #ii4e is called fever4 ,the number of degrees of fever does not necessarily bear a direct relation to the severity of an illness4 ,thus1 it does not follow that one person is twice as sick as another1 because his temperature is twice as many degrees above normal4 ,all symptoms1 including variations in temperature1 must be considered in connection with one another1 and it is generally impossible to state the significance of any one symptom taken by itself4 ,the temperature should be taken once or twice a day as a matter of routine in almost every form of illness1 and oftener when the patient's condition requires it4 ,also it should be taken as a matter of routine whenever there is indication of beginning sickness2 especially when there is headache1 pain1 sore throat1 coated tongue1 cough or cold1 chill1 vomiting1 diarrha1 or rash4 ,it is not a good plan to take one's own temperature oftener than necessary1 or indeed anyone's2 certainly not a baby's1 since frequent use of the thermometer may irritate the rectum4 ,,pulse4--,each time the heart beats1 blood is forced out from the heart into the arteries1 thus causing an expansion of the arterial walls4 ,this expansion1 called the pulse1 can be felt in some places where arteries lie close to the surface of the body4 ,the character of the pulse beat and its rate1 or the number of times the beat occurs each minute1 give information about the heart and blood vessels2 taken together they are perhaps more important than any other one symptom4 ,illustration3 ,,fig4 #aa4--,,taking ,,the ,,pulse ,,at ,,the ,,wrist4 ,,note ,,the ,,position ,,of ,,arm4 7,from ,elementary ,nursing ,procedures1 ,california ,state ,board of ,health47 ,the pulse rate varies much more than the temperature4 ,it differs in different individuals and at different ages1 and it often shows great temporary changes1 especially during exercise or eating1 or as a result of excitement1 fear1 or other emotion4 ,definite statements in regard to normal pulse rates are hard to make1 because different individuals though in perfect health show marked variations2 we generally say1 however1 that the pulse rate of a normal man at rest is about #gb a minute1 and that of a normal woman is about #hj a minute4 ,at birth the pulse is quickest2 it may then be from #abd to #add4 ,from the #fth to the #abth month it may be from #aje to #aae a minute1 and from #ij to #aje between the #b;d and #fth years4 ,about the time of puberty it reaches the adult rate1 and during old age it may be decidedly slower than the adult rate4 ,what we chiefly want to know about the pulse is #a4 ,its rate1 or number of beats per minute1 #b4 ,its force1--whether weak or strong1 #c4 ,its rhythm1--whether regular or irregular4 ,much practice is necessary before the pulse rate can be counted with any degree of accuracy1 and wide experience with both normal and abnormal pulses is required in order to judge its strength1 rhythm1 or other characteristics4 ,the pulse may be felt most conveniently on the thumb side of the front of the wrist4 ,the pulse should be counted while the patient is lying down1 and the watch used must have a second hand4 ,to count the pulse1 one should place two or three fingers 7not the thumb7 on the patient's wrist1 and after the pulse has been felt distinctly for a few beats1 the exact time by the second hand of the watch should be noticed and the counting begun immediately4 ,it is generally best to count for half a minute1 multiply the result by two to get the rate for a whole minute1 and then to repeat for another half minute4 ,the two results should agree within two beats1 if the patient is quiet4 ,a greater variation than two beats may mean that the pulse rate is varying1 but when it is counted by inexperienced persons the apparent difference is generally the result of inaccurate counting1 and it may be necessary to count two or three times more4 ,the force of the pulse varies also in different individuals2 it is1 however1 important to notice when it grows stronger or weaker in the same person4 ,normally the pulse-beat is regular like the ticking of a clock2 it is called irregular if a few rapid or slow beats are followed by others of a different rate4 ,during sickness the pulse should be counted whenever the temperature is taken1 or oftener2 and the result should be written down at once4 ,the pulse of a sick person often shows changes both in rate and character2 these changes are generally important and should be noticed4 ,,respiration4--,variations in the rate and character of respiration or breathing should be noticed4 ,the normal rate of respiration for an adult at rest is #af to #bj each minute1 but it may be much faster1 especially during muscular exercise4 ,in babies the rate is about #cj to #ce a minute1 and #bj to #be in little children4 ,the respirations1 especially of babies1 can best be counted during sleep by placing the hand lightly on the chest or abdomen4 ,since the respiration rate is partly under a person's control1 it is almost sure to alter if the patient knows it is being counted2 hence when the patient is awake it is better to keep one's fingers on his wrist1 to place his hand upon his chest1 and then to count the rise and fall of the chest while apparently counting the pulse4 ,sometimes it is possible to count the respirations merely by watching the rise and fall of the nightgown or bed clothes4 ,the respiration is usually counted for a full minute4 ,a watch with a second hand must be used1 and the result should be recorded immediately4 ,in certain forms of sickness breathing may become rapid1 especially if the lungs or air passages are affected4 ,in addition to the rate anything unusual about the breathing should be noticed whether it seems difficult or painful2 if noisy1 whether the sound is like snoring1 or wheezing1 or sighing1 and so on4 ,,general ,,appearance4--,any unusual expression of the face should be noted2 whether it is drawn1 pinched1 anxious1 excited1 or dull and stupid2 and also1 whether the face is thin1 swollen1 or puffy under the eyes4 ,the condition and appearance of the skin are significant3 the skin may be dry1 moist and clammy1 hot or cold2 its color1 and the color of the face especially1 may be flushed or pale or slightly yellow or blue4 ,a bluish tinge about the nose1 tips of the fingers1 or the feet should be specially noticed4 ,reddened or discolored areas on any part of the body may be important1 and also eruptions1 rashes1 swellings1 or sores4 ,it should be noticed whether the abdomen is normal or whether it is distended and hard4 ,strength or weakness is indicated to some extent by the way the patient moves1 and by his ability to walk1 stand1 sit1 hold up his head1 feed himself1 or turn in bed without assistance4 ,the position he habitually takes is sometimes significant2 in heart affections1 for instance1 he may be unable to lie down1 in pleurisy he ordinarily lies on the affected side1 and during abdominal pain he generally draws the knees up4 ,,special ,,senses4--,the special senses are frequently disturbed in sickness4 ,the eyes may be blood-shot2 the patient may be over-sensitive to light1 or see spots floating before the eyes1 or he may be unable to see at all4 ,the pupils of the eyes may be unusually large or small1 or one may be large while the other is small4 ,swelling1 redness1 or discharge from the eyes should be noticed4 ,hearing and touch and smell may be impaired2 or they may be abnormally acute1 and cause real suffering4 ,taste may be impaired1 especially when the nose is affected or when the mouth is not clean4 ,discharge from the nose or ears should be reported4 ,not only discharge1 but also trouble of any kind1 such as pain1 tenderness1 or swelling1 is important if situated in or near the ears4 ,,the ,,voice is often much altered in sickness4 ,it may be weak1 hoarse1 or whispered4 ,speech may be clear or thick1 or the ability to speak may be entirely lost2 in extreme weakness speaking is generally difficult1 and may be impossible4 ,moaning1 groaning1 and other unusual sounds should be noted4 ,a loud1 sharp cry at night with or without waking1 if a repeated occurrence1 may be an early symptom of some diseases of children4 ,,the ,,tongue in health is red and moist2 when extended it is somewhat pointed and can be held steadily4 ,in sickness it may be cracked1 dry and parched1 or if the patient is not properly cared for1 it may be covered with white1 yellow1 or brown coating2 in many exhausting illnesses it is flabby and trembling4 ,in scarlet fever the tongue is often a vivid red color1 and is then called strawberry tongue4 ,the odor of the breath may be foul from decay or neglect of the teeth1 from indigestion1 constipation1 nasal catarrh1 or special diseases4 ,,the ,,throat and tonsils are sometimes red and swollen as in simple sore throat2 or they may be covered by white patches4 ,,the ,,gums may be swollen1 tender1 or bleeding4 ,a collection of sticky brownish material may appear on the teeth and gums of neglected patients4 ,,cough when present may be3 dry1 or accompanied by expectoration2 painful1 frequent1 loud1 or whooping2 and worse by day or by night4 ,the sputum may be yellow1 white1 gray1 rusty1 blood-streaked1 dark1 or frothy4 ,the amount of sputum should be noticed as well as its appearance4 ,,appetite or absence of appetite should be noted1 and also the amount of food actually eaten by a patient2 the amount eaten is frequently not the same as the amount carried to him on a tray4 ,if ,,vomiting occurs1 the color1 consistency1 amount1 and general appearance of the vomitus should be noted2 if its appearance is unusual the vomitus should be saved for the doctor's inspection4 ,,excretions4--,the number of bowel movements is important1 and also their character4 ,the consistency of the feces may be hard1 soft or fluid2 their color may be any shade of brown1 yellow or green1 from black to clay color4 ,they should be saved for the doctor to see if appearance or odor is unusual4 ,,the ,,urine in health is clear1 amber colored1 and slightly acid4 ,from #cj to #ej ounces should be excreted in #bd hours2 the amount varies1 however1 especially according to the amount of fluid taken4 ,it is important to notice whether the urine is scanty or greatly increased in amount1 dark or pale1 clear or cloudy1 and whether sediment is deposited after standing4 ,it is essential that urine should be voided in sufficient amount2 the necessity for watching its quantity is frequently overlooked in the home care of the sick4 ,frequency of urination should also be noted4 ,inability to urinate1 particularly where the urine has previously been scanty1 is serious if continued2 it should be reported to the doctor without delay4 ,inability to control the bladder and bowels are also symptoms to be reported4 ,,loss ,,of ,,weight is significant in both adults and children1 and failure of babies and children to gain in weight is a danger signal4 ,,sleep4--,the number of hours a patient sleeps should be noticed and recorded as accurately as possible4 ,the word of the patient on this subject is not sufficient evidence4 ,character of sleep should also be noted1 whether it is quiet or restless1 and whether the patient sleeps lightly or is difficult to arouse4 ,,mental ,,conditions4--,it is important to watch carefully the mental condition of a patient2 whether1 for example1 he is normal1 or depressed1 irritable1 restless1 apathetic1 dull1 excited1 wandering1 delirious1 or unconscious4 ,hasty judgment of mental conditions should be avoided1 but close attention to them is necessary4 ,,subjective ,,symptoms ,,pain is the most important subjective symptom and should never be disregarded4 ,bodily pain does not occur in persons who are in all regards physically and mentally well2 hence pain is a sign that something1 small or great1 is out of order4 ,of all symptoms pain is the one which interests patients the most4 ,we here emphasize the truth1 too little understood1 that pain is an unpleasant sensation1 nothing more1 and is never imagined4 ,imagination may be its cause1 but the pain thus produced hurts just as truly as pain produced by a real disease4 ,pain is only a phenomenon of consciousness2 it is always real1 even that felt in a dream4 ,if the patient is too unconscious to feel it1 there simply is no pain1 no matter how badly the person's body is injured4 7,emerson3 ,essentials of ,medicine1 p4 #cef47 ,one should remember that no possible method exists to measure the intensity of pain exactly1 or to describe its quality accurately4 ,therefore in describing pain1 it is best to use the patient's own language4 ,four points should especially be observed1 7#a7 its location2 7#b7 its character1 which may be dull or sharp1 stabbing1 throbbing or continuous1 slight or severe2 7#c7 the time at which it is worst2 certain diseases1 for instance1 are characterized by more severe pain at night2 7#d7 it should be noticed whether the pain is relieved or increased by change of position1 eating or drinking1 heat or cold1 or the like4 ,pain may be felt in a part far from the place where the trouble really lies2 thus a dislocated shoulder causes pain in the elbow4 ,pain is always a danger signal1 although the significance is not always so great as the sufferer thinks4 ,the more attention a patient gives to his pain1 the more severe it always becomes1 therefore his attention should not be called to it unnecessarily4 ,a good observer1 however1 can get much information by noticing the patient's expression1 position1 motions1 etc41 without constantly asking him how he feels4 ,although many persons overestimate pain1 others persistently disregard it1 either because they are unwilling to take the necessary measures to remedy it1 or because they wish to appear heroic4 ,both courses of action are mistaken2 everyone should realize the folly and danger of bearing pain if it is possible to remove the cause4 ,nausea1 fatigue and malaise are other subjective symptoms2 malaise is the name given to a general feeling of physical discomfort not restricted to any one part of the body4 ,all three are abnormal when there is not apparent or sufficient cause4 ,,records4--,an accurate record should be kept of the patient's symptoms1 medicine1 diet1 treatment1 etc41 so that the doctor may have a continuous record1 and so that another person taking charge temporarily may know just what has been done for the patient4 ,the record must be written2 otherwise details cannot be remembered exactly4 ,it should be as simple and concise as possible2 it is the place for facts1 not for opinions1 and if inaccurate it is worse than none4 ,it is better not to keep the record in the patient's room1 for the patient should not see his own record1 nor hear its contents discussed4 ,the doctor usually writes his orders on the record sheet itself1 or on a separate sheet to be attached to the record for reference4 ,blank record forms can be purchased1 but a form that is made at home is entirely satisfactory4 ,an example of a daily record sheet follows4 ,,record ---------------------------------------- ---------------------- ,date ,hour ,tem4,pulse,resp4 ,diet and ,b4,m4,urine,remarks medicine ---------------------------------------- ---------------------- #aiaf ,jan4 #ad p4m4 #ajj #gf #bd ,medicine #e p4m4 #a vii #f p4m4 ,supper3 ,baked potato1 toast1 fruit1 tea4 #h p4m4 ,medicine ,sponge bath4 #i3cj p4m4 ,asleep4 ,jan4 #bc a4m4 ix #h a4m4 #ii #gd #bb ,medicine ,patient slept most of the night4 #h3cj a4m4 ,breakfast3 ,cereal1 orange1 toast1 coffee4 #i3cj a4m4 ,bath4 #aa3cj a4m4 ,sat up #a hour4 ---------------------------------------- ---------------------- ,,tuberculosis1 ,,cancer1 ,,and ,,mental ,,illness4--,as we have seen1 early symptoms of sickness are always important2 yet it seems worth while to mention particularly the early symptoms of tuberculosis1 cancer1 and mental disorders1 because each of these diseases1 though curable in many cases when taken in the early stages1 is serious and often fatal if neglected4 ,certain facts relating to their cause and prevention should be known to everyone4 ,tuberculosis1 long our greatest cause of death1 is gradually growing less2 but cancer and mental disease are now on the increase4 ,,tuberculosis4--,every year tuberculosis causes the death of about #aej1jjj people in the ,united ,states4 ,it is caused by the bacillus tuberculosis1 a germ which may attack any tissue of the body1 although it most frequently affects the lungs of grown people1 and the bones and glands of children4 ,the disease is not inherited1 but susceptibility to it appears to be2 it is readily communicated from person to person4 ,the germ of tuberculosis is so widely distributed that probably few persons over #cj years of age have not been infected with it at some time1 although the infection may have been too slight to be noticed4 ,indeed1 most people have probably been infected many times1 though without serious results4 ,tuberculosis is spread chiefly in two ways3 7#a7 through any bodily discharges from infected persons1 especially through the nose and mouth discharges2 7#b7 through milk from infected cows4 ,the ways by which the disease is spread indicate methods of prevention4 ,milk1 especially for children1 should either be pasteurized or should come from cows that have been tested and proved to be free from the disease4 ,other methods of prevention include avoiding any and all bodily discharges of infected persons1 and increasing bodily resistance as far as possible4 ,good food1 sufficient rest and fresh air are not only important preventives1 but also the most efficacious means of cure4 ,persons who suffer from insufficient food1 exposure1 bad housing1 long hours1 and bad conditions of work are especially susceptible to tuberculosis1 and thus it is rightly called a disease of poverty4 ,early symptoms of tuberculosis include cough1 hoarseness1 loss of appetite1 pain in the side1 loss of weight1 getting tired easily1 feeling run down1 rise in temperature in the afternoon1 night sweats1 expectoration1 and spitting blood4 ,no one1 nor even several1 of these symptoms necessarily indicates the presence of tuberculosis2 on the other hand1 even the cough is not necessarily present when tuberculosis actually exists4 ,when one or more of these symptoms appears and continues1 a thorough examination should be made by a doctor2 examination can do no harm1 certainly1 if tuberculosis is not found1 and if it is1 immediate treatment is of the greatest importance4 ,no known drug or medicine is a cure for tuberculosis4 ,successful treatment depends on taking the disease in time and in following the doctor's advice unremittingly4 ,,cancer4--,the cause of cancer is not known4 ,all the evidence1 however1 goes to show that it is neither communicable nor hereditary4 ,cancer may occur on the skin1 stomach1 or other organs2 in women it most commonly occurs in the breast or uterus 7womb74 ,in both sexes it occurs most frequently after #dj years of age4 ,no known medicine will cure cancer2 salves and ointments have no effect4 ,radium and x-ray should not be relied upon if the cancer can be removed by operation4 ,safety consists in removing the growth entirely1 and complete removal is possible only in the early stages4 ,early diagnosis is consequently of the greatest possible importance1 and an examination can do no harm in any case4 ,warts and moles on the skin may develop into cancer1 and should be removed if they show signs of irritation4 ,loss of appetite and weight1 any disturbance of the stomach or intestines1 and sores that refuse to heal should lead a person to consult a physician2 the same is true of any lump in the breast1 and of irregular or persistent bleeding from the uterus in women over forty4 ,the fact that pain is not present in cancer until the late stages leads many persons to neglect the trouble until it is too far advanced for operation4 ,time is all-important2 hope depends on operation in the early stages when there is a very great probability of permanent cure4 ,,mental ,,illness4--,insanity1 like cancer1 is increasing4 ,like both cancer and tuberculosis1 hope lies in prevention and early treatment2 and like them both1 in its early symptoms it is too often unrecognized or neglected4 ,many people are surprised to learn that known1 avoidable causes are responsible for the condition of about #ej of the insane patients now under treatment4 ,chief among these known causes is a communicable germ disease called syphilis1 to which is due the disease called paresis1 or softening of the brain4 ,about #be of patients admitted to hospitals for the insane are there from the effects of habitual use of alcohol1 even in moderate quantities4 ,other cases of insanity result from diseases of the heart1 arteries1 and kidneys1 and still others have been traced to the poisons of tuberculosis1 typhoid1 diphtheria1 and other communicable diseases4 ,prevention of insanity caused by these diseases depends upon prevention or complete cure of the diseases themselves4 ,still other causes of insanity are known4 ,hereditary nervous weakness may predispose to insanity1 and for such persons1 those whose nervous resistance is naturally not very great1 the stress of living may prove too much4 ,mental breakdowns are rarely caused by overwork unless accompanied by worry or bad hygienic conditions1 but they result not infrequently from bad mental habits4 ,the average person1 little realizes the danger of brooding over slights1 injuries1 disappointments1 or misfortunes1 or of an unnatural attitude towards his fellowmen1 shown by unusual sensitiveness or marked suspicion4 ,yet all these unwholesome and painful trains of thought1 may if persisted in and unrelieved by healthy interests and activities1 tend towards insanity4 ,wholesome work relieved by periods of rest and simple pleasures and an interest in the affairs of others1 are important preventives of unwholesome ways of thinking4 ,we should train ourselves not to brood1 but to honestly face personal difficulties4--7,why ,should ,anyone ,go ,insane81 by ,folks and ,ellwood47 ,prevention of insanity consequently depends chiefly upon avoiding alcohol and communicable diseases1 especially syphilis2 upon good hygiene1 self-control1 and avoidance of bad mental habits2 and upon adopting a program of living and working that will not overtax one's nervous strength4 ,sleeplessness1 unusual nervous fatigue following slight exertion1 and diminished power to control the emotions1 are among the danger signals4 ,and when a person becomes unusually depressed or morose1 excited or irritable1 suspicious1 unreasonable1 or queer1 it is probable that expert medical advice should be obtained as quickly as possible4 ,,exercises #a4 ,what is a symptom8 ,why are early symptoms especially important8 #b4 ,distinguish between objective and subjective symptoms4 #c4 ,tell all you can about normal and abnormal variations in the body temperature4 ,what symptoms would lead you to take a person's temperature8 #d4 ,describe the method of taking temperatures4 #e4 ,how should you cleanse a clinical thermometer8 ,what are the dangers of neglecting to cleanse it properly8 #f4 ,describe both normal and abnormal pulse and respiration4 #g4 ,discuss the significance and importance of pain4 #h4 ,describe early symptoms of tuberculosis1 cancer1 and mental illness4 ,what is the first step to be taken when any one of these symptoms appears8 #i4 ,what symptoms of all those mentioned in this chapter did you notice in the last sick person with whom you had anything to do8 #aj4 ,what are the essentials of a good daily record8 ,the following is an account that a mother gave of the first twenty-four hours of a child's illness4 ,make a chart for the patient1 and include in it all the information the mother gave4 ,which do you consider more useful1 your chart or the narrative8 ,yesterday1 ,october #ajth1 ,johnny came home from school about half past three1 and said he was too cold to play outdoors4 ,he lay down and slept till about five1 when he vomited a large amount of undigested food4 ,i took his temperature and found that it was #ajc4h1 pulse #abf1 and respiration #bh4 ,at #aj that night his temperature was #ajb4e1 pulse #aaf1 and respiration the same as before4 ,the next morning at #h he had a temperature of #ajj4f1 pulse #aad1 respiration #bd4 ,at noon his temperature was #aja1 pulse #aah1 respiration #bd2 and at #d o'clock his temperature was #ajj4f1 pulse #abb1 respiration #bb4 ,the doctor came at #f o'clock yesterday afternoon2 according to his orders ,i put ,johnny to bed1 gave him half a tablespoonful of castor oil at #f4cj1 and a special gargle4 ,his throat was red and sore and he seemed to feel very miserable4 ,the doctor took a culture from the child's throat4 ,at #h4ae and again at #h4ej he had fluid bowel movements4 ,at #i4cj he had a glass of milk1 after which he slept until #f a4m4 when his bowels moved again and urine was passed4 ,he passed eight ounces of urine at noon and four ounces at #c4cj4 ,he drank a glass of water at #f this morning1 and at #f4cj ,i gave him a cup of hot broth4 ,at #h he had a glass of milk1 but at #aj he refused everything but a glass of water4 ,at #a4cj he had a large dish of ice cream4 ,he had a cool sponge bath last night at #i1 and a cleansing bath this morning at #h4de4 ,this morning his throat was still sore but not so red1 and ,i saw that he gargled every half hour when he was awake4 ,this afternoon he seems brighter and asked for his harmonica1 so his throat is probably more comfortable4 ,,for ,,further ,,reading ,essentials of ,medicine--,emerson1 ,chapters ,,xvi1 ,,xvii4 ,the ,human ,mechanism--,hough and ,sedgwick1 ,chapter ,,xii4 ,notes on ,nursing--,florence ,nightingale1 ,pages #aje-acf4 ,why ,worry8--,walton4 ,those ,nerves--,walton4 ,tuberculosis3 ,its ,cause1 ,cure1 and ,prevention--,otis4 ,publications of the ,national ,association for the ,study and ,prevention of ,tuberculosis--#aje ,east #bb;d ,street1 ,new ,york ,city4 7,pamphlets free on request47 ,publications of the ,national ,committee for ,mental ,hygiene--#ej ,union ,square1 ,new ,york ,city4 7,pamphlets free on request47 ,publications of the ,mental ,hygiene ,committee of the ,state ,charities ,aid ,association--#aje ,east #bb;d ,street1 ,new ,york ,city4 7,pamphlets free on request47 ,publications of ,the ,american ,society for the ,control of ,cancer--#be ,west #deth ,street1 ,new ,york ,city4 7,pamphlets free on request47 ,,chapter ,v ,,equipment ,,and ,,care ,,of ,,the ,,sick ,,room ,adequate care of the sick consists to a large extent in rendering their physical and mental surroundings as favorable as possible4 ,obviously1 a sick person1 since his strength is already depleted1 needs not only to have his resistance increased in all possible ways1 but also to have all his remaining strength conserved by eliminating every unnecessary tax upon it4 ,in sickness even slight fatigue1 chill1 or nervous strain1 insufficient ventilation1 or improper feeding1 may become factors of immense importance4 ,nothing is trivial if it affects the welfare and comfort of a patient4 ,even when perfect provision for the care of the sick is out of the question1 every effort should be made to insure as satisfactory arrangements as possible4 ,ideal conditions are seldom found except in buildings originally planned for the sick2 yet in many houses a few simple changes will produce excellent results4 ,of course1 it is not necessary in every case to adopt all the following suggestions4 ,common sense must be the guide4 ,for instance1 in illness that is slight and likely to be of short duration1 a patient may be more distressed than benefited by radical changes in his surroundings4 ,except when certain essentials are concerned1 great consideration should be given to a patient's preferences2 yet on the other hand it is not reasonable to make an entire family miserable in order to gratify some slight whim4 ,,choice ,,of ,a ,,sick ,,room4--,a south or east exposure is generally best for a sick room4 ,a south room may be undesirable in very hot weather1 but sunshine during a part of the day is essential4 ,the room should be quiet1 near the bath room1 and well removed from odors from the kitchen4 ,it should be situated so that good ventilation is possible4 ,it is desirable though not necessary for it to have more than one window2 in summer the windows must be thoroughly screened4 ,it should be possible to open the window without exposing the patient to a direct current of air1 and to open the door without placing him in full view of all who pass through the hall4 ,it is essential for the patient to have a room to himself4 ,unless he needs care or help or watching at night1 not even the person caring for him should sleep in the room4 ,neither should the rest of the family keep their possessions in the sick room4 ,closets opening into the room1 bureaus1 and chiffoniers should be emptied of the belongings of other members of the family1 to prevent people from tiptoeing into the sick room at all hours to remove garments4 ,the sick room should for the time belong exclusively to the patient1 and resulting inconvenience should be borne by well members of the family4 ,every possible precaution should be taken to exclude from a sick room unnecessary noises of all kinds2 flapping curtains1 squeaky doors and rocking chairs1 heels without rubber1 creaking corsets1 noisy petticoats1 ticking clocks1 refractory bureau drawers1 and rustling newspapers are among the everyday sounds that irritate the nerves of sick and well alike4 ,ordinary out-of-door noises do not usually disturb the sick1 except when the country patient is brought to the city1 or the reverse2 but nearby and generally avoidable noise is the kind that distracts and harasses nervous patients4 ,whispering is an annoying sound and should not be allowed1 either in the patient's room or just outside the door4 ,whatever the subject of conversation may be1 the patient thinks that he is under discussion4 ,anything undesirable for him to hear should be settled well out of his hearing1 and in speaking to him there is no possible objection to an ordinary well modulated voice4 ,usually a person's own room is more restful and less disturbing than a strange place1 but if it serves as a work room as well as a bed room1 it may easily be the worst place during sickness4 ,the sight of a desk piled high with papers or a basket overflowing with accumulations of family mending may actually delay recovery2 even the room itself may constantly suggest work1 and work necessarily left undone4 ,the essential thing to remember is that mental rest is no less important than physical1 and every effort should be made to secure them both4 ,,furnishing4--,superfluous articles add to the care of a sick room1 and in consequence they should be removed at the outset4 ,all the furnishings that remain should be easy to clean1 but it is not necessary for a sick room to look bare and desolate4 ,the woodwork as in any other room should have a hard finish1 and angles and corners that harbor dust should be as few as possible4 ,hard wood floors without cracks are best from the point of view of cleanliness and convenience4 ,a few light1 washable rugs make the best floor covering1 but very small rugs on highly polished floors slide easily and are decidedly dangerous4 ,carpets diminish noise1 but are objectionable from every other point of view4 ,in furnishing houses people ought to realize more frequently than they do how greatly nervous fatigue may be increased by ill chosen wall coverings4 ,plain papers or tinted walls are best for bed rooms and the color should not be harsh or striking2 soft gray1 green1 or buff is good4 ,the design is no less important than the color2 a design that on casual inspection appears quite harmless may become an instrument of torture to a person unable to escape from it for a single hour4 ,weak or nervous patients sometimes become quite exhausted from attempting to follow an intricate pattern1 or from counting over and over a design that is frequently repeated on the wall4 ,if the patient sees grotesque faces and figures in the design the paper is more objectionable still4 ,necessary furniture includes the bed1 which will be discussed in detail later1 a small table to stand by the head of the bed1 a dresser1 two chairs1 and a wall thermometer4 ,if the patient is able to sit up three chairs are needed1 of which one should be an armchair with a high back4 ,no rocking chair should be allowed in the room unless the patient himself prefers to sit in one2 no one else should be allowed to rock in the room1 since the motion is almost always annoying to patients4 ,elaborate1 carved1 or upholstered furniture is unsuitable in a sick room1 but if it must be used it should have washable covers4 ,other desirable articles of furniture are a couch1 screen1 foot-stool and a second1 larger table4 ,in few cases1 if any1 is anything further really necessary1 although patients frequently desire special articles to which there can be no objection4 ,most ornaments add much work and little beauty1 and have no place in a sick-room4 ,no heavy unwashable curtains or hangings should be allowed1 but simple washable curtains and clean white covers for the tables and dresser are desirable4 ,pictures1 if suitable1 give much pleasure1 but must be used with discretion4 ,it goes without saying that the subjects should be pleasant1 but not everyone realizes that complicated subjects are undesirable and that pictures of people or things in motion should be avoided2 patients are sometimes worried to see motion that is forever incomplete4 ,flowers give great pleasure to the sick by adding color and variety and interest to their surroundings4 ,they should be carefully tended and given fresh water daily4 ,fading flowers and forlorn plants should be removed from the sick room1 and those having strong1 heavy odors should not even be admitted4 ,they do not need to be very many or very expensive2 indeed1 a potted plant or a few cut flowers are often more acceptable than the great masses of costly flowers that are daily brought to the private wards of hospitals4 ,,ventilation4--,a patient needs fresh air certainly as much as a well person1 and probably even more4 ,his room should be thoroughly ventilated night and day4 ,a fireplace makes the problem easier1 but in most cases an open window is the main dependence4 ,it should be possible to open windows at the top as well as at the bottom1 and the patient may be protected from a direct draught by a screen1 or by a sheet stretched along the side of the bed and fastened at the head and foot by tying it around the posts4 ,ventilating a room without subjecting the patient to draughts is not always easy4 ,one method is to insert a board three or four inches high under the lower sash so that air is admitted between the two sashes4 ,another way to ventilate without causing a draught is to remove one or two panes of glass and tack cheese cloth over the opening2 or to tack cheese cloth to the lower edge of the upper window casing and to the upper edge of the upper sash1 after the sash has been lowered about a foot4 ,once or twice a day the room should be thoroughly aired by opening windows and doors until the air has been completely changed4 ,the patient1 including his head1 must be well-covered during the process4 ,an electric fan is useful in summer1 but it should not be close enough to the bed for the patient to feel air blowing upon him4 ,,heating4--,great care should be taken to maintain a suitable temperature in the sick-room1 and for this purpose a thermometer in the room is a necessity4 ,between #fe and #fh is generally the best temperature1 and hot water bags and extra covers may be given if the patient is chilly4 ,during a bath or other treatment in which the patient is more or less exposed the temperature should be #gj4 ,the temperature at night may be lower2 how low will depend largely on the patient's condition and on what must be done for him during the night4 ,hot water1 steam heat1 or electricity is best for the sick room4 ,gas or oil stoves should never be used except in emergencies1 and then for a short time only4 ,,lighting4--,sunlight is one of the most powerful disinfectants1 and for this reason if for no other it is needed in every sick room4 ,sunless rooms1 moreover1 even if they were wholesome1 are too depressing to a patient's spirits for use except perhaps in hot summer days4 ,ordinary well-regulated light is best in a sick room1 and except in a few diseases1 especially those in which the eyes are affected1 it is undesirable to darken the room or to encourage in any way an appearance of gloom4 ,the patient's eyes1 however1 should be protected from bright lights shining directly upon them2 in this connection it is well to remember that lights and their reflections strike differently upon the eyes of a person lying down from the way in which they strike the eyes of persons sitting or standing1 and a light that seems agreeable to the attendant may therefore be painful to the patient4 ,almost all persons sleep best in dark rooms1 and in most cases it is undesirable for a sick room to be lighted at night4 ,the attendant1 however1 must be able to see what she is doing and generally needs a shaded candle1 small night light1 or electric flash4 ,it should be possible to see the patient clearly in case of need1 otherwise serious changes in his condition occurring in the night may pass unnoticed4 ,a reading lamp on the bedside table is desirable for patients allowed to read1 but reading in bed even with a well-regulated light is fatiguing1 and should not be continued for long uninterrupted periods4 ,a pocket flash light is safer than matches and a candle for patients who wish to consult their watches in the night2 indeed1 matches in the hands of patients always involve risk4 ,some patients find twilight a time of great depression4 ,in such a case it had best be shortened by drawing the shades early1 turning on the lights1 and remembering not to leave him alone4 ,,cleaning4--,the sick-room should be kept thoroughly clean at all times1 and the less dust stirred up in doing so the better4 ,dry sweeping or dusting should not be allowed4 ,ordinary brooms should be dampened or covered with damp cloths1 and dust cloths should be dampened also2 but dustless mops and dusters are still better4 ,vacuum cleaning is very desirable2 the noise1 which is its only disadvantage1 is not a serious objection in most cases4 ,the cleaning of rooms after a communicable disease will be considered later4 ,a sick room must be kept tidy as well as clean4 ,the effect of order is quieting1 but it should be maintained whether the effect upon the patient is apparent or not4 ,food and medicine should not be kept in the sick-room1 and all used dishes1 tumblers1 soiled linen1 etc41 should be removed at once4 ,unnecessary articles should not be found in the room at any time2 every necessary article should be kept in its place1 and its place should be a good one4 ,maintaining order in the room does not mean that patients should be made uncomfortable4 ,all patients1 especially old people1 want certain possessions within reach1 and their wishes should be considered in spite of the fact that the sthetic effect is generally far from good4 ,for instance1 a perfectly smooth bed is undesirable if in order to make it smooth the patient must be tucked in so tightly that he is uncomfortable4 ,and it would be a mistake to remove an old man's newspapers before he has read them1 even if he persists in strewing them all over the floor4 ,,the ,,attendant4--,one person and one person only should carry the entire responsibility for the patient4 ,she should plan for him as well as care for him1 should see the doctor and take the doctor's orders4 ,confusion and innumerable mistakes result when several members of the family attempt to do the talking and directing4 ,the attendant should wear washable dresses with sleeves that can be rolled up1 washable aprons1 and shoes with rubber heels4 ,all her clothing should be comfortable4 ,she should be neat in appearance1 scrupulously clean in person1 and should keep her finger nails short and smooth4 ,jewelry1 especially rings and chains that rattle1 and finery of any sort are all out of place in a sick-room4 ,the attendant must learn that her own sleep1 her diet1 and her out-of-door exercise are essential to the patient's well-being hardly less than to her own4 ,an amateur nurse often considers that going without food and sleep is a proof of her devotion4 ,in a passion of self-sacrifice she neglects herself utterly for the first few days1 and as a consequence is quite useless at a later period when her services may be most needed4 ,an exhausted1 sleepy nurse1 trained or untrained1 is wholly unfit to be trusted with medicines and doctor's orders1 to note changes in the patient's condition1 or to give him kindly attention4 ,efficiency and fatigue have never pulled together since the world began1 and no one can do good work when suffering from lack of sleep and rest4 ,the person1 then1 who genuinely wishes to give her patient the best possible care should not make a martyr of herself4 ,she should go out of doors daily2 both fresh air and occasional absence from the patient are essential to her physical and mental well-being4 ,moreover1 she will be showing her patient the greatest kindness in the long run if during her recreation time she thinks of him as little as possible4 ,indeed1 she need not consider herself inhuman if she has a thoroughly good time4 ,on the other hand1 a person who is responsible for the care of a patient must be made to realize that she and she only is ultimately responsible during the entire #bd hours of every day4 ,being responsible for a patient does not mean that she should be with him every minute1 or do everything herself3 it does mean that she should plan so effectively that everything necessary is done1 either by herself or by another competent person4 ,when she goes away for even half an hour1 she should appoint someone else to be responsible in her place and to her when she comes back4 ,she must consequently make very clear just what she wants done4 ,if there is medicine1 nourishment1 or treatment to be given1 she can easily make a list1 with the time for each1 and ask that each item be crossed off the list as soon as the work has been done4 ,she should not forget to ask for the list when she returns4 ,what is really needed is a little executive ability4 ,as ,florence ,nightingale said3 ,it is impossible in a book to teach a person in charge of the sick how to manage1 as it is to teach her how to nurse4 ,circumstances must vary with each different case4 ,but it is possible to press upon her to think for herself4 ,now what does happen during my absence8 ,i am obliged to be away on ,tuesday4 ,but fresh air1 or punctuality is not less important to my patient on ,tuesday than it was on ,monday4 ,or3 ,at #aj p4m4 ,i am never with my patient2 but quiet is of no less consequence to him at #aj than it was at #e minutes to #aj4 ,curious as it may seem1 this very obvious consideration occurs comparatively to few1 or1 if it does occur1 it is only to cause the devoted friend or nurse to be absent fewer hours1 or even fewer minutes from her patient--not to arrange so as that no minute and no hour shall be for her patient without the essentials of her nursing4--7,notes on ,nursing47 ,it is exceedingly difficult to care for members of one's own family or to be cared for by them4 ,too much or too little is almost invariably expected by one person or the other1 and where great affection is involved not only is the strain increased on both sides1 but often harm results from too great unselfishness on either side or both4 ,but sometimes the reverse is true1 and then one should remember that normal behavior may be impossible for the sick4 ,during weakness and pain1 irritability and unreasonableness are as characteristic as other symptoms1 and it is as foolish to demand a normal mental state from a sick person as it would be to demand a normal temperature4 ,for a cheerful1 reasonable1 and unselfish patient--and there are surprisingly many--one should be devoutly thankful1 but patience and pity should be given no less to those whose tortured nerves cause suffering to others as well as to themselves4 ,every woman who cares for the sick should remember that she is the patient's chief if not his only link with the normal world1 and that his plight is pitiful indeed if she is complaining or irritable or unwilling4 ,anyone who cares for the sick should remember also that she is necessarily in a most intimate relation with the patient1 and that such enforced intimacy calls for extra consideration on her part1 and for the most scrupulous respect for confidential matters4 ,it is inexcusable even for members of the patient's family to discuss with one another the patient's private concerns1 or his queer or unreasonable or annoying ways4 ,during sickness the skeletons in most people's mental closets walk forth1 and anyone who misuses special opportunities to know intimate affairs can only be classed with eavesdroppers and village gossips4 ,,exercises #a4 ,what are the essentials of a good sick room as to3 7a7 ,situation and exposure4 7b7 ,lighting and heating4 7c7 ,furnishing4 7d7 ,ventilation4 #b4 ,how may a sick room be ventilated without exposing the patient to draughts8 #c4 ,how should the bed be placed in relation to doors1 windows1 and walls8 #d4 ,how should a sick room be cleaned8 #e4 ,what in general are the duties of the attendant8 #f4 ,make a plan of your own bedroom1 and show what changes1 if any1 would be desirable if it were to be used as a sick room4 ,,for ,,further ,,reading ,notes on ,nursing--,florence ,nightingale1 ,pages #a-fc1 #hd-aje4 ,,chapter ,,vi ,,beds ,,and ,,bedmaking ,the common saying that the best bed for an invalid is his own bed contains an element of truth4 ,taking from a patient his own accustomed bed1 even when a better is substituted1 sometimes disturbs him greatly and makes him feel that he is indeed very ill4 ,nevertheless1 a suitable bed is essential to the proper care of a helpless person1 and no patient should continue to use an unsuitable one1 unless his illness is slight and also likely to be of very short duration4 ,besides being comfortable1 a bed suitable for the sick must be clean and easy to keep in a sanitary condition4 ,the springs should be firm1 and the mattress should be elastic and should give an even support without lumps and hollows4 ,the bed covers should be clean1 light1 and warm2 the pillows should be sufficient in number not only to make the head and shoulders comfortable1 but also any other part of the body in need of support4 ,moreover1 the bed should be so placed and of such a kind that the work of caring for the patient may be rendered as easy for the attendant as possible4 ,in every household at least one bed suitable for a sick person should be available in case of need4 ,,bedsteads4--,beds of white enameled iron1 brass1 or brass and iron combined are most easily kept clean1 and are the best in every way4 ,the frame should be strong enough to stand firmly1 yet not so heavy that it is hard to move4 ,it should have as few angles as possible1 and all its joints should be smooth and well finished4 ,the springs should be made of wire stretched tightly on a metal frame that fits smoothly into the head and foot pieces4 ,large castors should be used2 they may be removed from the foot if the bed moves too easily4 ,a bed to be used in sickness should have the following dimensions--length1 #f ft4 #f in41 height #bd to #bf inches1 width1 #cf inches4 ,if a bed is either too high or too low the labor of lifting and moving the patient is greatly increased4 ,if the bed is too narrow the patient is insecure4 ,if the bed is too wide1 its center is difficult or impossible to reach without leaning or kneeling upon it2 and if too short1 it will prove uncomfortable for a tall person4 ,a bed that is too low may be raised on four heavy boxes of the same height2 or still better1 upon heavy wooden blocks which any carpenter can easily make1 and which are well worth a little trouble to obtain4 ,in the top of each block a hollow should be made into which the leg of the bed will fit after the castor has been removed4 ,a broad firm stool or a low chair may be provided for a patient who has difficulty in getting in and out of a high bed4 ,beds with complicated attachments for moving patients are not recommended for family use4 ,they are expensive1 likely to get out of order1 seldom needed1 and generally unsatisfactory4 ,in some surgical cases a bed with a firm1 flat surface is necessary4 ,such a surface may be secured by placing between the mattress and springs two boards slightly separated1 or one wide board with holes bored in it to afford ventilation4 ,wooden beds are undesirable3 they are difficult to keep clean1 they readily absorb moisture and odors1 they cannot well be disinfected1 and their solid frames prevent a free circulation of air4 ,moreover1 it is almost impossible to render fit for use again a wooden bed into which vermin have once made their way4 ,folding beds and lounges even of the best type are unhygienic1 usually too low for the patient's comfort1 and often insecure4 ,a bedstead should be wiped frequently with a damp cloth2 if it is of enameled iron it may be washed with soap and water4 ,the springs may be cleansed with a stiff brush dipped in kerosene oil4 ,excessive use of water upon the springs is likely to make them rust4 ,,mattresses4--,various substances are used in the manufacture of mattresses1 but nothing has yet been found that is as satisfactory as curled hair4 ,it is light and clean and elastic1 it does not readily absorb odors1 and it is easily renovated4 ,although hair is more costly than other materials1 a hair mattress may be used almost indefinitely if it is occasionally made over4 ,felt or cotton mattresses are firm1 but heavy1 difficult to keep clean1 and likely to absorb odors4 ,a useful mattress made from straw is sometimes found in country districts4 ,such a bed is thoroughly hygienic1 for the worn straw may be burned and the tick washed and refilled with clean straw2 but straw beds are generally hard and lumpy4 ,the least desirable of all mattresses is the old fashioned feather bed1 and it should never be used if a better can by any possibility be obtained2 but a feather bed should not be arbitrarily taken away from an old person accustomed to its use1 unless his welfare is really at stake4 ,a mattress made in two sections is unnecessary for a single bed2 indeed1 a mattress made in one piece is more easily kept in place if the patient is restless4 ,a good quality of blue and white ticking makes a serviceable cover for both mattress and pillows since its color is not likely to run4 ,,care ,,of ,,the ,,mattress4--,a mattress should be brushed frequently with a whisk broom1 especially around the tufts and edges4 ,if a patient is long confined to bed1 a fresh one should occasionally be substituted so that the regular mattress may be removed1 well brushed1 beaten with a carpet beater1 and left exposed to the sun and air for a day or two4 ,a mattress that is badly soiled should be sent to a cleaner and made over2 it cannot be cleaned properly at home4 ,it is generally possible to remove blood stains1 if they have not soaked through the ticking1 by applying a thick cream made from raw starch and cold water4 ,when the starch becomes dry it should be brushed away1 and the application should be repeated until the stain has disappeared4 ,for the best results the starch should be applied before the stain is dry4 ,,pillows4--,one patient can use an almost unlimited number of feather pillows4 ,some should be soft and others firm1 some large and some small2 but pillows that are very large and thick are less useful than a greater number of smaller ones4 ,it is well to have several small pillows of varying size and thickness to support different parts of the body4 ,hair pillows are often acceptable in warm weather1 and they are also desirable for patients with high fever or excessive perspiration4 ,rubber air pillows are a convenience in traveling and add much to the comfort of a patient when he first goes out in a carriage or motor car1 but air pillows are not sufficiently durable for general use4 ,if a pillow tick becomes soiled1 the feathers may be transferred to a clean tick by making an opening about six inches long in the end of each pillow1 sewing the ticks together1 and then shaking the feathers from one tick to the other4 ,the soiled tick can then be washed4 ,if the feathers themselves have become soiled they should be renovated by a cleaner4 ,pillows1 like mattresses1 should be frequently brushed1 sunned1 and aired4 ,they should not be held in the mouth while a clean pillow-case is adjusted4 ,,protection ,,of ,,the ,,mattress ,,and ,,pillows4--,in all cases of sickness the mattress must be adequately protected4 ,neglect is inexcusable and may cause expense and trouble as well as discomfort to the patient4 ,the following may be used to protect the mattress or pillows3 large quilted pads1 small pads of cotton batting covered with old muslin or cheese cloth1 slip covers for the mattress1 rubber sheets and pillow-cases1 old blankets and quilts that may be washed easily4 ,heavy wrapping paper1 builders' paper1 and newspapers serve well in emergencies1 or for a short time4 ,,rubber ,,sheets ,,and ,,pillow-,,cases4--,soft rubber cloth1 single or double faced1 is most frequently used when it is necessary to protect the bed from discharges4 ,it may be purchased by the yard4 ,rubber sheets should not be used unless they are really necessary4 ,they are hot and uncomfortable1 and increase the tendency to perspire4 ,when used1 a rubber sheet should be #a yard wide or wide enough to reach from the lower edge of the pillows down to the patient's knees1 and long enough so that it can be tucked in securely on both sides of the bed4 ,rubber sheets may be cleaned by laying them on a flat surface and washing on both sides with soap and water1 using a small brush if necessary4 ,after rinsing they should be wiped1 and when thoroughly dry they should be rolled rather than folded1 to prevent the rubber from breaking4 ,rubber pillow-cases are used for a patient who perspires profusely1 or who has a discharge of any kind from the head or neck1 and also when substances which may wet or stain the pillow are applied to the head4 ,they should be put on next to the pillow1 securely fastened with tapes1 snap hooks1 or buttons1 and covered with the regular pillow slip4 ,rubber sheets and pillow-cases are not durable4 ,they should be used carefully1 and frequently examined for holes or worn places by holding them up to the light4 ,even a pin hole near the center may render a rubber sheet or pillow-case as useless as a sieve4 ,,sheets4--,sheets of ample proportions are necessary for comfort1 and important for sanitary reasons as well4 ,for a bed of the dimensions mentioned in this lesson sheets should be three yards long1 and two yards wide4 ,a safe rule for any bed is to have the sheets one yard longer and one yard wider than the mattress4 ,a sheet of these dimensions is large enough to be tucked under the sides and foot of the mattress1 while at least twelve inches are left to fold over the blankets at the top4 ,cotton sheets are as good as linen for general use1 or even better1 and are far less expensive4 ,,draw ,,sheets are used to cover rubber sheets1 and to protect beds when the rubbers are not used4 ,in hospitals special draw sheets are usually provided1 but an ordinary sheet folded answers every purpose4 ,new and expensive sheets should not be used for draw sheets1 since they are more likely than other sheets to become stained4 ,draw sheets should be wide enough to extend about four inches beyond the rubber sheet at the top and bottom4 ,,pillow ,,covers4--,pillow covers are generally made of cotton1 but persons who can afford the cost frequently prefer linen1 especially in hot weather4 ,unless fastened with buttons or tapes1 a pillow case should be several inches longer than its pillow4 ,it should be wide enough to slip on easily1 but not so wide that it wrinkles or allows the pillow to turn4 ,if it is too small the pillow will become hard and uncomfortable4 ,these small things1 unimportant as they are to the well1 may cause much discomfort to a restless or nervous patient4 ,,blankets4--,all wool blankets are both light and warm1 and are consequently the most comfortable bed covering4 ,but unless they can be dry cleaned frequently1 it is better to select blankets made from one part wool and two parts cotton4 ,blankets containing equal parts of wool and cotton are warmer1 but are more injured by washing4 ,very light blankets of wool or outing flannel are useful in summer4 ,double blankets should always be cut in two and bound at the ends1 since single blankets are easier than double blankets to handle and wash4 ,patients are frequently too warmly covered by day4 ,too much warmth is enervating1 it causes the patient to perspire1 and makes him restless and more susceptible to draughts and to changes of temperature4 ,two light blankets are warmer and more comfortable than one heavy blanket4 ,,comforters ,,and ,,quilts4--,heavy cotton comforters are burdensome without being correspondingly warm4 ,eiderdown quilts or those padded with wool are good for a patient who sleeps out of doors1 or whose room is kept at a low temperature4 ,bed covers that cannot be laundered readily should be protected by basting on both sides of the top a wide piece of muslin or linen1 which can be removed and washed4 ,,counterpanes4--,white dimity counterpanes are desirable1 since they are light in weight1 easily laundered1 and inexpensive4 ,a heavy counterpane is uncomfortable at any time1 and still more uncomfortable in sickness4 ,if a light spread is not available1 a sheet makes a good substitute4 ,a counterpane should be wide enough to cover the sheets and blankets at the sides when the bed is open1 and long enough to protect the bedding at the top and bottom4 ,,bed ,,making ,all methods of making beds for the sick are based upon a few underlying principles4 ,the aim in every case is to obtain the following results with the least expenditure of time and labor3 first1 to secure comfort for the patient1 and to eliminate all causes of friction1 irritation1 or pressure upon his skin2 next to keep the covers firmly in place1 so that the bed will not easily become disarranged2 then to protect the mattress1 and last1 to secure as good an appearance as possible4 ,illustration3 ,,fig4 #ab4--,,the ,,draw ,,sheet ,,in ,,place4 7,from ,elementary ,nursing ,procedures1 ,california ,state ,board of ,health47 ,,to ,,make ,,an ,,unoccupied ,,bed1 proceed as follows3 remove the pillows and covers one at a time1 and place them on chairs1 near an open window if possible4 ,brush the mattress and then set it up on its ends to air1 or turn it back over the foot board4 ,wipe the bedstead with a damp cloth4 ,replace the mattress after it has aired1 turning it from side to side and from end to end on alternate days4 ,cover the mattress1 unless it is enclosed in a slip cover1 with a white quilted pad or an old blanket1 and then spread the lower sheet over the mattress1 so that the middle fold of the sheet lies upon the center of the mattress in a straight line from the head of the bed to the foot4 ,tuck the sheet under1 first at the top and then at the bottom1 drawing it so that it is firm and tight4 ,if the sheet is of proper length tuck fourteen or sixteen inches under at the top1 but take care to cover the mattress at the foot also4 ,next tuck the sheet under at the side1 folding its corners to make a neat finish like an envelope4 ,place the rubber sheet1 if it must be used1 across the bed1 with its upper edge where the lower edge of the pillows will come4 ,a draw sheet somewhat wider than the rubber sheet is needed next2 an ordinary sheet1 folded once the long way of the sheet1 may be used1 with the fold toward the head of the bed4 ,tuck both rubber and draw sheet securely under the mattress at the side4 ,in some cases the rubber sheet may be placed next to the mattress1 and covered by the mattress pad and lower sheet4 ,place the draw sheet as directed1 whether the rubber is used or not4 ,after the lower1 rubber1 and draw sheets have been adjusted on one side of the bed1 go to the opposite side1 draw them over smoothly1 and tuck them under the mattress as tightly as possible4 ,next spread the upper sheet over the bed so that its upper edge reaches to the upper edge of the mattress1 and its middle crease lies over the middle line of the mattress1 and place it right side down1 so that the smooth side of the hem will be uppermost when the sheet is turned over the blankets4 ,place the blankets so that their upper edges lie a little higher than the place where the lower edge of the pillow will come1 and tuck them in firmly at the bottom and sides4 ,if the blankets are not long enough to tuck in at the foot1 place the lower blanket as directed and the upper blanket five or six inches lower than the first4 ,when tucked in1 the upper blanket holds the lower one in place fairly well4 ,place the counterpane evenly and smoothly1 tuck it under at the foot1 turn its corners neatly1 turn its upper edge under the upper edge of the blankets and fold the upper sheet down over the whole4 ,last of all1 shake the pillows and place them neatly on the bed4 ,illustration3 ,,fig4 #ac4--,,the ,,closed ,,bed4 7,from ,elementary ,nursing ,procedures1 ,california ,state ,board of ,health47 ,practice is necessary before it is possible to make a bed quickly and well1 and a certain amount of proficiency in making an unoccupied bed should be acquired before undertaking to make a bed with a patient in it4 ,one should learn to work in an orderly way1 without confusion1 unnecessary motion1 or jarring of the bed4 ,,to ,,change ,a ,,patient',s ,,pillows4--,stand preferably on the right side of the bed and slip the left arm under the patient's shoulders1 supporting his head in the hollow of the arm4 ,raise him slightly and remove the pillows one at a time with the right hand1 drawing them outward on the left side of the bed4 ,place a small pillow under his head4 ,shake the pillows1 change the cases if necessary1 and replace them on the left side of the bed1 ready to be drawn back into position4 ,raise the patient as before1 remove the small pillow and draw the others into place4 ,it is sometimes better to hold the patient on the upper pillow while removing and replacing the under one4 ,,lifting ,a ,,patient ,,in ,,bed4--,patients tend to slip down toward the foot of the bed1 and they should be raised if unable to help themselves4 ,to raise the patient1 instruct him to flex his knees and to press his feet firmly upon the bed2 place one arm under his shoulders1 as when changing pillows1 the other arm under the thighs1 and lift him upward without jerking4 ,the lifting can be done more easily by two people1 and with less discomfort to the patient3 if he is entirely helpless two people are necessary4 ,two people should proceed as follows3 ,let ,a place her left arm under the patient's head and shoulders as before1 her right arm under the small of his back2 let ,b place her right arm also under the small of his back and her left arm under his thighs1 and at a signal let them lift together4 ,in this way the weight is so evenly distributed that a heavy person can be lifted without great difficulty4 ,,to ,,turn ,a ,,patient ,,in ,,bed4--,a patient may be turned toward or away from you4 ,in turning a patient toward you1 place one hand over his farther shoulder and the other over his hip1 and turn him toward you4 ,then flex his knees slightly4 ,to turn a patient from you1 pass one hand as far as possible under the shoulders1 and the other as far as possible under the thighs4 ,then raising the patient slightly1 draw him back toward you1 turning him at the same time1 and then flex the knees4 ,lastly place a pillow firmly against his back to support it4 ,,to ,,change ,,the ,,sheets ,,while ,,the ,,patient ,,is ,,in ,,bed proceed as follows3 ,first collect the fresh linen and place it conveniently near the bed4 ,then draw the bedclothes from beneath the mattress1 raising the mattress meanwhile with one hand to prevent jarring the bed4 ,remove first the spread and then the upper blanket if there are two1 fold each once and place it on a chair4 ,hold the remaining blanket in place with one hand1 while with the other you draw the upper sheet out from under it2 then fold the edges of the blanket up over the patient to keep them out of the way4 ,the upper sheet1 unless soiled1 may be folded once and used again as a draw sheet4 ,next remove all the pillows1 unless the patient prefers to keep one4 ,then move the patient toward one side of the bed and turn him on his side so that he faces the edge nearest him4 ,roll the draw sheet and rubber sheet together if both are to be removed1 or separately if the rubber sheet is to remain on the bed2 then roll the bottom sheet throughout its entire length1 and bring the three sheets1 all rolled as flat and as tightly as possible1 close to the patient's back4 ,pleat about half of the fresh lower sheet lengthwise and place the pleated portion as close as possible to the rolled soiled sheets4 ,tuck in the other half of the fresh sheet at the top1 bottom and side1 draw the rubber sheet if it is to be replaced back over the fresh lower sheet1 arrange the fresh draw sheet in place1 tuck it in at the side1 and roll its free portion close to the patient's back4 ,the fresh side of the bed is then ready for the patient4 ,lift his feet back over the rolled sheets keeping his knees flexed1 then turn him back over the rolled sheets on to the fresh smooth part1 remove the soiled sheets and arrange the fresh ones in place on the side where the patient has just been lying4 ,be careful to keep him well covered with the blanket4 ,after the lower sheets are in place and firmly tucked in1 spread above the blanket the fresh upper sheet1 and over the sheet spread the second blanket4 ,hold the sheet and blanket in place with one hand while using the other hand to draw out the first blanket from beneath the sheet4 ,in this way the patient is constantly covered by a blanket4 ,place the blanket just removed above the other and finish the bed according to the directions given for an unoccupied bed1 using special care1 however not to draw the covers too tightly over the patient's feet4 ,illustration3 ,,fig4 #ad4--;,,changing ,,the ,,draw ,,sheet4 7,from ,pope ,home ,care of the ,sick1 ,american ,school of ,home ,economics1 ,chicago47 ,,to ,,move ,a ,,patient ,,from ,,one ,,bed ,,to ,,another4--,on the fresh bed have the lower sheets in place but not the upper covers4 ,place the two beds close together side by side1 and draw one mattress a little over the place where the two sides meet4 ,loosen the draw sheet under the patient1 roll it on both sides close to the body and draw him gently over by means of this sheet1 moving his shoulders at the same time4 ,if the beds are unequal in height1 use firm pillows or folded blankets to make an inclined plane4 ,illustration3 ,,fig4 #ae4--;,,changing ,a ,,patient ,,from ,,one ,,bed ,,to ,,another4 7,from ,pope ,home ,care of the ,sick1 ,american ,school of ,home ,economics1 ,chicago47 ,if the beds differ greatly in height and indeed in most cases1 it is better to carry the patient from one bed to the other4 ,at least two people are needed2 one alone should never attempt to carry anyone heavier than a small child4 ,one method for lifting is as follows3 ,let two bearers1 ,a and ,b stand on the same side of the bed4 ,if the patient is to be moved into the right side of the fresh bed let both bearers stand on the right side of the occupied bed2 if he is to go into the left side of the fresh bed1 let them both stand on the left side of the occupied bed4 ,let ,a place one arm under the patient's shoulders and her other under the small of his back1 while ,b places one arm under his hips and the other just below his knees4 ,draw the patient to the edge of the bed1 instruct him to place his arms about the shoulders of ,a and to hold the body rigid1 and then lift together at a given signal1 keeping his weight well up on the chests of the bearers4 ,whenever a patient must be turned1 lifted1 carried1 or moved in any way1 let him know beforehand just what you intend to do so that he may not be startled1 and also that he may coperate if possible4 ,grasp him firmly but gently1 avoid pinching the skin1 and move him steadily and smoothly1 avoiding jerks and false starts4 ,do not attempt alone more than your strength is amply sufficient to accomplish1 and endeavor at all times to handle the sick with the utmost gentleness and consideration4 ,,exercises #a4 ,describe a bedstead and mattress suitable for a sick person's use1 and tell why they are to be preferred4 #b4 ,how should the bedstead be cared for8 the mattress8 the pillows8 #c4 ,how should a mattress and pillows be protected8 #d4 ,describe in detail the bed covers that are desirable for use in sickness4 #e4 ,name the results that a good method of bedmaking aims to secure4 #f4 ,describe the method of making an unoccupied bed4 #g4 ,how should one change the pillows of a helpless patient8 #h4 ,describe the way in which you would lift and turn a patient in bed4 #i4 ,describe the method of changing sheets and remaking a bed while the patient is in it4 #aj4 ,why are beds and bedmaking considered so important in the care of the sick8 ,,for ,,further ,,reading ,notes on ,nursing--,florence ,nightingale1 ,pages #gi-hd4 ,,chapter ,,vii ,,baths ,,and ,,bathing ,bathing is necessary in sickness no less than in health4 ,it stimulates and equalizes the circulation1 is soothing in feverish conditions1 is refreshing to most people1 and by affording a certain amount of exercise it lessens the fatigue of lying in bed4 ,moreover1 without frequent bathing it is impossible to keep the skin in good condition1 since scales of dead skin1 oily matter1 and solid substances left by perspiration collect on the surface of the body when a person is lying still in bed as well as when he is leading an active life4 ,the common belief that sick people are likely to catch cold from bathing is quite unfounded2 every patient1 unless his condition is such that the doctor orders otherwise1 should have one complete cleansing bath each day4 ,in addition to the regular cleansing bath other kinds are often prescribed as medical treatment4 ,,cleansing ,,baths ,a tub bath if allowed by a patient's condition1 is the most satisfactory kind1 but special precautions must be taken to guard her from fatigue and chill4 ,the bath room and everything to be used should be made ready before she leaves her bed4 ,necessary clothing and toilet articles should be collected and arranged conveniently1 a chair covered with a blanket and also a bath mat should be placed beside the tub1 and the temperature of the bath room should be regulated so that it is about #gj ,f41 or a little lower if the room is likely to become overheated as the bath proceeds4 ,the bath water should be drawn last4 ,its temperature1 tested by a thermometer1 should be between #if and #ajj at the beginning1 and may be increased if desirable4 ,if the patient is weak1 wash and dry her face1 neck1 and ears1 and if necessary cut the finger and toe nails before she leaves the bed1 in any case before she enters the tub4 ,as soon as the patient has left the bed1 strip it and leave it to air2 then assist her into the bath room and help her carefully into the tub4 ,do not allow her to stay in the water more than ten minutes at most1 and stop the bath at once if she shows the slightest sign of faintness1 dizziness1 exhaustion1 difficult breathing1 marked change of color1 or other unusual symptom4 ,indeed1 if the patient is weak or her reaction to the bath uncertain1 as when she takes her first tub bath after an illness1 someone should always be within call to help the attendant in case of need4 ,a faint1 heavy patient in a bath tub is an impossible load for one person to handle4 ,while the patient is in the tub1 soap her well1 brush her finger and toe nails1 rinse1 and rub her to stimulate the circulation4 ,then help her from the tub1 seat her in the chair1 draw the blanket closely about her from neck to feet1 dry her with warm towels1 exposing the body as little as possible1 and1 if she is to return to bed1 put on a fresh night gown1 and wrapper and slippers4 ,next place the lower sheet1 the draw sheet1 and one pillow on the bed as quickly as possible1 help the patient into bed1 keeping her well covered with a blanket1 and finish making the bed4 ,if she seems chilly1 give a hot water bag and hot drink and leave the blanket next her in place4 ,after the patient has been made comfortable1 clean the tub and put the bath room in order4 ,even patients supposedly able to take tub baths without assistance should not lock the bath room door nor be left alone a long time4 ,,bed ,,bath4--,practice is essential in order to give a bed bath skillfully4 ,the aim is to make the patient thoroughly clean and thoroughly dry1 without chilling1 fatiguing1 or exposing her1 without making the bed damp1 and without unnecessary haste or delay4 ,one method of giving a bed bath follows1 but any method that accomplishes these aims is likely to be satisfactory4 ,first see that the room is about #gj ,f4 and likely to remain so1 and exclude draughts4 ,collect everything to be used1 including a blanket to cover the patient1 an old blanket or large bath towel to protect the bed1 at least two other towels1 one a bath towel and the other a face towel1 two wash cloths1 soap1 nail brush1 powder1 alcohol1 comb and brush1 nail file1 scissors1 etc42 fresh bed and personal linen2 a large basin containing water at #aje1 a jug of hotter water1 and a slop jar4 ,remove the upper bed clothes except one blanket1 which should cover the patient constantly during the bath1 and spread them where they will air2 remove all the pillows but one1 and place the bath blanket under the patient as the under sheet is placed in bed making4 ,if a bath blanket is not used1 keep the bath towel under the part that is being bathed by moving the towel from place to place4 ,next remove the night gown in the following way3 ,let the patient lie on her back1 with her knees flexed2 draw the gown up as far as possible1 then raise or get her to raise her hips so that the gown may be drawn up above the waist4 ,next raise her head and shoulders with one arm and draw the night gown up to the neck with the other2 remove one sleeve1 draw the gown over the head and then off the other arm4 ,illustration3 ,,fig4 #af4--,,washing ,a ,,patient ,,without ,,exposure4 7,sanders ,modern ,methods in ,nursing47 ,the patient is now ready for the bath4 ,wet the wash cloth thoroughly1 but hold it gathered in the hand so that it will not drip4 ,wash the face1 neck1 and ears first1 dry them thoroughly1 and next1 using the second wash cloth1 wash the arms and hands1 chest and abdomen1 giving particular attention to the armpits and navel4 ,raise the blanket slightly with one hand to keep it from becoming damp1 but expose the patient as little as possible2 the arms and legs need not remain covered while being washed4 ,dry each part thoroughly before washing the next4 ,next turn the patient on her side and wash the back1 the buttocks1 and upper part of the thighs2 give special attention to the fold between the buttocks4 ,then turn the patient on her back1 and wash the thighs1 legs1 and feet4 ,if it is important to move the patient as little as possible1 leave the back until last so that the under sheet may be changed without turning her again4 ,cut the toe nails if necessary before washing1 and clean them carefully afterward4 ,unless there is a reason to the contrary1 wash the hands and the feet in the basin1 first protecting the bed with a towel1 newspaper1 or clean wrapping paper4 ,be sure to clean well between the toes1 and to dry the feet thoroughly2 they may need some friction4 ,throughout the bath empty and refill the basin as necessary4 ,wash the genital region last4 ,let the patient lie upon her back with knees flexed and separated1 or upon one side with the knees flexed and one slightly raised4 ,patients who are able may take this part of the bath themselves with whatever assistance may be necessary4 ,the attendant1 however1 must either do it herself or make sure that the patient does it thoroughly4 ,to neglect a helpless patient is always unkind1 and no less unkind when the motive is a mistaken sense of modesty4 ,if discharge from the genitals is present use absorbent cotton1 or clean1 soft old cloth to wash the parts1 and burn it afterward4 ,it is sometimes desirable to place the patient on a bedpan and rinse the parts by a gentle stream of warm water poured from a jug4 ,after the attendant has completed this part of the bath she should wash her own hands thoroughly4 ,after the bath rub the patient with alcohol4 ,if a complete alcohol rub is impossible1 at least rub the points where pressure comes1 especially the back4 ,after the rub apply a little toilet powder if the patient desires it4 ,when the toilet is complete remove the bath blanket1 remake the bed and put the room in order4 ,,care ,,of ,,the ,,mouth ,,and ,,teeth4--,in sickness the mouth and teeth require more than ordinary attention2 indeed1 the condition of a patient's mouth is a fair index to the quality of the care she is receiving4 ,if the patient can brush her own teeth she should do so in the morning1 at night1 and after meals4 ,at those times the attendant1 without waiting to be asked1 should bring her a towel1 tooth-brush1 cup of tepid water1 tooth paste or powder1 and a small basin or dish to receive the used water4 ,the process is generally more thorough when the patient does it herself1 and even a patient unable to sit up can brush her teeth successfully if the nurse holds the powder and cup of water1 and provides a basin shallow enough for the patient to use by turning her head to one side4 ,illustration3 ,,fig4 #ag4--,,the ,,nurse ,,assisting ,,the ,,patient ,,in ,,brushing ,,the ,,teeth4 7,from ,elementary ,nursing ,procedures1 ,california ,state ,board of ,health47 ,the attendant must cleanse the mouth of a patient who is unable to do it herself4 ,if this cleansing is neglected1 a dark tenacious substance collects upon the teeth and gums1 composed chiefly of food particles1 bacteria1 mouth secretions1 and worn out cells of the mucous membrane4 ,once formed it is difficult to remove1 hence the mouths of all patients and especially those who have fever1 must receive proper care from the very beginning of illness4 ,cotton swabs are convenient for cleansing the mouth2 they are made by winding a small piece of absorbent cotton upon a match or wooden tooth-pick4 ,to cleanse the mouth of a helpless patient1 take to the bedside the mouth wash prescribed by the doctor1 a towel to protect the bedclothes1 several swabs1 and a receptacle for used swabs2 the latter should be a strong paper bag or several thicknesses of newspaper4 ,clean the tongue1 gums1 teeth1 and spaces between the teeth gently but thoroughly1 using especial care if the gums are tender4 ,dip only clean swabs in the solution1 discard each one after using it once1 and burn it afterward4 ,let the patient rinse her mouth after cleansing it if she is strong enough4 ,if the mouth is very dry1 encourage her to drink more water4 ,notify the doctor if the gums and tongue crack or bleed since he may wish to order a special mouth wash4 ,cold cream or boracic ointment may be used if the lips are dry and cracked4 ,false teeth should be thoroughly brushed and cleansed1 and kept in cold water if taken out during the night4 ,,care ,,of ,,the ,,hair4--,long hair1 if neglected1 becomes tangled and matted in a surprisingly short time4 ,unless the patient is actually in a dying condition she is not too sick to have it properly attended to at least once a day4 ,before combing the hair protect the pillow with a towel2 then part the hair in the middle from the forehead to the nape of the neck1 and draw it to either side4 ,begin to comb at the ends1 holding the strand of hair firmly in one hand placed between the head and the comb2 in this way tangles can be removed without hurting4 ,after combing and brushing the hair1 braid it in two braids1 beginning near the ears2 draw it as tightly or loosely near the head as the patient prefers1 but remember that tight braids mean fewer tangles4 ,if the hair is heavy or badly tangled the patient may be too much fatigued to have it all combed at one time2 in this case braid the part that has been finished and complete the work later4 ,,to ,,wash ,,the ,,hair ,,of ,a ,,bed ,,patient4--,the hair of a patient can be successfully washed in bed if sufficient care is taken not to chill or tire the patient1 or to wet the bed4 ,the following articles are needed3 one small jug of strong soap suds made by dissolving a pure soap in hot water1 one large jug of hot water at about #aab ,f41 one jug of cold water1 a slop jar or foot tub1 one long rubber sheet or piece of enamel cloth1 and several towels including at least one bath towel4 ,let the patient lie as near the edge of the bed as possible4 ,roll one small towel lengthwise1 place it below the hair at the back of the neck1 bring it up above the ears to the forehead and pin tightly1 in order to catch water that might wet the face and neck4 ,next make a kind of trough of the large rubber by rolling its long edges inward for a few inches4 ,place this across the bed under the patient's head so that her neck rests on the lower roll4 ,raise by means of pillows the end of the rubber trough that lies toward the middle of the bed1 in order to prevent water from running into the bed or collecting under the patient's head4 ,let the other end of the rubber extend over the edge of the bed down into the slop jar or foot tub1 which may be placed on a chair or stool4 ,then wash the hair and scalp with the soap solution1 and rinse them thoroughly with water from the large jug4 ,squeeze as much water as possible from the hair1 remove the rubber and substitute a heavy bath towel1 and rub and fan the hair until dry4 ,a shampoo in bed is tiring4 ,do not attempt it unless the patient is strong enough to stand not only the shampoo itself1 but also a complete change of bed clothing1 which will almost certainly be necessary if the attendant has been careless or clumsy in the slightest degree4 ,,hot ,,foot ,,baths properly speaking are medical treatment1 but they are taken by many persons to relieve colds1 headache1 or insomnia4 ,let the patient sit1 well wrapped1 with her feet in water at about #aje1 and then increase the temperature gradually by adding hotter water4 ,take care to add hot water slowly and not to pour it directly upon the patient's feet or ankles2 otherwise she may be scalded4 ,mustard may be added to the bath water in the proportion of one tablespoonful of mustard to each gallon of water4 ,if mustard is to be used make it into a smooth paste with cold water1 thin the paste with warm water1 and when thin enough to pour easily add it to the bath water and stir well4 ,the bath may continue for #aj to #bj minutes1 and the feet should be dried afterward without friction4 ,the patient should go to bed at once2 she should not wander about1 clearing away her foot bath1 doing forgotten things1 getting herself chilled1 and losing all the good effects4 ,a foot bath may be given easily to a patient in bed4 ,bring to the bedside a blanket1 a towel1 the tub filled with water1 and something with which to protect the bed2 this may be a rubber sheet1 bath towel1 old blanket folded1 or several thick clean newspapers4 ,loosen the upper covers at the foot of the bed1 fold them back above the patient's knees1 and cover her legs and feet with the extra blanket making it overlap the bed clothing so that it will not slip4 ,flex the patient's knees1 put the bed protector under her feet1 place the tub on the side of the bed1 raise the legs and feet with one hand and arm1 and slide the tub into place with the other1 raising the elbow in such a way that it keeps the blanket out of the water4 ,lower the feet slowly into the water1 fold the towel1 and place it over the edge of the tub in order to protect the patient's knees from the cold rim2 then tuck the blanket closely about the tub and legs and proceed as before4 ,after the bath use the towel1 unless it is wet1 to receive the feet when they are withdrawn from the tub4 ,remove the tub1 dry the feet thoroughly1 cover them warmly1 and remake the bed4 ,,cool ,,sponge ,,bath4--,for feverish patients doctors often order cool sponge baths4 ,in order to give a cool sponge bath1 first protect the bed thoroughly1 but leave the patient uncovered except for a towel laid over the hips4 ,use cool water1 or cool water and alcohol1 and have the wash cloth as wet as it can be without dripping4 ,bathe the body without friction1 using long1 light strokes1 and leave each part wet until the bath has been completed4 ,do not use soap4 ,sponge in this way the arms1 legs1 chest1 and back1 but not the abdomen1 for ten to twenty minutes1 giving special attention to the neck and inner side of the arms and legs1 because in those places large blood vessels lie nearer the surface of the body4 ,after finishing the bath dry the body by patting it gently with towels4 ,take the patient's pulse occasionally during the bath1 and stop the bath at once if the patient's pulse grows weaker1 if she shivers violently1 or if her face1 fingers1 or toes turn a bluish color4 ,babies react rapidly to cool sponging2 for a baby use tepid water1 sponge for five minutes only1 and watch the child closely during the bath4 ,,exercises #a4 ,what may a bath be expected to accomplish in addition to cleansing8 #b4 ,in giving a tub bath1 what precautions should be taken to avoid chilling the patient8 to avoid tiring the patient8 #c4 ,what symptoms would lead you to think that a tub bath was not agreeing with a patient8 ,what should you do in such a case8 #d4 ,name six essentials of a skillfully given bed bath4 #e4 ,what preparations should be made and what articles assembled before beginning a bed bath8 #f4 ,describe the method of bathing a patient in bed4 #g4 ,what care should the mouth and teeth of every sick person receive8 ,how should such care be given to a patient who is helpless8 #h4 ,describe the daily care of a patient's hair1 and tell how a shampoo may be given to a patient in bed4 #i4 ,how should you give a mustard foot bath to a patient in bed8 #aj4 ,when and how should you give a cool sponge bath8 ,,for ,,further ,,reading ,the ,human ,mechanism--,hough and ,sedgwick1 ,chapter ,,xi4 ,,chapter ,,viii ,,appliances ,,and ,,methods ,,for ,,the ,,sick-,,room ,patients who are confined to bed even for a few days often suffer acutely from muscular tension1 from pressure1 and from fatigue due to lack of exercise4 ,indeed1 many a sick person is surprised to find that the bed which had seemed so infinitely desirable can change into a place of torment after a few short days of illness4 ,bed-weariness is hard to bear in any case of illness1 but it is doubly hard for persons who are really helpless4 ,unless the patient is an experienced sufferer he often has no idea what should be done to make him comfortable2 while an equally inexperienced helper1 though full of good will1 is often discouraged to find that the arrangement she had thought perfect soon fails to satisfy her restless patient4 ,but if she is willing to devote thought and ingenuity to removing small annoyances1 she can do many things to alleviate his misery4 ,,bed ,,sores1 or pressure sores1 are caused by continued pressure upon the skin4 ,the weight of the body1 or of a part of the body1 if it comes for a long time upon one place finally interferes with the circulation in the tissues on which the part rests1 and consequently interferes with the nutrition of the affected part4 ,any tissue to which the blood is not bringing all its necessary food supply tends to lose its tone1 to become weak1 and if the condition persists1 to break down altogether4 ,the direct cause of bed sores then is pressure1 and pressure is aggravated by moisture1 wrinkles in the bed clothes1 crumbs or other hard particles1 lack of cleanliness1 friction of any kind1 or by rough1 careless handling4 ,bed sores occur most often over bony prominences1 such as the end of the spine1 elbows1 heels1 shoulders1 hips1 ankles1 and knees1 but they may form anywhere1 even on the ears or back of the head4 ,they are more likely to appear on thin1 aged1 or depleted patients4 ,these painful and serious sores can be prevented almost always by faithful care4 ,when they occur1 they result in the great majority of cases purely from negligence1 and a person who knows the danger and yet through carelessness allows one to develop upon a patient may justly feel herself disgraced4 ,prevention of bed sores depends upon keeping the skin dry and clean and upon relieving pressure by special devices and by turning the patient frequently4 ,the parts where pressure comes should be washed at least twice daily with warm water and soap1 rubbed frequently with alcohol to improve the circulation and to keep up the tone of the skin1 and powdered with a little good toilet powder4 ,much powder is likely to do harm by collecting in hard1 irritating particles4 ,the bed should be kept constantly dry and smooth1 and free from crumbs1 lumps1 wrinkles1 or other inequalities4 ,prolonged pressure should be relieved by turning the patient often1--once every waking hour is not too often if the body is emaciated1--and by pillows1 pads1 and rings4 ,small pillows or thick pads of cotton should be placed under the patient's back and shoulders1 between the knees and ankles when he lies on his side1 and in other places where sores are likely to develop4 ,rubber rings are useful1 but few patients like them for a long time4 ,they should not be inflated more than necessary to raise the affected part from the bed2 if much inflated1 they are uncomfortable and may do harm4 ,the ring may be covered with a muslin pillow case1 or it may be wound smoothly with long strips of bandage or old muslin4 ,ordinary cotton batting wound with strips of muslin may be made into rings and used to remove pressure from heels1 elbows1 or other parts4 ,these cotton rings are less heating than pads1 and give better support4 ,the first sign of a bed sore is either redness of the skin or a dark discoloration like a bruise4 ,every point where a bed sore may form should be inspected daily4 ,if the slightest symptom of a sore appears1 the patient must not lie on the affected part1 and every effort should be made to keep the skin from breaking2 vigorous rubbing at this stage is dangerous1 and will by no means make up for previous neglect4 ,the condition should be reported to the doctor at once4 ,if in spite of all efforts the skin does break1 a peculiarly difficult kind of open wound results which must be treated and dressed according to the doctor's directions4 ,,devices ,,to ,,give ,,support4--,the variety and number of pillows one patient can use is almost unlimited4 ,a weak patient when lying on his side should have his back supported by a pillow4 ,when he lies on his back a pillow should be placed under his knees to lessen muscular tension1 and if he may be raised in bed1 several pillows are needed to support him comfortably4 ,a back rest is useful for a patient who can sit up in bed4 ,satisfactory back rests of several types can be purchased1 or one may be improvised from a straight chair placed on the bed bottom side up1 so that its legs lie against the head of the bed and its back forms an inclined plane4 ,back rest and chair alike should be covered by several pillows to make them comfortable1 and other pillows should be used to support the patient's arms4 ,a person who is sitting up in bed always tends to slip down toward the foot4 ,this tendency may be corrected by using a foot rest1 knee pad1 or pillow4 ,a hard pillow may be placed in the bed at the foot for the patient to brace his feet against2 or a short board1 well padded1 may be arranged as follows for the feet to rest against3 ,fasten ropes to the board1 as the ropes of a swing are fastened to the seat2 set the padded board on edge at a convenient point below the patient's feet1 and hold it in place by tying the ropes of the swing to the head of the bed4 ,a pillow may be used in the same way1 either at the feet or under the knees1 by folding it over a long strip of muslin1 the ends of which are then tied to the sides of the bed1 brought up to the head1 and there tied to prevent slipping4 ,a cylindrical cushion six or eight inches in diameter and as long as an ordinary pillow1 stuffed with firm material1 may also be used for this purpose4 ,it should be held in place by strips of strong muslin or ticking sewed to the ends of the cushion and tied to the head of the bed4 ,the cushion should have a washable cover4 ,illustration3 ,,fig4 #ah4--,,showing ,,foot-,,sling ,,for ,,supporting ,,patient ,,in ,,the ,,upright ,,position4 7,sanders ,modern ,methods in ,nursing47 ,supports called bed cradles are used to keep the weight of the bed covers from sensitive parts of the body1 generally the feet or abdomen4 ,they are semi-circular pieces of wood or iron fastened together so that they will stand up4 ,a satisfactory cradle may be improvised as follows3 ,cut a barrel hoop in two1 cross the halves at right angles and tie them together firmly2 place the cradle over the affected part under the bed clothes4 ,a smaller cradle may be made by taking sections that are less than half of the barrel hoop4 ,if used for one foot only1 the cradle should be small enough not to interfere with the motion of the other foot2 if used for both feet1 it should be large enough to allow some freedom of motion4 ,since the cradle leaves an air space1 the feet should be wrapped in a piece of soft flannel4 ,a cradle used for the protection of the abdomen should extend a little beyond the body on each side4 ,illustration3 ,,fig4 #ai4--;,,adjustable ,,bed ,,rest4 ,adjustable tables are convenient for patients who are able to sit up in bed4 ,these tables are supported on one side only so that they may extend over the bed4 ,another kind of bedside table has short legs and stands directly on the bed4 ,such a table can easily be made at home from a wide board with supports six or eight inches high nailed to each end4 ,a lap board supported by heavy books may serve for temporary use4 ,indeed1 home-made substitutes are often as good as expensive apparatus or even better4 ,if sick-room appliances must be bought1 it is well to remember that simple standard designs are best4 ,complicated apparatus is soon out of order1 and is generally a trial both to the patient and to those who must adjust it4 ,persons taking care of chronic patients may often obtain valuable suggestions in regard to appliances by consulting a visiting nurse or the superintendent of the local hospital4 ,illustration3 ,,fig4 #bj4--;,,adjustable ,,table4 ,,bedpans are utensils to receive bowel and bladder discharges of patients lying in bed4 ,enamel bedpans are better than porcelain1 although more expensive4 ,the shape known as the ,perfection is best for general use4 ,a slipper bedpan1 although harder to clean and ordinarily less comfortable1 may be preferable if it is especially difficult or undesirable to raise the patient4 ,the square or douche pan is preferred by some people1 and is especially useful when the quantity of discharge is large1 as after an injection4 ,when a patient asks for the bedpan it should be brought if possible without a moment's delay1 not only because no other form of neglect makes a patient realize her helplessness more acutely1 but also because the desire to use it often passes quickly and delay may encourage the habit of constipation4 ,if the patient does not ask for the bedpan1 the attendant should offer it at suitable times4 ,bedpans should be warmed before use4 ,an easy way to warm one is to let hot water run over it2 the outside should afterward be dried4 ,to place the bedpan1 first flex the patient's knees and push the night gown up2 place one hand under the patient's hips1 raise them slightly1 and with the other hand slip the pan into place4 ,if the patient is entirely helpless two persons are needed to lift her4 ,place a pad or folded cloth between the patient's back and the pan2 then lower the patient gently4 ,before removing the pan1 bring toilet paper1 water and two pieces of soft old muslin or gauze4 ,a patient1 if able1 prefers to use the toilet paper without assistance2 her hands should afterward be thoroughly washed4 ,if she is unable1 the attendant must do everything needed4 ,after the patient has been cleaned as thoroughly as possible with paper raise her hips with one hand and then remove the pan2 it is important to raise her first because the skin often adheres and may be injured if the pan is suddenly pulled away2 carelessness in managing the bedpan has caused more than one bed sore4 ,then remove the pan with one hand and cover at once4 ,turn the patient1 if helpless1 on her side1 wash the parts with one piece of old muslin1 thoroughly dry them with the other1 and either burn or thoroughly wash both pieces afterward4 ,empty the bedpan and clean it at once2 ordinarily one can clean it without wetting or soiling the hands4 ,use cold water first1 removing all adhering solid particles with a tightly rolled piece of toilet paper4 ,do not use a brush for this purpose4 ,after using cold water1 rinse the pan thoroughly in hot water1 and at least once a day wash it well in hot soapsuds4 ,directions for disinfecting the pan will be given later1 but remember that a properly kept pan needs no deodorant solution4 ,glass urinals should be provided for men1 and kept clean in the same way4 ,contents of both bedpan and urinal should always be carefully inspected2 neither should be emptied in the dark4 ,,daily ,,routine ,,in ,,the ,,sick-,,room ,obviously the routine of a patient's day must vary according to her condition1 her preferences1 and the amount of time the attendant has to give her4 ,the temperature1 pulse1 and respiration must be taken and all medicine1 nourishment1 and treatment given at the exact times ordered1 but the attendant should learn whether or not the doctor wishes her to wake the patient for food or treatment4 ,good management in the sick-room depends upon foresight and planning1 and therefore it is well to keep in mind the following suggestions3 ,vitality is lowest in the early morning1 hence baths and treatments1 especially if they are fatiguing or painful1 should if possible be left until after breakfast4 ,patients often wake early and wait1 weak and miserable1 for the day to begin4 ,a hot drink at this time may give relief and enable the patient to sleep again4 ,even though breakfast time is near1 nourishment should be given as soon as the patient wakes4 ,she may not admit that she is hungry1 but her nourishment should not be delayed until the family breakfast is ready1 or still worse1 finished4 ,before breakfast the bedpan should be offered1 the patient's face and hands should be washed1 her teeth brushed1 her hair tidied1 the bed straightened1 and the room put in order4 ,these services should require a few minutes only4 ,the room if properly arranged at bed time needs only a little attention now unless untidy work has gone on during the night2 disorder in a sick-room is as unnecessary in the early morning as at any other time4 ,after the patient has finished her breakfast she may rest1 or if allowed1 read her mail or the newspaper while the attendant prepares for her day's work2 about an hour after breakfast the patient should be bathed1 unless she prefers her bath in the evening4 ,after the bath some form of light nourishment should be given1 even to a patient who has regular meals4 ,if a patient is able to sit up in a chair1 the best time for her to do so is generally just after the bath and toilet have been completed2 but if she feels tired she had better wait until afternoon4 ,the bed room can be better aired and cleaned if it is possible to take her into another room2 and she herself generally profits by a change of scene4 ,the doctor should definitely state when and for how long a patient may sit up for the first time after an illness1 and an amateur who may be ignorant of the dangers involved should not assume the responsibility of deciding4 ,when a patient is to sit up for the first time1 put on her stockings1 slippers1 and wrapper before she leaves the bed4 ,arrange an arm chair with pillows in the seat and at the back1 bring it close to the bedside and cover it with a large blanket unfolded4 ,the chair may face either the head or the foot of the bed4 ,help the patient to a sitting position on the extreme edge of the bed1 with her feet hanging down4 ,next1 standing in front of her and supporting her well1 let her slip down until she stands upon her feet1 then let her turn1 and gently lower her into the chair4 ,see that the patient while sitting up is warmly covered1 and that her foot-stool1 pillows1 etc41 are adjusted comfortably4 ,move her chair so that the outlook may be as interesting as possible1 and at least a little different from the view from the bed4 ,most patients like to look out of the window2 children and old people enjoy it particularly4 ,if the patient shows signs of fatigue1 she should go back to bed even before the appointed time4 ,to help her back to bed1 reverse the process of helping her out4 ,a footstool may be needed if the bed is high1 or two people to lift her if she is weak or heavy4 ,when a patient is in bed no one should ever sit on the bed1 lean against it1 use it as a table for folding linen1 making pads1 etc41 take hold of the bed posts in passing1 or touch the bed unnecessarily in any way4 ,the best time for visitors is the last of the morning or the early afternoon4 ,a judicious visitor may do an immense amount of good1 especially to a chronic patient2 indeed1 she may be the only ray of light in a dark day4 ,subjects of conversation should be pleasant1 but not too stimulating or exciting4 ,the visitor should be prepared to carry the burden of the conversation1 to drop topics skillfully that seem to involve fatigue or excitement1 and either to go or to stop talking if the patient seems tired4 ,visitors should remember to talk naturally and cheerfully on ordinary topics1 and to avoid excessive sympathy and labored attempts to cheer the patient4 ,they should also remember that few patients bear well even the mildest forms of teasing4 ,the patient's room is not the place to discuss personal or family troubles2 yet it is only too often chosen for such purposes1 probably because the complainer knows that in it an audience is always to be found4 ,visitors not belonging to the family should not be present in the sick-room during treatment of any kind1 unless their help is required2 neither1 as a rule1 should they stay during the patient's meals4 ,a member of the family may stay with advantage if the patient tires of eating alone1 but casual visitors almost invariably offend by undue urging if the patient's appetite is poor1 or by facetious remarks if it is good4 ,ordinarily only one visitor should be admitted at a time1 since a weak patient may be tired merely by looking from one to another4 ,if it is desirable to limit the call1 the attendant should tell the visitor beforehand how long to stay1 or arrange a signal for the visit to end4 ,to announce baldly in the sick-room that the patient is tired and the visitor must go1 will only elicit aggrieved protests from both4 ,in illness lasting only a day or two all visitors should be discouraged2 during colds1 because they are communicable2 during general fatigue1 headaches1 digestive upsets1 and painful menstruation1 because rest and quiet are highly desirable4 ,visitors at such times too frequently give injudicious sympathy1 and may actually delay the recovery of patients who enjoy playing the rle of interesting invalid4 ,the time when a trustworthy visitor is present may be the best time for the attendant to rest4 ,the patient should be told when the attendant is going1 and approximately when she will return4 ,it is a mistake to slip away while the patient sleeps2 she seldom fails to wake before the time scheduled and to resent the desertion4 ,surprises of any kind1 pleasant or unpleasant1 are seldom good for patients4 ,toward the end of the afternoon the patient is probably tired1 especially if she has not slept during the day4 ,when fever is present her headache and restlessness increase as the day goes on1 but it should be remembered that uncomfortable beds and too heavy covers cause much of the restlessness attributed to fever4 ,rubbing the back and legs with alcohol1 giving a tepid sponge bath1 remaking the bed or changing her position may help to soothe her4 ,the evening should be kept free from excitement1 and every possible effort should be made to encourage sleep4 ,it is a mistake to think that a better night results from keeping a sleepy patient awake all the evening2 sick people should sleep when they can4 ,just before bedtime the attendant should prepare her own cot1 and then make the following preparations for the patient to sleep3 wash the patient's face and hands or give a sponge bath if it is desired1 brush the hair1 change the night gown1 brush crumbs from the bed1 tighten the sheets or remake the bed if necessary1 rub the back and other pressure points with alcohol1 shake the pillows1 give liquid nourishment1 preferably hot1 cleanse the mouth1 and give the bedpan4 ,see that the patient's feet are warm1 the bed covers right1 the room ventilated properly and in good order1 and the light extinguished or arranged for the night4 ,if the patient is inclined to be wakeful a hot foot bath may help her1 or sponging the entire length of the spine for fifteen minutes1 using very hot water and long downward quiet strokes4 ,no conversation should be encouraged during preparations for the night4 ,patients in bed all day often lose the habit of sleeping at the regular time1 and lie awake far into the night from a vague feeling that someone else is coming or something further is to be done for them4 ,consequently last of all ask the patient if she wants anything more2 if not1 say good-night1 go out and stay out1 at least until she has had a chance to go to sleep4 ,she is thus helped to realize that nothing further is likely to happen1 and that it is time to go to sleep4 ,toward morning the patient grows weaker4 ,more bed covers will probably be needed1 and they may often be added without waking her4 ,night at the best is a dreary time for the sick4 ,pain and weariness and discouragement are less bearable in the darkness2 nervous fears and morbid fancies defy control4 ,never is kindness more needed or more appreciated than it is by those who lie awake and watch for the morning4 ,,exercises #a4 ,name all the causes1 direct and indirect1 of pressure sores4 #b4 ,why are pressure sores generally more serious than injuries of equal extent to the skin of a well person8 #c4 ,where are pressure sores most likely to occur and what are their symptoms8 #d4 ,what measures should be employed to prevent pressure sores8 #e4 ,describe ways to support a person lying down in bed4 #f4 ,describe ways to support a person sitting up in bed4 #g4 ,how may the weight of the bedclothes be removed from any particular part of the body8 #h4 ,how should a bedpan be cared for8 #i4 ,describe in detail a day's routine either of yourself the last time you were ill in bed1 or of another patient personally known to you4 ,could the plan of the day have been improved1 and if so1 in what ways8 ,,chapter ,,ix ,,feeding ,,the ,,sick ,substances used for food are generally grouped into three classes1 called the three nutrients4 ,the nutrients are3 first1 the proteids or nitrogenous substances1 which are found in meat1 fish1 eggs1 milk1 cheese1 peas1 beans1 etc42 second1 the carbohydrates1 which include sugars and starch2 and third1 the fats1 which are found in butter1 oil1 the fat of meat1 etc4 ,in addition to the nutrients1 water and certain mineral salts are essential to life1 while some indigestible material like the fibre of vegetables is needed to give bulk and to stimulate the action of the intestines4 ,the nutrients furnish the body with materials for growth1 and for repair of tissues worn out by use2 they also furnish fuel substances from which the body obtains its heat and its energy4 ,all three nutrients can serve as fuel1 but the proteids alone can furnish materials for growth and repair of tissues4 ,in order to be used by the body for any purpose1 nutrients must first go through a series of complicated changes known as digestion1 which renders them soluble so that they can soak through the walls of the intestine4 ,,the ,,digestive ,,process ,digestion begins in the mouth4 ,there the food is crushed and its fibres separated by the teeth1 it is moistened by the saliva1 and substances in the saliva begin a chemical action upon the starch4 ,chewing should be sufficient to reduce the food to a soft mass well moistened with saliva4 ,slow eating is desirable1 but the emphasis should be placed on thorough chewing4 ,for instance1 long intervals between bites are of no special benefit if mouthfuls of food are washed down by swallows of water4 ,after it has been swallowed1 the food passes into the stomach and remains there for a variable length of time1 while it undergoes further preparation for absorption4 ,it is moved about by the contraction of the muscular walls of the stomach1 so that it becomes mixed with the stomach juices and more thoroughly softened4 ,some digestion of proteids goes on in the stomach1 and a little absorption through the walls4 ,little by little the food is discharged from the stomach into the small intestine1 and the most important part of digestion then begins4 ,it is acted upon chemically by a fluid flowing into the intestine from an organ called the pancreas2 this pancreatic juice acts upon all three nutrients and is of great importance in the digestive process4 ,the bile and other juices that flow into the intestine perform important functions also4 ,the food masses are moved along by rhythmic contractions of the intestine1 and absorption goes on when the food has been so changed that it can soak through the intestinal walls into the blood and lymph vessels4 ,the small intestine is about #bj feet long1 and consequently affords a large surface for absorption1 as does also the large intestine1 into which the small intestine opens4 ,the blood and lymph carry the digested food substances to all parts of the body1 and thus the different tissues are provided with the materials they need for growth1 repair1 and energy4 ,excess of food substances may be stored as fat or expelled from the body4 ,as the blood and lymph go through the tissues they take from the tissues the refuse1 or the part that remains after the fuel substances have been consumed4 ,this refuse from the tissues may be likened to the ashes from a furnace2 it is finally eliminated from the body through the kidneys and lungs1 and to some extent through the skin and bowels4 ,the part of the food that is not digested of course never soaks through the intestinal walls2 it merely passes through the small and large intestines and is finally expelled as feces or bowel movements4 ,the characteristic odor of fecal matter results from the action of bacteria upon it while in the large intestine4 ,it must be remembered that the body is not nourished merely by swallowing food3 in order to nourish the body food must also be digested1 absorbed1 and made use of by the tissues4 ,many factors may operate both in health and in sickness to render food indigestible4 ,it may be originally unsuited to the human digestive apparatus1 or spoiled1 or poor in quality1 or badly cooked4 ,but even when wholesome in itself it may be ill-adapted to a particular person at a particular time2 thus it may be too great in amount1 or eaten at improper hours4 ,moreover a person's own idiosyncrasy or manner of living or fatigue or illness may render it especially indigestible for him4 ,experiments have shown that pain1 fear1 worry1 and other unpleasant emotions actually stop the action of the digestive juices and check muscular contractions of the small intestine4 ,furthermore1 even the absence of pleasant anticipation of food has been shown to delay digestion for hours4 ,thus scientific knowledge confirms our common experience that such mental states seriously interfere with digestion4 ,the converse is also true4 ,agreeable taste and odor of food1 or even pleasurable thought of it1 start the secretion of digestive fluids4 ,it is a common saying that the mouth waters at the prospect of inviting food1 but it is less well known that appetizing food does actually start the stomach juices also4 ,a person who understands the physiological effect that the emotions have upon digestion is in a far better frame of mind to cope successfully with the difficulties of feeding the sick than one who considers sick persons' likes and dislikes entirely irrational4 ,,feeding ,,the ,,sick ,nourishing the sick is not always an easy problem1 but its importance can hardly be overestimated4 ,indeed1 proper feeding in many illnesses makes the difference between life and death4 ,the actual amount of nourishment needed in sickness is often less than in health1 but it may be just as great1 or even greater if the illness causes increased tissue waste4 ,yet the digestive process of a sick person must be rendered as little laborious as possible1 all foods ordinarily difficult to digest must be eliminated1 certain others must be withheld or restricted according to the nature of the sickness1 and in addition one may have to deal with an appetite that is capricious1 diminished1 or totally absent4 ,diet for the sick is often a part of medical treatment2 in such cases the doctor will prescribe special diets and his orders must be carefully carried out4 ,except for special diets1 food for the sick is generally divided into four classes3 first1 liquid or fluid diet2 second1 semi-solid diet2 third1 light or convalescent diet2 and lastly1 full diet4 ,these diets are not very sharply distinguished4 ,,liquid ,,diet generally includes milk1 eggnog1 albumen water1 broths1 soup1 beef juice1 thin gruel1 and beverages4 ,liquid diet makes least demand upon the digestive powers1 because it consists of food already dissolved and therefore nearer the condition in which it can be absorbed4 ,moreover1 it is less likely than other foods to contain excess of fat1 improperly cooked starches1 and other indigestible material4 ,liquids must be given at regular intervals and at shorter intervals than solid foods2 #f to #h ounces every two or three hours is not too much if the patient can take it4 ,the doctor usually specifies the amount and the interval4 ,some patients will take more nourishment at one time if the interval is slightly increased4 ,,semi-,,solid ,,diet includes all fluids and in addition soft milk toast1 soft cooked eggs1 well cooked cereal1 custards1 ice cream and ices1 junket1 and gelatine jellies4 ,liquid or semi-solid diet is commonly given in acute fevers because digestive juices and other fluids of the body are then diminished1 and also because their digestion places a minimum of work upon a system already burdened with bacterial poisons4 ,,light ,,or ,,convalescent ,,diet generally means a simple mixed diet4 ,in addition to the articles in the two preceding diets it includes oysters1 chicken1 baked potatoes1 most fruits except bananas1 simple desserts1 white fish1 and other meats and vegetables added judiciously until full diet is reached4 ,fried foods should not be included4 ,,full ,,diet means an unrestricted menu1 but even from full diets especially indigestible foods should be excluded4 ,the principles of feeding sedentary persons as described in manuals of dietetics apply to patients who are obliged to be inactive although not really ill1 as for example1 a patient suffering from a broken leg4 ,ordinarily in such cases1 as in other kinds of illness1 the appetite is greatly diminished1 but a word of warning should be given against overfeeding patients whose meals are their chief interest4 ,such patients are only too likely to interpret full diet as anything they desire in any quantity at any time of day or night1 and then to attribute their discomfort and irritability to their illness rather than to overeating4 ,constipation is especially stubborn in sickness1 since the patient is deprived of his usual exercise and variety of food4 ,so far as possible the bowels should be regulated by diet4 ,laxative foods include most vegetables with a large amount of fibre1 coarse cereals and flour1 oils and fats1 and most fruits and fruit juices4 ,unfortunately many laxative foods are difficult for sick persons to digest and must therefore be used with caution4 ,a glass of hot or cold water or orange juice an hour before breakfast may be helpful1 and at bed time hot lemonade1 oranges1 prunes1 figs1 or other fruit if allowed4 ,it is essential for patients to drink water freely1 and it should be given between meals and also between liquid nourishments4 ,persons inexperienced in the care of the sick frequently make the mistake of bringing water only when a patient asks for it4 ,many acute illnesses begin with fever1 headache1 sore throat1 and especially among children with vomiting1 diarrha1 and other digestive disturbances4 ,in such cases all food should be withheld until the doctor comes1 but boiled water1 hot or cold1 should be given freely4 ,efforts to tempt the appetite are then mistaken2 few people are injured and many are benefited by omitting food even for #bd hours at the beginning of an acute illness1 and with few exceptions a doctor can be found in a shorter time4 ,,serving ,,food ,,for ,,the ,,sick4--,food for the sick should always be most carefully prepared and of the best quality1 and in addition it should be as inviting1 as varied1 and as well served as possible4 ,neglect in these respects is inexcusable4 ,even slight carelessness in preparing or serving food may arouse disgust and thus banish permanently some valuable article from the dietary4 ,trays1 dishes1 tray cloths1 and napkins for the patient must be absolutely clean and as attractive as possible4 ,cracked or chipped dishes should not be used4 ,individual sets of dishes for the sick may be purchased1 and their convenience makes them well worth their price4 ,paper napkins may be used in many cases to save laundry work2 clean white paper is always superior to soiled linen4 ,before the tray is brought to the bedside1 everything should be arranged so that the patient can eat in comfort4 ,it is bad management to let the soup cool while the patient's pillows and table are being adjusted4 ,in setting the tray great care should be devoted to placing the articles conveniently1 and to the appearance and garnishing of the food4 ,careful serving requires more thought1 but little if any more actual time than slovenly serving4 ,dishes should not be so full that food is spilled in transit2 hot dishes should be covered2 hot dishes should reach the patient hot1 and cold dishes cold4 ,liquid nourishment in a glass or cup should be served on a small tray or plate covered with a doily4 ,neither glass nor cup should be held by the rim4 ,it is not uncommon to overload trays and to serve everything at once in order to save steps1 but a patient is ordinarily more interested in a meal that is served in courses unless very long intervals elapse between4 ,moreover1 if the meal is served in courses he is not tempted to eat dessert first and then to refuse the rest of the meal4 ,if food is given sufficiently often it is safer to err on the side of serving too little at a time rather than too much1 since the sight of large amounts of food is often disgusting4 ,the patient's likes and dislikes should be considered as far as possible1 but most patients should not be consulted about their menus beforehand4 ,great variety in one meal is not necessary2 it should be introduced by varying successive meals4 ,an article that has been especially disliked should not be served a second time1 unless it can be disguised beyond a possibility of detection4 ,an article of food to which a patient objects should be removed at once2 one may appear disappointed if it seems wise1 but should never argue4 ,when patients persistently refuse necessary nourishment a difficult situation is presented2 persuasion and every form of ingenuity must be used1 and the doctor's coperation enlisted4 ,when1 for example1 a strict milk diet is ordered for a patient who announces that he never takes milk in any circumstances the situation may seem hopeless but it is not necessarily so4 ,,to ,,feed ,a ,,helpless ,,patient4--,helpless and weak patients must be assisted to eat or drink4 ,a napkin should first be placed under the patient's chin4 ,the attendant should place her hand under the pillow1 raise the head slightly1 and hold the glass to his lips with her other hand4 ,an ordinary tumbler can be used by a patient lying down if it is not more than a quarter full1 or a special feeding cup may be purchased4 ,bent glass tubes may be used for cool liquids2 they should be washed immediately after use4 ,a child who can sit up sometimes takes more nourishment if it is given through a soda water straw4 ,if the patient must be fed with a spoon care should be taken that the liquid is not too hot1 but the attendant should not blow upon it to cool it4 ,it should be given from the point of a spoon placed at right angles to the lips1 and plenty of time between mouthfuls should be allowed4 ,a swallow should not be given at the moment when the patient is drawing the breath in4 ,great patience is required if a helpless person is to be fed acceptably4 ,the attendant should sit by the bedside rather than stand1 should present at least the appearance of having unlimited time1 and should endeavor not to deprive the patient in any way of the satisfaction he may derive from his nourishment4 ,,exercises #a4 ,what needs of the body do food substances supply8 #b4 ,give an outline of the digestive process4 #c4 ,describe the effect of different mental states upon digestion1 and give examples of the ways by which a knowledge of these effects may be utilized in feeding patients4 #d4 ,why is the problem of nourishing the body of especial importance in sickness8 #e4 ,name the four ordinary classes of diet for the sick1 and mention all the articles you can belonging to each class4 #f4 ,why is constipation a common ailment among patients confined to bed1 and what attempts should be made to overcome it by the diet8 #g4 ,why is it necessary for sick persons to drink water freely1 and what efforts should the attendant make to encourage them to do so8 #h4 ,describe the proper serving of a patient's tray4 #i4 ,how should helpless patients be assisted to eat8 ,,for ,,further ,,reading ,health and ,disease--,roger ,i4 ,lee1 ,chapter ,,ii4 ,the ,human ,mechanism--,hough and ,sedgwick1 ,chapters ,,viii1 ,,xiii1 ,,xix4 ,notes on ,nursing--,florence ,nightingale1 ,pages #fc-gi4 ,how to ,live--,fisher and ,fisk1 ,chapter ,,ii4 ,bodily ,changes in ,pain1 ,hunger1 ,fear and ,rage--,cannon1 ,chapter ,i4 ,food for the ,invalid and the ,convalescent--,winifred ,s4 ,gibbs4 ,practical ,dietetics--,pattee1 ,chapters ,,iv1 ,v4 ,feeding the ,family--,rose4 ,diet in ,health and ,disease--,friedenwald and ,ruhrah4 ,feeding ,children from ,two to ,seven ,years ,old--,new ,york ,city ,department of ,health4 ,american ,red ,cross ,text ,book on ,home ,dietetics--,ada ,z4 ,fish4 ,emergency ,cooking--,pamphlet #gjh1 ,american ,red ,cross4 ,war ,diet in the ,home--,pamphlet #gjf1 ,american ,red ,cross4 ,red ,cross ,conservation ,food ,course for ,children and ,special ,classes--,pamphlet #gje1 ,american ,red ,cross4 ,,chapter ,x ,,medicines ,,and ,,other ,,remedies ,,action ,,of ,,drugs4--,modern medical practice increasingly emphasizes diet1 baths1 exercises1 and other hygienic measures in the treatment of sickness4 ,drugs are given far less than they were a generation ago2 yet medicines are still the most familiar of all remedies1 and the most abused by those who persist in treating themselves4 ,misuse of medicine even by intelligent people is astonishingly common4 ,problems of sickness and health would be enormously clarified if the uses and limitations of drugs were more generally understood4 ,many people still believe that every disease can be cured by a drug if only the doctor is clever or lucky enough to think of the right one to give4 ,such beliefs result naturally enough from centuries of faith in charms and magic1 and occasionally are confirmed by remarkable cures apparently brought about by drugs1 but really pure coincidence or the result of suggestion4 ,it is a fact that a few medicines are known which if rightly used actually do cure certain diseases4 ,an example of their action is the curative effect of quinine in malaria4 ,such medicines1 unfortunately1 are few4 ,in the great majority of cases medicines do not cure disease2 their beneficial action is ordinarily indirect and is due to their power either to increase or to check certain processes within the body4 ,it is here that the abuse of drugs comes in4 ,disordered bodily processes give rise to symptoms of disease2 and it is the symptoms of disease1 not the disease itself1 that trouble the patient4 ,a patient with typhoid1 for example1 is not conscious of the toxins in his blood1 but of headache1 weakness1 and fever2 the man with eyestrain is not aware of an imperfectly shaped lens1 but of headache and indigestion4 ,what the patient wants is to have his symptoms relieved2 in some cases they can be controlled by drugs1 and the sufferer then considers himself cured4 ,but the original condition persists3 it may in the meantime be improving1 but it may on the other hand be growing worse4 ,not infrequently it is best to check symptoms1 and to check them by means of drugs4 ,when they should be checked1 only a thoroughly trained physician is qualified to decide4 ,the question is not one for amateurs1 since the whole practice of medicine1 including the prescription of drugs1 constantly becomes more nearly an exact science4 ,people should obtain and follow expert advice in regard to health as they would in regard to other affairs of life4 ,the constant self-dosing practised by thousands of people is harmful and unintelligent2 it is1 however1 no less irrational to go to the other extreme and refuse to take medicine prescribed by a competent doctor4 ,,amateur ,,dosing4--,amateur dosing either of oneself or of others is dangerous in more ways than one4 ,in the first place1 time is lost4 ,moreover1 symptoms are characteristic2 checking or altering them increases the difficulty of finding the real trouble4 ,the man with eyestrain who takes one drug to stop his headache and another to cure his stomach1 is simply delaying the time when properly adjusted glasses will relieve both4 ,in this case the result may not be serious2 but such a loss of time in finding the trouble and beginning proper treatment might prove fatal in the case of tuberculosis4 ,another objection to amateur prescription of medicine is the fact that most drugs have more than one effect4 ,in addition to their main action they have others1 subordinate or ordinarily less marked4 ,these minor effects may be serious in some cases4 ,many headache remedies1 for example1 affect the heart2 a dose that is harmless for a normal person may be strong enough to injure seriously a person with a weak heart4 ,a doctor1 and a doctor only1 is competent to decide when and in what quantity medicines will be beneficial1 because he alone understands both the condition of the patient and all the possible effects of the drug4 ,in no circumstances should medicine prescribed for one person be taken by another4 ,this rule seems obvious enough2 yet every day people pass on their pet remedies to friends4 ,some medicines deteriorate after standing1 and others grow stronger2 nevertheless1 medicine supposed to have cured a cough or a tonic supposed to have strengthened some member of the family after an attack of grippe is cheerfully administered months later to another member of the family1 who1 to make matters worse1 may differ in age1 strength1 and probably in the nature of his sickness4 ,drugs are expensive1 and it is considered economical to use them up2 measured by lost time and impaired health such practices may be anything but thrifty4 ,cathartics1 tonics1 and various drugs to relieve pain and sleeplessness are among the remedies most commonly taken without medical advice4 ,enough has already been said about constipation to indicate proper hygienic treatment1 but another warning should be given against habitual use of cathartics4 ,many of these drugs are irritating2 even when not irritating1 they are harmful1 since the body depends more and more upon the drug to do for it what it should be enabled to do for itself1 by remedying the original cause of the trouble4 ,licorice powder1 cascara1 saline cathartics such as ,seidlitz powders and ,rochelle ,salts and some others are harmless for occasional use1 if occasional is not too liberally interpreted4 ,tonics are poor substitutes for proper diet1 rest1 and fresh air4 ,using them may be likened to beating a tired horse2 the horse goes faster1 but he is not really stronger4 ,in some emergencies the horse must go faster and there is nothing to do but beat him1 and in some cases the tonic should be given2 these1 however1 are cases for a doctor to decide4 ,people persist in taking tonics because they are unwilling or unable to rest1 or otherwise to change their ways of living4 ,medicines to stop pain or to induce sleep are probably the most pernicious of all self-prescribed remedies1 for they add to other dangers the possibility of forming drug habits4 ,these habits are so insidious and so powerful that it is not safe to take habit-forming drugs even once except by a doctor's direction4 ,in short periods of time strong people1 apparently firm in will and character1 have acquired habits from supposedly moderate use of drugs like morphine1 cocaine1 and alcohol4 ,no one1 no matter how sure of his own self-control1 can afford to run so grave a risk4 ,,patent ,,remedies4--,objections to self dosing in general apply even more strongly to using patent medicines4 ,the ingredients of patent medicines are ordinarily unknown1 so that using them is unintelligent at best4 ,sometimes they contain habit-forming or other harmful drugs4 ,in other cases the ingredients are innocent enough1 but totally unable to bring about the results claimed for them4 ,the old story about a powerful remedy discovered by accident and thus unknown to the medical profession deceives only the ignorant or credulous2 with our present knowledge of chemistry and physiology powerful remedies are not discovered in that way4 ,even to these comparatively harmless patent preparations there are two serious objections4 ,one is the loss of time1 during which the patient may grow worse4 ,the other is that money is obtained under false pretenses2 fraud is a common element in the success of patent remedies4 ,one of the least harmful1 a substance called ,murine may be taken as an example#b4 ,this substance was widely advertised at one time as a positive cure for sore eyes4 ,analysis showed it to be a solution of borax1 which cost about five cents a gallon to prepare4 ,it sold for one dollar an ounce1 or at the rate of #abh4jj a gallon4 ,although it could not bring about the wonderful cures advertised1 it was practically harmless1 and buyers of ,murine must have been injured chiefly in pocket4 ,but with cancer cures and consumption cures it is a different story4 ,early treatment of these diseases is essential to recovery2 delay in many cases means robbing the sufferer of his only chance of life4 ,no drugs are now known that will cure these diseases1 and it seems incredible that anyone should be willing to practise such cruel deception upon ignorant people merely for the sake of making money4 ,,administration ,,of ,,medicine4--,medicines may be introduced into the body in a number of ways4 ,in the majority of cases they are swallowed and finally carried to the tissues by the blood just as digested food is carried4 ,except in rare emergencies no medicine should be given to a sick person without the doctor's order4 ,the prescribed dose should be accurately measured in a medicine glass having a scale to show the number of teaspoonfuls4 ,when measuring medicine1 think only of what you are doing2 neither talk nor listen to conversation4 ,first read the label on the bottle4 ,next1 shake the bottle1 if the medicine is liquid1 in order to mix the contents thoroughly4 ,then remove the cork with the second and third fingers1 and hold it between them while pouring1 thus keeping the cork clean and protecting the contents of the bottle4 ,hold the medicine glass on a level with the eyes1 and in the other hand hold the bottle1 with the side bearing the label uppermost to avoid soiling it2 pour out the dose1 measuring exactly1 wipe the bottle1 replace the cork1 and again read the label on the bottle4 ,most medicines should be diluted with a little water4 ,pills and capsules should not be presented to patients in the attendant's fingers1 but on a saucer or teaspoon4 ,acids and medicines containing iron should be taken through a glass tube kept for medicine exclusively4 ,tubes and glasses should be washed at once after use1 and neither they nor the bottles should stay in the patient's room4 ,if a dose is omitted for any reason1 do not increase the next dose2 give the regular dose at the next regular time4 ,serious mistakes in giving or taking drugs are far too common1 and no precautions are too great to guard against them4 ,never use medicine from a box or bottle that has no label4 ,never take or give another person a medicine selected in the dark1 even though you have positive knowledge that there is no other bottle or box of medicine in the whole house2 in just such circumstances the fatal mistakes occur4 ,a few things can be done to make medicines more palatable4 ,the water used to dilute the dose and to be taken after it should be very cold4 ,holding the nose is helpful4 ,a piece of cracker1 a peppermint1 or a slice of lemon or orange1 if allowed1 may be taken afterward4 ,giving disagreeable medicine in ordinary food1 as lemon juice1 orange juice1 or milk1 and giving bitter powders in jam or jelly1 is unwise because it sometimes results in life long dislike for a useful article of diet4 ,where food is given directly after the dose to take away its taste1 the association of dislike seems to be formed less frequently4 ,the taste of castor oil is so disgusting that it often causes vomiting1 but if skillfully given the oil need not be tasted by a patient who is willing to coperate4 ,its way of sticking to the tongue and teeth constitutes the chief difficulty2 the object therefore is to prevent it from sticking by swallowing the dose all at once4 ,to administer the oil1 wet the inside of a medicine glass or large spoon with very cold water1 and leave a little water in the bottom4 ,pour the required dose in slowly and cover it with more cold water4 ,let the patient hold in his hand something to take away the taste1--cracker1 bread1 peppermint1 or whatever is allowed2 for castor oil water is not very effectual4 ,then direct him to hold his nose1 open his mouth1 and hold his breath2 caution him to let the oil run down without swallowing until all has been taken1 and afterward to chew the cracker1 continuing to hold his nose until he has swallowed the cracker4 ,when the patient understands and is ready1 pour the dose in quickly as far back as possible1 taking care not to spill the last drop on the lips4 ,this process may seem unduly troublesome1 but when castor oil is needed it is badly needed and efforts to make it stay down are worth while4 ,the following method also effectually disguises the taste of castor oil3 place in a glass a teaspoonful of baking soda1 add the prescribed dose of oil and then the juice of half a lemon4 ,mix all together thoroughly and let the patient take the mixture while it is effervescing4 ,this method may be used unless the patient is not allowed soda and lemon juice4 ,castor oil may be bought in capsules1 but on account of their size many people find the capsules impossible to swallow4 ,,suppositories4--,sometimes medicines are given through the rectum4 ,for this purpose they are combined with cocoa butter or other material1 and made into small cones called suppositories4 ,they melt at a low temperature and should be kept on ice until needed4 ,a suppository should be lubricated with vaseline1 and inserted very gently as far as the finger can be introduced1 while the patient is lying on the back or left side4 ,,enemata4--,an injection of a fluid into the rectum is called an enema4 7,plural1 enemas1 or enemata47 ,enemas are generally used to cause evacuation of the bowels4 ,for a simple purgative enema one of the following is generally used3 plain water2 or a solution of common salt in the proportion of one teaspoonful of salt to one pint of water2 or soap suds made with a white soap such as castile or ivory4 ,unless otherwise ordered the temperature of the enema should be between #aje and #aaj ,f4 ,to give an enema1 one should proceed as follows3 ,first protect the bed by placing under the patient's hips a rubber sheet1 covered by a draw sheet or large towel4 ,let the patient lie on the back1 with the knees flexed and head low4 ,bring to the bedside a commode or bedpan1 and lastly the solution contained in a fountain syringe having a long rubber tube1 stopcock and short hard rubber nozzle4 ,the bag of the syringe may be hung on the bed post or elsewhere1 but it should not be more than three feet at most above the patient's head4 ,lubricate the nozzle with vaseline either from a tube1 or removed from a jar by means of a piece of toilet paper2 never dip the nozzle itself into a vaseline jar4 ,let the solution flow into the bedpan until it runs warm and smoothly2 a jerky flow means presence of air bubbles which cause pain if injected into the bowels4 ,unless the patient is able to do it herself1 gently insert the nozzle1 and at the same time start the flow4 ,force must not be used in inserting the nozzle1 and the flow should be gentle2 if the solution goes in rapidly the patient may be unable to retain it4 ,if there is a desire to expel the enema as soon as the injection has begun1 shut off the current and wait a minute1 meanwhile making gentle pressure upon the patient's abdomen with one hand2 then lower the bag a little and begin again4 ,a grown person should take from two to four pints1 and a child from one to two pints4 ,after the enema is finished give the bedpan immediately2 the enema will1 however1 be more effective if retained a few minutes4 ,the bedpan should be given and removed according to the directions on page #agf4 ,sometimes an enema is expelled with such violence that it soils the upper sheet2 to protect the covers a rubber sheet may be spread over the patient's knees and legs4 ,since an enema sometimes causes nausea or faintness1 a patient should be watched constantly during the process4 ,to give an enema to a baby one may use a small syringe having a soft rubber bulb with a nozzle directly attached1 or the ordinary fountain syringe with the small1 hard rubber tip designed for infants4 ,the enema should be given in a warm room free from draughts1 and the baby must be warmly covered throughout the process4 ,first cover the lap with a pad or folded blanket4 ,upon the blanket place a warmed rubber sheet1 and over the rubber a warm diaper4 ,hold the baby on your lap1 so that he lies on his back with his knees drawn up4 ,hold his feet or legs firmly in your left hand4 ,lubricate the nozzle thoroughly with vaseline4 ,be sure that all the air is expelled from the syringe1 and then proceed as already directed4 ,a baby will take from two or three ounces up to half a pint or even more1 according to the size of the child4 ,after the injection is finished place a small vessel under the baby's hips1 and hold it until the fluid has been expelled1 keeping the child well covered all the time4 ,after being used1 the nozzle of a fountain syringe should be washed with soap and water1 boiled1 dried and put away in a clean place4 ,inserting the nozzle into the bag of the syringe immediately after withdrawing it from the rectum is a filthy but not uncommon practice4 ,the syringe should be kept clean inside and out2 it should be washed in hot soapsuds1 rinsed in clean hot water1 drained1 and when thoroughly dry wrapped in a clean towel or tissue paper4 ,the ordinary fountain syringe hanging for months by a dirty string on a hook in the bath room is an unpleasant and generally an unclean object4 ,,sprays ,,and ,,gargles4--,several other methods of administering medicines are occasionally employed4 ,some remedies may be applied directly to the throat by gargles1 and to the nose and throat by sprays4 ,the throat may be cleansed by gargling with a solution of a teaspoonful of baking soda or common salt in a glass of warm water4 ,nose sprays should not be used except under medical advice1 and it is well to remember that if the mouth washes1 gargles1 and sprays advertised to be disinfectants were really strong enough to kill germs1 they would be too harsh for common or continued use4 ,the nozzles of nose and throat sprays should be boiled immediately after use4 ,a surprising number of families who have progressed far beyond common drinking cups and towels1 continue to use a common nose spray without even washing the nozzle4 ,children while they are well should be taught to gargle the throat2 a child with a sore throat and an aching head is in a poor condition to learn anything4 ,,inhalation or breathing in1 is another method used to introduce drugs into the membranes of the nose1 throat1 and lungs4 ,smelling salts are an example of substances used for inhalation2 they are used to stimulate persons who are faint4 ,they should not be placed close to the nostrils1 nor used at all when the patient is totally unconscious4 ,inhalations of steam are often used in asthma1 croup1 and bronchitis4 ,special croup kettles are made for the purpose1 but an ordinary pitcher half full of boiling water may be used instead4 ,the patient's head should be held closely over the pitcher1 and a towel should be adjusted around the top covering the patient's nose and mouth1 but admitting just enough air to make it possible for him to breathe4 ,if a drug is ordered it should be added to the water4 ,,inunction1 or rubbing a substance into the skin1 is sometimes ordered for delicate babies and children4 ,after the skin of the abdomen has been washed with warm soapy water and thoroughly dried1 the substance ordered1 generally olive oil or cod liver oil1 should be applied by means of a circular movement of the palm of the hand4 ,the oil should be warm and the rubbing continued until it is absorbed4 ,ointments are also applied by inunction4 ,a small quantity at a time should be rubbed in1 using a circular motion4 ,if an ointment is ordered to be applied where the skin is broken1 the ointment should be spread upon gauze and applied without friction4 ,liniments are rubbed in in the same way as ointments4 ,in many cases rubbing accomplishes more than the ointment or liniment itself1 so that this part of the treatment must not be slighted4 ,,household ,,medicine ,,cupboard4--,in every household a small cupboard is needed for medical and surgical supplies4 ,glass shelves are desirable1 because they show when dirty and are easily cleaned1 but a wooden cupboard can easily be lined with clean paper or white enamel cloth held in place with thumb tacks4 ,dirty1 stained shelves should not be tolerated4 ,the cupboard should be kept locked and the key put well out of the reach of children4 ,in the cupboard should be kept medicines in daily use2 they should not be paraded on family dinner tables4 ,poisonous drugs should have rough glass bottles and conspicuous labels4 ,all medicine bottles should be kept well corked1 since evaporation may take place and the remaining solution1 by becoming stronger1 may be dangerous to use in the ordinary amount4 ,pills and tablets sometimes deteriorate by standing1 and may become so hard that they pass through the stomach and intestines without dissolving4 ,it is best to buy drugs and surgical supplies in small quantities2 when it is cheaper to buy more at a time the druggist should be asked whether they will deteriorate or not4 ,almost every family needs to keep on hand some cathartics1 some disinfectants1 some material for first aid1 and a few simple appliances4 ,most families have certain other needs peculiar to themselves1 and for those who live at a distance from drug stores a greater quantity and variety may be required4 ,elaborate equipment and extensive supplies of medicines are neither economical nor necessary for household use4 ,castor oil1 ,rochelle or other laxative salts1 and two grain cascara tablets ordinarily constitute a sufficient supply of cathartics4 ,the dose of castor oil is one or two teaspoonfuls for a baby up to a tablespoonful for an adult4 ,rochelle salts and seltzer aperient are given dissolved in water2 the ordinary dose is from one to four teaspoonfuls4 ,seidlitz powders come in two packets1 one white and one blue4 ,the contents of the packets should first be dissolved in separate glasses each filled about a quarter full of water4 ,one solution should then be poured into the other and the mixture taken while it is effervescing4 ,cascara tablets are generally given in one to ten grain doses4 ,a small bottle of tincture of iodine and one of #gj alcohol should be kept for disinfecting4 ,neither one is for internal use4 ,the iodine is used to disinfect small wounds and abrasions of the skin4 ,it is applied with cotton swabs and several swabs should be made and kept on hand in a box or envelope4 ,alcohol is used to disinfect thermometers and other instruments that cannot be boiled1 for rubbing1 and may also be used for disinfecting the skin4 ,a #ij solution is sometimes used for rubbing2 it need not be bought until needed4 ,denatured and wood alcohol are poisons and should be used in households only in spirit lamps2 they are not safe for other purposes4 ,first aid materials may include two gauze bandages two and one-half inches wide and two bandages one inch wide1 one ,american ,red ,cross ,first ,aid ,outfit1 a small package of absorbent cotton1 a roll of old muslin1 a package of adhesive plaster one inch wide1 boracic ointment1 picric acid gauze or other application for burns1 safety pins1 and a pair of scissors4 ,for use in cases of fainting or exhaustion it is well to keep aromatic spirits of ammonia on hand4 ,its bottle should have a rubber stopper4 ,the dose is one-half to one teaspoonful1 in a quarter to half a glass of water4 ,hot coffee and tea are also good stimulants1 but the time necessary to prepare them makes it desirable to have aromatic ammonia on hand4 ,household or ordinary ammonia must not be used as a substitute4 ,olive oil1 mustard1 and baking soda may be brought from the kitchen when needed4 ,it is assumed that vaseline1 cold cream1 hand lotion1 talcum powder1 and other toilet preparations will also be available4 ,only a few appliances are necessary4 ,among them are a medicine glass1 a teaspoon1 clinical thermometer1 hot water bag1 fountain syringe1 and an alcohol lamp in houses without gas or electric stoves4 ,it is better not to buy other appliances until they are needed1 particularly rubber goods since they deteriorate rapidly4 ,,exercises #a4 ,why is it dangerous for persons without medical training to prescribe medicines8 ,what is the especial danger of dosing oneself8 #b4 ,what is meant by a habit-forming drug8 ,name all you can1 and tell why they are peculiarly dangerous4 #c4 ,what are the special objections to patent medicines8 #d4 ,what precautions should be taken in order to administer medicine accurately8 ,what precautions to avoid giving wrong medicines8 #e4 ,how may some disagreeable medicines be made more palatable8 #f4 ,tell how to prepare and give a soapsuds enema4 #g4 ,how should a fountain syringe be cared for8 a throat spray8 #h4 ,describe methods for giving steam inhalations4 #i4 ,describe the equipment and care of a household medicine cupboard4 #aj4 ,what drugs is it well for a family to keep on hand8 ,what appliances8 ,what materials for first aid8 #aa4 ,how many drugs in addition to those prescribed by a physician have you or your family on hand at the present time8 ,how many do you consider really necessary8 ,are any of these medicines used to remedy troubles that might be cured by sufficient attention to rest1 exercise1 diet1 and fresh air8 ,,for ,,further ,,reading ,health and ,disease--,roger ,i4 ,lee1 ,chapter ,,vi4 ,how to ,live--,fisher and ,fisk1 ,supplementary ,notes1 ,sections ,,iv1 ,v4 ,scientific ,features of ,modern ,medicine--,frederic ,s4 ,lee1 ,chapters ,,iii1 ,,viii4 ,the ,human ,mechanism--,hough and ,sedgwick1 ,chapter ,,xx4 ,the ,conquest of ,nerves--,courtney4 ,primitive ,psychotherapy and ,quackery--,lawrence1 ,chapters ,i-,v4 ,nostrums and ,quackery--,american ,medical ,association4 7,see especially ,cancer ,cures and ,consumption ,cures47 ,,footnotes3 #b ,see ,nostrums and ,quackery1 p4 #dde4 ,,chapter ,,xi ,,application ,,of ,,heat1 ,,cold1 ,,and ,,counter-,,irritants ,,inflammation4--,a process called inflammation sometimes occurs in tissues that have been injured or invaded by bacteria4 ,although painful1 it is nevertheless one of the reparative processes of the body1 and therefore beneficial4 ,common examples of inflammation are boils1 sore throat1 and the swollen1 painful condition resulting from sprains and fractures4 ,characteristic symptoms of inflammation are heat1 redness1 swelling1 and pain4 ,when a tissue has been invaded by bacteria1 nearby blood vessels dilate1 thus bringing an increased supply of blood to the affected part4 ,this extra supply serves to wash away the offending substance1 and at the same time it brings more white blood corpuscles1 one function of which is to destroy bacteria4 ,from the increased supply of blood the affected part becomes red and hot1 and so much blood may come that the vessels further on are unable to carry it away fast enough4 ,some of the fluid part of the blood is then forced out into the tissues1 and the part becomes swollen4 ,distension of the tissues and pressure on the nerve endings cause pain1 and the injured part now exhibits the characteristic symptoms of inflammation4 ,illustration3 ,,fig4 #ba4--,,the ,,history ,,of ,a ,,boil4 ,this figure represents a cross-section of normal skin4 ,note the surface layer1 or cuticle1 and the true skin1 or cutis4 ,in the cutis one sees that the blood capillaries are just wide enough for the blood-cells to pass through in single file4 ,the skin has just been pricked by a dirty pin4 ,on the point of this pin were several poisonous germs which were deposited at a4 7,from ,emerson's ,essentials of ,medicine47 ,illustration3 ,,fig4 #bb4--,,the ,,history ,,of ,a ,,boil 7continued74 ,the poison from these germs diffuses through the cutis4 ,the capillaries dilate4 ,the leucocytes force their way through the walls of the capillaries and travel towards these germs4 ,note the dumb-bell shape of the leucocytes as they pass through the minute holes in the capillary walls1 and their pseudopods as they travel towards their common destination1 attracted by the poison from the germs4 ,the skin in this region is now swollen1 red1 hot1 and painful4 7,from ,emerson's ,essentials of ,medicine47 ,at this point1 if the injury begins to heal or the bacterial infection to yield1 the extra blood supply is gradually carried off1 the blood vessels resume their normal size1 and the tissues return to their usual condition4 ,if1 however1 the infection does not yield so quickly1 more and more white blood corpuscles assemble and pass through the walls of the tiny blood vessels into the tissues4 ,here the struggle continues4 ,some bacteria and some white blood corpuscles are killed1 and substances are formed which liquify these dead cells and also some cells of the surrounding tissues4 ,the resulting fluid is called pus or matter1 and in the case of a boil we then say it has come to a head4 ,if the infection occurs near a cavity or near the surface of the body1 the pus may escape by breaking through at the point of least resistance1 and may carry most of the poisons along with it4 ,if the pus finds no outlet it may be gradually absorbed by the blood stream1 and healing may result without discharging4 ,on the other hand1 the germs may make their way into the circulation1 thus causing the serious condition known as blood poisoning4 ,illustration3 ,,fig4 #bc4--,,the ,,history ,,of ,a ,,boil 7continued74 ,the migration of leucocytes has continued until now they form a dense mass surrounding the germs4 ,the poison of the germs has killed all the leucocytes and also all the cutis immediately around them1 and now digestive fluids from the dead leucocytes is turning the whole dead mass into liquid pus4 ,the boil has come to a head4 ,there is a little lump on the skin and through its thin covering of cuticle can be seen the yellow pus4 7,from ,emerson's ,essentials of ,medicine47 ,inflammation may be treated by means of hot applications1 cold applications1 or counter-irritants4 ,the effect of heat is to dilate the vessels and hence to increase the flow of blood to the injured part4 ,this increased blood supply makes the reparative process go on more vigorously1 and also makes it possible for the accumulated fluid to be more rapidly carried away4 ,moist heat softens the tissues so that pus1 if formed1 can escape more easily4 ,illustration3 ,,fig4 #bd4--,,the ,,history ,,of ,a ,,boil 7concluded74 ,the boil has finally ruptured4 ,the liquid pus has escaped carrying with it the germs and most of their poisons2 the migration of leucocytes has stopped2 the capillaries are returning to normal size and now new tissue will grow and fill up this hole4 7,from ,emerson's ,essentials of ,medicine47 ,cold acts in just the opposite way4 ,it decreases the size of the blood vessels so that less blood comes to cause pain and swelling2 at the same time it diminishes the number of white blood corpuscles and the nutritive substance brought by the blood4 ,the nature and location of the infection determine whether heat or cold is to be preferred4 ,counter-irritants1 of which mustard is an example1 have a complicated action4 ,a counter-irritant affects the blood circulation of the place to which it is applied1 and at the same time it irritates the superficial nerves1 which in turn stimulate other more distant nerves4 ,the latter nerves control the circulation in tissues not adjoining those to which the counter-irritant is applied1 and thus it is possible for a mustard paste1 for example1 if applied at one point to bring about changes in the blood supply of another part of the body4 ,the mechanism by which counter-irritation is brought about is an intricate nervous process called reflex action4 ,,hot ,,applications ,in applying either moist or dry heat the danger of burning or scalding a patient must be constantly kept in mind4 ,this danger is always great1 but it is especially great when the skin is tender like that of babies1 children1 and old people1 or when the vitality is low as in cases of chronic or exhausting illness4 ,unfortunately accidents in applying heat are not uncommon2 a moment's carelessness may cause serious injury and prolonged suffering4 ,,dry ,,heat4--,hot water bags are used to apply dry heat4 ,they should be filled not more than two-thirds full of hot water1 but the water must not be so hot that there is the slightest possibility of scalding the patient if the bag should leak4 ,boiling water should never be used4 ,before the stopper is screwed on1 expel the air by squeezing the bag or by resting it upon a flat surface until the water reaches the top4 ,after closing the bag make sure that both bag and stopper are in order1 by noting whether leakage occurs when the bag is inverted and pressed moderately4 ,before it is placed near the patient the bag should be dried and entirely covered with a towel or canton flannel bag4 ,strong bottles1 jugs1 and jars1 if they can be securely stoppered1 may be used sometimes instead of hot water bags4 ,the same precautions are necessary4 ,bricks1 flat irons1 or thick flannel bags containing salt or sand may be heated in the oven and used in the same way4 ,salt and sand retain heat for a long time1 but are correspondingly slow to heat2 therefore one bag should be heating in the oven while the other is in use4 ,their effect on the skin must be no less carefully watched than the effects of other hot applications4 ,hot dry flannel may be used without fear of burning a patient1 and it sometimes yields sufficient warmth to relieve pain1 particularly abdominal pain of babies4 ,after it has been heated on a radiator or in an oven1 it should be applied quickly and covered closely with another flannel to prevent escape of heat4 ,dry heat can be applied conveniently by an electric pad4 ,the part to be heated may be wrapped in flannel or placed directly above or below the pad4 ,the pad should be carefully watched to see that the switch is not accidentally turned1 as it is possible for the pad to become hot enough to burn the patient or to set fire to the bed covers4 ,,moist ,,heat4--,to apply moist heat poultices or fomentations 7stupes7 are used4 ,poultices may be made of various heat-retaining substances1 but flaxseed meal is generally used4 ,the poultices when ready should be applied without delay1 therefore all preparations should be made in advance4 ,to prepare a poultice1 first provide a piece of gauze or thin old muslin about two inches wider than you wish the poultice to be when finished1 and about two inches more than twice as long4 ,in a shallow saucepan boil water1 varying in amount according to the size of the poultice desired2 about equal parts of water and meal will be needed4 ,when the water is boiling briskly add the meal gradually1 beating constantly with a spatula or knife4 ,the poultice is done when the mixture coheres and is thick enough to drop from the spatula leaving it clean4 ,quickly spread a layer of the hot flaxseed from a quarter to half an inch thick on one-half of the muslin1 leaving a margin on three sides of about an inch 7,fig4 #be74 ,fold in the margins of the cloth 7,fig4 #bf7 and then bring the other half of the cloth over the flaxseed so that the top of the poultice is covered4 ,tuck the free end of the upper half of the cloth under the turned in edges of the long sides4 ,illustration3 ,,fig4 #be4--,turn the edges of the muslin over the flaxseed by folding first on the line ,,aa'1 and then on the lines ,,bb' and ,,cc'4 ,illustration3 ,,fig4 #bf4--;,fold on the line ,,ee'1 bringing ,,ff' up over the flaxseed and tucking it under at ,d and ,d'4 ,carry the poultice on a hot plate1 or rolled in a newspaper or hot towel4 ,test it carefully with the back of the hand1 apply it to the skin gradually1 cover it with cotton batting1 oiled muslin1 or several thicknesses of flannel1 and keep it in place with a bandage or towel4 ,remove it as soon as it has become cold1 and unless the skin is much reddened apply a fresh poultice4 ,if the skin is much reddened1 anoint it with vaseline or sweet oil1 wrap it warmly1 and apply the next poultice as soon as the appearance of the skin is normal4 ,stupes or hot fomentations are cloths1 preferably of flannel or flannelette1 wrung out of boiling water and applied to the skin4 ,each stupe should be three or four times as large as the area to be covered4 ,two are needed1 so that one may be prepared before removing the other4 ,to prevent escape of heat and moisture the stupe should be covered after it has been applied1 first with a piece of rubber cloth or oiled silk or muslin1 and next with several thicknesses of flannel1 or cotton batting made into a pad4 ,the whole should be kept in place with a bandage or towel used as a binder4 ,the doctor will tell how often the stupes are to be applied1 but if the skin becomes irritated they must be stopped until its appearance is again normal4 ,illustration3 ,,fig4 #bg4--,,wringing ,,stupe4 7,from ,elementary ,nursing ,procedures1 ,california ,state ,board of ,health47 ,great care must be taken in applying fomentations4 ,they do little good unless very hot1 but if applied too hot the patient is likely to be scalded4 ,they must be wrung as dry as possible2 but it is difficult to wring them without scalding the hands unless stupe wringers are used4 ,stupe wringers are heavy pieces of cloth1 like roller towels or pieces of ticking1 long enough to extend over opposite sides of the basin in which the stupe is to be boiled1 and wide enough to hold the stupe easily4 ,the wringer should be placed in the basin with the stupe arranged upon it4 ,boiling water should then be added1 or the water1 stupe1 and wringer may be boiled together in the basin4 ,after the stupe is ready1 the wringer with the stupe upon it should be removed from the water by grasping the dry ends of the wringer4 ,then the ends should be twisted in opposite directions until the stupe inside is as dry as possible4 ,wringing is made easier if the wringer has wide hems into which sticks such as pieces of broom handles are inserted4 ,by twisting the sticks in opposite directions the stupe may be wrung out easily4 ,,cold ,,applications ,,dry ,,cold4--,cold1 like heat1 may be used either dry or moist4 ,bags of rubber or of ,japanese paper filled with small pieces of ice are used to apply dry cold4 ,when weight is to be avoided1 the bag should not be completely filled4 ,after the bag has been filled and the air has been expelled1 it should be stoppered securely and wrapped in a towel or piece of flannel1 since it is possible for an uncovered ice bag to freeze the skin4 ,ice bags are easily punctured1 and care should be taken not to bring pressure upon them especially when filled with sharp pieces of ice4 ,an ice bag not in use should be thoroughly dry inside and out2 it should be put away with enough absorbent cotton inside to keep the surfaces from adhering4 ,bags of ,japanese paper are less costly than rubber1 but less durable4 ,to close them one should roll the top over and then tie it tightly with string4 ,,moist ,,cold4--,cold compresses for the head are often used for patients with fever or headache2 they sometimes quiet a patient who is restless4 ,an old handkerchief or piece of soft linen folded with the raw edges inside may be used as a compress4 ,it should be large enough to cover the forehead4 ,two compresses at least should be provided1 and a large piece of ice in a basin4 ,one compress should be wrung so that it will not drip1 and then applied to the head4 ,the other meanwhile should be placed on the ice to cool4 ,as soon as the first compress becomes warm1 the second should be applied in its place4 ,cold ,compresses for the ,eyes4--,soft material should be selected for eye compresses4 ,each one should be cut only a little larger than the eye and should fit neatly over it4 ,several compresses should be placed on a block of ice while one is applied to the eye1 and every few minutes the compress should be changed4 ,if there is discharge from the eye1 each compress should be used but once2 when used1 they should be collected in a paper and afterward burned4 ,separate compresses should be used if both eyes are being treated4 ,definite directions in regard to changing compresses and the length of time the applications should be continued are generally given by the physician4 ,,counter-,,irritants ,to some extent all hot applications are counter-irritants1 but mustard pastes1 mustard leaves1 and the mustard foot-bath already described are the counter-irritants most commonly used4 ,mustard ,paste4--,to make a mustard paste1 mix dry mustard with flour1 using for adults one part of mustard and six of flour to make a weak paste2 increase the proportion of mustard up to equal parts of mustard and flour1 according to the strength required4 ,use a smaller proportion of mustard for children2 one part of mustard with from #f to #aj parts of flour is generally enough4 ,add to the mustard and flour enough tepid water to make a paste1 which must be absolutely free from lumps4 ,do not use hot water for this purpose1 because it destroys some of the active properties of the mustard4 ,spread the paste on thin muslin1 apply it to the skin1 and remove it as soon as the skin is reddened so that its color resembles that of a strong sun-burn4 ,if the skin is especially sensitive1 mix a little sweet oil or vaseline with the paste4 ,mustard leaves should be dipped in tepid water and may then be applied to the skin directly1 but if specially sensitive1 the skin should be protected by thin muslin or gauze4 ,the leaf should remain until the skin is well reddened2 a few minutes are generally sufficient4 ,care must be taken not to leave either a mustard leaf or a paste in place long enough to blister the skin4 ,after the application has been removed2 the part should be protected by a soft cloth until redness disappears4 ,vaseline or sweet oil should be applied to the skin if it is greatly irritated4 ,other counter-irritants in common use are iodine1 turpentine1 ammonia1 kerosene1 camphorated oil1 capsicum vaseline1 and various liniments4 ,tincture of iodine may be diluted with alcohol for especially sensitive skins2 it sometimes causes blisters1 and should not be applied more than once a day at most4 ,ammonia and turpentine cause blisters2 they should not be used as counter-irritants except by a doctor's order1 and then only after exact directions have been obtained4 ,turpentine and kerosene are inflammable and hence dangerous to use4 ,it should be remembered that the action of all counter-irritants is physiologically the same1 so that no advantage is obtained from the use of dangerous substances like kerosene and turpentine4 ,,exercises #a4 ,what are the causes and symptoms of inflammation8 #b4 ,describe the process of inflammation4 #c4 ,what is the effect of heat on an inflamed area8 of cold8 #d4 ,what are the dangers from hot applications1 and how may they be guarded against8 #e4 ,how should you fill a hot water bag8 ,how should you cover it8 #f4 ,describe the method of preparing and applying a flaxseed poultice4 #g4 ,tell how to prepare and apply fomentations4 #h4 ,how should you apply cold compresses to the head8 to the eyes8 #i4 ,how should you make a mustard paste for a baby six months old8 for a grown person only slightly ill8 for a feeble old person with a sensitive skin8 ,,for ,,further ,,reading ,essentials of ,medicine--,emerson1 ,chapter ,i4 ,the ,human ,mechanism--,hough and ,sedgwick1 ,chapter ,,ix4 ,,chapter ,,xii ,,care ,,of ,,patients ,,with ,,communicable ,,diseases ,the first chapter of this book described the ways in which communicable diseases are carried from person to person1 and also some principles underlying methods of prevention4 ,this chapter aims to show how these principles apply in the actual care of patients whose diseases are transmissible4 ,in order to apply them intelligently1 it is necessary to keep in mind certain facts in regard to the transmission of infections4 ,a brief summary of these facts follows4 ,disease germs are present in the bodies of persons suffering from communicable disease1 but they may also exist in the bodies of persons in good health2 if present in the body1 they may leave it in any bodily discharge4 ,while every kind of germ does not leave the body by all the different routes1 it is nevertheless true that most germs expelled from the body are carried in discharges from the nose1 throat1 bladder or bowels4 ,germ-laden discharges of an infected person may be distributed to other persons by water1 milk and other foods1 by certain insects1 by unclean hands1 by common drinking cups1 towels1 handkerchiefs1 and similar articles1 and directly by nose and throat spray4 ,after they have been thus conveyed to other persons1 the germs make their entrance into the body of their new victims through the digestive tract1 through the nose1 throat1 and other mucous membranes1 or through breaks in the skin4 ,prevention of communicable diseases1 therefore1 depends upon the measure of success attained in blocking the transit of germs from person to person2 but methods of prevention1 though easy to understand1 are unfortunately sometimes difficult to carry out4 ,in order to carry them out effectively one must devote to the problem great accuracy1 unremitting care1 considerable intelligence1 and a highly developed conscience4 ,care of a patient suffering from transmissible disease is adequate only when it accomplishes two definite results4 ,one result1 which concerns the patient primarily1 is to bring about his recovery as rapidly and as surely as possible2 the other result1 which concerns the community rather than the individual1 is to make it impossible for the patient to infect others with his disease4 ,in every case of communicable disease1 from a slight cold in the head up to serious cases of pneumonia or typhoid fever1 both the patient and the community must be constantly safe-guarded4 ,,incubation ,,period4--,the interval between the moment when pathogenic germs enter the body1 and the time when symptoms first appear and the patient begins to feel ill1 is called the incubation period4 ,incubation periods vary according to the disease from a few hours to two or three weeks4 ,the length of the period also varies somewhat in different cases of the same disease4 ,,care ,,of ,,patients ,,with ,,colds ,,or ,,other ,,slight ,,infections4--,the usual symptoms of infectious diseases include fever1 chill1 sore throat1 nasal discharge1 cough1 headache1 vomiting and other digestive disturbances1 and a general feeling of being sick all over4 ,when one or more of these symptoms appear1 unless they are very slight1 a doctor should be sent for4 ,the patient1 whether child or grown person1 should go to bed in a room alone and should stay in bed at least as long as the fever and symptoms of cold in the head continue1 in order to protect others as well as himself4 ,persons in active life1 it is true1 are not always able to go to bed during colds2 but there is no doubt that ultimately they would save time by doing so4 ,it is especially necessary for children to remain in bed when suffering from colds1 not only to insure their own well-being but also to protect others1 since children are notably careless in regard to coughing1 sneezing1 and borrowing handkerchiefs4 ,the patient needs mental rest as well as physical1 and should not be allowed to work in bed4 ,the patient's nose and throat discharges should be received only in material that can be burned1 like old linen or muslin1 gauze1 or paper napkins4 ,as soon as they are soiled these handkerchief substitutes should be placed in strong paper bags and afterward burned4 ,soiled handkerchiefs lurking under pillows or in other parts of the bed may infect other people or re-infect the patient4 ,handkerchiefs that may not be burned should be placed as soon as soiled in a covered receptacle filled with cold water containing a little washing soda2 when several have been collected they should be boiled in the same covered receptacle for #bj minutes4 ,after boiling they may go to the regular laundry4 ,the patient's diet at first should be liquid or semi-solid4 ,large amounts of nourishment are not necessary during the first day or two1 especially if the illness is likely to be short1 but water should be taken as freely as possible4 ,cold drinks are generally acceptable during the feverish stage1 but lemonade and other acids should be used with caution1 since they sometimes irritate a sore throat4 ,when the active symptoms have subsided the patient will need more food than usual1 and a liberal1 nourishing diet for a few days will do much to prevent the weakness and depressed vitality that often follow colds1 tonsilitis1 and other comparatively slight infections4 ,the bowels should be carefully regulated1 and a mild cathartic is often beneficial at the outset4 ,even during slight illness a patient should receive the daily care already described1 and should be made as comfortable as possible4 ,as in any illness1 sponging and alcohol rubs are refreshing4 ,an ice bag or cold compress may relieve headache1 and hot applications or a cold compress on the throat are often soothing4 ,the throat may be gargled with a solution of one teaspoonful of common salt dissolved in a pint of boiled water4 ,if the patient perspires profusely he should be rubbed with a towel until dry1 and provided with fresh warm1 night clothes4 ,an alcohol rub may well follow4 ,it is most unwise for a patient who is perspiring freely to get up in a cold room and attend to himself4 ,common colds are far more serious than they are usually supposed to be4 ,more people suffer from common colds than from any other single ailment4444 ,could the sum total of suffering1 inconvenience1 sequel1 and economic loss resulting from common colds be obtained1 it would at once promote these infections from the trivial into the rank of the serious diseases4444 ,colds are contracted from other persons having colds1 just as diphtheria is contracted from diphtheria4 ,arctic explorers exposed to all the conditions ordinarily supposed to produce colds do not suffer from these ailments until they return to civilization and become infected by contact with their fellowmen4444 ,while common colds are never fatal1 the complications and sequel are serious4 ,these are rheumatic fever1 pneumonia1 sinusitis1 nephritis1 and a depressed vitality which favors other infections and hastens the progress of organic diseases4 ,common colds are perhaps most contagious during the early stages4 ,if persons isolate themselves by remaining in bed during the first three days of a cold1 they would not only benefit themselves1 but would largely prevent the spread of the infection4 ,the contagiousness and severity of colds differ in different epidemics and in different seasons of the year1 depending upon the particular micro-organism involved and other factors not well understood4 ,,prevention4--,the prevention of colds consists1 first in avoiding the infection1 and1 secondly1 in guarding against the predisposing causes4 ,contact should be avoided with persons who have colds1 especially in street cars1 offices1 and other poorly ventilated spaces where the risk of persons coughing or sneezing directly in one's face is imminent4 ,contact with the infection may further be guarded against by a careful self-education in sanitary habits and cleanliness1 based upon the modern conception of contact infection4 ,colds1 like other diseases conveyed in the secretions from the nose and mouth1 are often conveyed by direct and indirect contact through lack of hygienic cleanliness and a disregard of sanitary habits4 ,kissing1 the common drinking cup1 the roller towel1 pipes1 toys1 pencils1 fingers1 food1 and other objects contaminated with the fresh secretions will transmit the disease4--7,preventive ,medicine and ,hygiene1 ,rosenau47 ,,care ,,during ,,more ,,serious ,,infections4--,when a patient is suffering from serious transmissible disease1 he needs the most skillful care available1 and for the sake of others he must be strictly isolated or quarantined4 ,by isolating or quarantining a patient is meant making such arrangements that germs expelled by the patient are necessarily destroyed before they can enter the body of another person4 ,isolation1 therefore1 includes disinfection1 and while methods vary according to the nature of the particular disease1 yet the principles given below are applicable in most cases4 ,the first essential is that the patient should have a room to himself4 ,no one except those caring for him should enter the sick-room for any purpose whatever2 visitors should be rigidly excluded4 ,at the outset all unnecessary articles should be removed from the sick-room1 and it should be possible to boil1 burn1 scrub1 or otherwise thoroughly clean everything allowed to remain4 ,the windows should be screened in summer1 and flies must be excluded4 ,fresh air is especially needed by patients with communicable diseases1 and ventilation of the room must be adequate both day and night4 ,foul odors plainly indicate that the patient or something in the room is not clean4 ,the remedy is obvious and deodorants are quite unnecessary if the patient and the room are properly cared for4 ,it is highly desirable to reserve a bath room for the exclusive use of the patient and his attendant and also to reserve a room adjoining the patient's room for the exclusive use of the attendant4 ,when it is impossible1 as it often is1 to give up so much space1 each family must make the best arrangement it can to separate the patient and his attendant from the rest of the family4 ,the attendant must remember that her ten fingers are the ten most active agents in distributing the communicable diseases4 ,after handling the patient or anything that the patient has touched1 and whenever she leaves the patient's room1 she must scrub her hands thoroughly with warm water1 soap1 and a nail brush4 ,she should not soil her hands unnecessarily1 even though she intends to scrub them later4 ,she must remember for her own protection to keep her hands away from her mouth and face1 and to cleanse them with special care just before eating4 ,if disinfection is needed in addition to the scrubbing1 she must use conscientiously whatever solution the doctor orders4 ,at the same time that she is caring for a patient with a communicable disease1 the attendant ought not to care for children or other members of the family1 she ought not to prepare food1 and she ought not to handle dishes or utensils used by other persons4 ,every day1 however1 many women are doing just these things1 and it is true that in many instances no bad results are observed4 ,yet if any arrangement to insure safety can possibly be made1 it is inexcusable to run the risk of spreading diseases which kill thousands of persons every year and injure many more for life4 ,when home conditions render adequate care and strict isolation of the patient impossible1 hospital care should be seriously considered4 ,no personal or sentimental objections should be allowed to influence the decision1 if removing the patient to a hospital is necessary to safeguard his welfare or the welfare of the family4 ,hospital care should be considered especially for patients with typhoid fever1 because untrained persons cannot safely care for patients so seriously ill4 ,since a patient with typhoid needs skilled care1 and since he greatly endangers other persons1 most authorities consider hospital care essential unless the patient can have the continuous services of a trained nurse and almost ideal home conditions4 ,many cases of typhoid1 it is true1 are successfully nursed at home in extremely adverse conditions by visiting nurses2 yet in few kinds of sickness is continuous care by a graduate nurse more necessary to protect the community as well as to safeguard the patient himself4 ,members of a family in which there is typhoid should be immunized if the doctor advises it4 ,this process1 which is performed by the doctor1 in the majority of cases renders a person immune to typhoid fever for three or four years4 ,the question of home or institutional care for persons with tuberculosis must also be carefully considered4 ,in some cases tuberculosis may be cared for at home with comparative safety1 and in some other cases the risk is not very great if the patient is intelligent1 careful1 and well supervised4 ,but everyone should face the fact that all cases of tuberculosis of the lungs involve some risk to others in the family1 and most cases involve great risk4 ,the danger to children is greater than to adults4 ,most tuberculosis infections1 it is now believed1 are acquired in childhood4 ,the bad results of an infection acquired in childhood may not show themselves for years1 since the germs may remain inactive until the person's resistance is lowered by some unfavorable condition4 ,,the ,,children',s ,,diseases4--,the so-called children's diseases are probably the most familiar and the least regarded of all those belonging to the communicable group4 ,most persons1 it is true1 realize that scarlet fever is serious2 everyone should also realize that measles and whooping-cough are serious4 ,for example1 in the ,state of ,new ,york during the year #aiaf1 more children died from each of these diseases than from scarlet fever3 in that year #gde1 or four times the number that died of scarlet fever1 lost their lives from whooping-cough1 while #iac died of measles4 ,if diseases that kill hundreds of children every year are not serious1 one is at a loss to know what a serious disease is4 ,some parents even expose children unnecessarily to these infections on the fatalistic theory that they must have the diseases sometime1 and therefore the sooner the better4 ,nothing could be more mistaken2 the diseases are not inevitable1 and there is no advantage whatever in having them if escape is possible4 ,moreover1 serious as the children's diseases are in themselves1 their after-effects may be even more serious4 ,at this very moment hundreds of people are going through life handicapped by weakened hearts or kidneys1 by defective sight or hearing1 merely because their parents considered the children's diseases necessary4 ,the common belief that children should have these diseases as early as possible is also erroneous1 since statistics show that the younger the child the more likely is the disease to prove fatal4 ,every mother should realize that the children's diseases are most infectious in the early stages4 ,early symptoms include fever1 sore throat1 and nasal discharge1 and the trouble at first often resembles a severe cold4 ,during this stage the diseases are most easily communicated4 ,measles in particular is generally not recognized until its most infectious stage has passed4 ,the moral to be drawn is that sore throats1 coughs1 and colds should never be regarded lightly1 and that their spread should be prevented by all possible means4 ,the accompanying table taken from the regulations of the ,new ,york ,state ,department of ,health1 gives symptoms of communicable diseases among children1 and rules for isolation and exclusion from school4 ,,new ,,york ,,state ,,department ,,of ,,health ,,communicable ,,diseases ,,among ,,children ,,rules ,,for ,,isolation ,,and ,,exclusion ,,from ,,school ,,herman ,m4 ,,biggs1 ,m4,d4 ,commissioner ,issued by the ,division of ,public ,health ,education ,,disease ,,principal ,,signs ,,method ,,of ,,and ,,symptoms ,,infection ---------------------------------------- ---------------------------- ,,chickenpox ,rarely begins with fever4 ,contact with discharges ,rash appears on second day from nose and throat of as small pimples1 which in a patient4 about a day become filled with clear fluid4 ,this fluid becomes yellow colored1 a crust forms and the scab falls off in about #ad days4 ,successive crops of papules appear until tenth day4 ---------------------------------------- ---------------------------- ,,diphtheria ,onset may be rapid or ,contact with discharges gradual4 ,the back of the from nose and throat1 throat1 tonsils1 or palate occasionally by may show patches4 ,the most drinking infected milk4 pronounced symptom is sore throat4 ,there may be hardly any symptoms at all4 ---------------------------------------- ---------------------------- ,,measles ,begins like cold in the ,contact with discharges head1 with running nose1 from nose and throat sneezing1 inflamed and of a patient4 watery eyes and fever4 ,mulberry-tinted spots appear about the third day2 rash first seen behind the ears1 on forehead and face4 ,the rash varies with heat2 may almost disappear if the air is cold1 and come out again1 with warmth4 ---------------------------------------- ---------------------------- ,,measles ,illness usually slight4 ,same as above4 7,,liberty7 ,onset sudden4 ,lymph nodes in back of neck enlarged4 ,rash often first thing noticed2 no cold in head4 ,usually have fever1 sore throat1 and the eyes may be inflamed4 ,rash sometimes resembles measles and scarlet fever1 variable4 ---------------------------------------- ---------------------------- ,,mumps ,onset may be sudden1 ,same as above4 beginning with sickness and fever1 and pain about the angle of the jaw4 ,the parotid glands become swollen and tender4 ,opening the mouth is accompanied by pain4 ---------------------------------------- ---------------------------- ,,poliomyelitis ,onset sudden1 fever1 ,contact with discharge excitable1 pain on bending from nose1 throat or neck forward1 pain on being bowels of a patient handled1 headache1 vomiting4 or carrier4 ,sometimes sudden development of weakness of one or more muscle groups4 ---------------------------------------- ---------------------------- ,,scarlet ,the onset is usually sudden1 ,discharges from nose ,,fever with headache1 fever1 sore and mouth1 suppurating throat1 and often vomiting4 glands or ears of a ,usually within twenty-four patient4 hours the rash appears as ,milk may convey fine1 evenly diffused1 and infection4 bright red dots under skin4 ,the rash is seen first on the neck and upper part of chest1 and lasts three to ten days1 when it fades and the skin peels in scales1 flakes1 or even large pieces4 ---------------------------------------- ---------------------------- ,,smallpox ,onset sudden usually with ,all discharges of a fever and severe backache4 patient and particles ,about third day upon of skin or scabs4 subsidence of constitutional symptoms red shot-like pimples1 felt below the skin1 and seen first about the face and wrists most on exposed surfaces1 develop4 ,they form little blisters and after two days more become filled with yellowish matter4 ,scabs form which begin to fall off about the fourteenth day4 ---------------------------------------- ---------------------------- ,,sore ,,throat1 ,begins with sore throat and ,discharges from nose ,,acute1 weakness4 ,throat diffusely and mouth of a ,,septic reddened and may show patient4 patches like diphtheria4 ---------------------------------------- ---------------------------- ,,whooping ,begins with cough which is ,discharges from nose ,,cough worse at night4 ,symptoms may and mouth of a at first be very mild4 patient4 ,characteristic whooping cough develops in about #b weeks1 and the spasm of coughing sometimes ends with vomiting4 ,,exclusion ,,from ,,school ---------------------------------------- ------ ,,other ,,children ,,other ,,school ,,of ,,same ,,children ,,disease ,,household ,,especially ,,exposed ------------------------------------- ,patient ,non- ,non- immunes,immunes#c immunes ,immunes#c ---------------------------------------- ----------------- ,,chickenpox ,yes ,yes ,no ,yes ,no ---------------------------------------- ----------------- ,,diphtheria ,yes ,yes ,yes ,yes ,yes ---------------------------------------- ----------------- ,,measles ,yes ,yes ,no ,yes ,no ---------------------------------------- ----------------- ,,measles ,yes ,yes ,no ,yes ,no 7,,liberty7 ---------------------------------------- ----------------- ,,mumps ,yes ,yes ,no ,yes ,no ---------------------------------------- ----------------- ,,poliomyelitis ,yes ,yes ,yes ,yes ,yes ---------------------------------------- ----------------- ,,scarlet ,yes ,yes ,yes ,yes ,yes ,,fever ---------------------------------------- ----------------- ,,smallpox ,yes ,yes ,yes ,yes ,no ---------------------------------------- ----------------- ,,sore ,,throat1 ,yes ,no ,no ,no ,no ,,acute1 ,,septic ---------------------------------------- ----------------- ,,whooping ,yes ,yes ,no ,yes ,no ,,cough ,,duration ,,of ,,exclusion ,,from ,,date ,,of ,,onset ---------------------------------------- ----------------------- ,,patient ,,patient ,,remains ,,goes ,,to ,,isolated ,,at ,,hospital ,,home ,,disease ------------------------------------ ,,patient ,other ,other ,children ,children children children who leave exposed of who household at the same remain at as soon as school household home disease is discovered ---------------------------------------- ---------------------------------- ,,chickenpox ,until all ,exclude if non-immune until ,exclude scabs are #bast day after child last from shed and saw patient4 school if disinfection non-immune of person2 during at least #aath to #bb;d #ab days4 days after child last saw patient4 ---------------------------------------- ------------------------------------ ,,diphtheria ,until ,until two cultures at least #bd patient is hours apart are reported recovered negative4 ,those showing and has two diphtheria bacilli should not cultures necessarily be immunized from throat unless symptoms appear4 and nose which contain no diphtheria bacilli2 cultures not to be taken until #i days from date of onset4 ,disinfection of person4 ---------------------------------------- ------------------------------------ ,,measles ,until ,exclude non-immunes until ,if recovery and #aeth day after child last non-immune disinfection saw patient4 exclude of person2 from school at least #g during #hth days from to #aeth onset4 day after child last saw patient4 ---------------------------------------- ------------------------------------ ,,measles ,until ,exclude if non-immune until ,exclude from 7,,liberty7 recovery and #bb;d day after child last school if disinfection saw patient4 non-immune of person2 during #aath at least #h to #bb;d days days4 after child last saw patient4 ---------------------------------------- ------------------------------------ ,,mumps ,two weeks ,exclude #aeth to #bb;d day after ,exclude after onset child last saw patient4 from #aeth and one week to #bb;d day after after child disappearance last saw of swelling patient4 and after disinfection of person4 ---------------------------------------- ---------------------------------- ,,polio- ,until #ad days ,until #ad #ad days ,,myelitis patient is from time days from time recovered4 child after child ,disinfection last saw quarantine last of person at patient4 raised4 saw least #ba patient4 days4 ---------------------------------------- ---------------------------------- ,,scarlet ,at least #cj ,seven days ,until ,seven ,,fever days and until from time seven days days from discharges child after time have ceased last saw quarantine child and patient4 raised4 last saw disinfection patient4 of person4 ---------------------------------------- ---------------------------------- ,,smallpox ,recovery and ,exclude if ,exclude if ,exclude if ,exclude #bj disinfection non-immune non-immune non-immune days unless of person until #bast until #bj until #bast they have at least #ad day after days after day after been days4 child last quarantine child last successfully saw patient1has been saw patient1vaccinated or #g days raised or or #g days within #a after #g days afterafter year in successful successful successful which vaccination vaccination vaccination case they and and and may return disinfectiondisinfectiondisinfectionat once4 of person4 of person4 of person4 ---------------------------------------- ---------------------------------- ,,sore ,,throat1,until ,,acute1 recovery4 ,,septic ---------------------------------------- ------------------------------------ ,,whooping ,eight weeks ,fourteen days provided no cough ,,cough or until #a develops4 week after last characteristic cough and disinfection of person4 ,,disease ,remarks ---------------------------------------- ----------------------- ,,chickenpox ,a mild disease and seldom any after effects4 ---------------------------------------- ----------------------- ,,diphtheria ,very dangerous1 both during attack and from after effects4 ,when diphtheria occurs in a school all children suffering from sore throat should be excluded and the health officer notified4 ,the medical school inspector or health officer should take cultures from all inflamed throats and noses4 ,there is great variation of type1 and mild cases are often not recognized1 but are as infectious as severe cases4 ,there is frequently no immunity from further attacks4 ---------------------------------------- ----------------------- ,,measles ,after effects often severe4 ,period of greatest risk of infection three days1 before and after the rash appears4 ,great variation in type of disease4 ,dangerous in children under #b years of age4 ,during an outbreak all children having a temperature over #ii;,f4 should be sent home and the health officer notified4 ---------------------------------------- ----------------------- ,,measles ,after effects slight4 ,regulations strict1 7,,liberty7 because frequently confused with scarlet fever4 ---------------------------------------- ----------------------- ,,mumps ,seldom leaves after effects4 ,very infectious4 ,inflammation of genital organs of male or female may occur4 ---------------------------------------- ----------------------- ,,poliomyelitis ,disease is most communicable in the early stages4 ,after effect is paralysis of certain muscle groups1 transitory or permanent4 ,death is due usually to paralysis of respiratory muscles4 ---------------------------------------- ----------------------- ,,scarlet ,dangerous both during attack and from after ,,fever effects4 ,great variation in type of disease4 ,slight attacks are as infectious as severe ones4 ,many mild cases not diagnosed and many concealed4 ,a second attack is rare4 ,when scarlet fever occurs in a school1 all cases of sore throat should be sent home and health officer notified4 ,most fatal in children under ten years4 ---------------------------------------- ----------------------- ,,smallpox ,peculiarly infectious4 ,when smallpox occurs in connection with a school or with any of the children's homes all persons exposed must be vaccinated or quarantined for a period of #bj days4 ,cases of modified smallpox in vaccinated persons1 may be1 and often are1 so slight as to escape detection4 ,fact of existence of disease may be concealed4 ,mild or modified smallpox is as infectious as severe type4 ---------------------------------------- ----------------------- ,,sore ,,throat1 ,often leads to serious results1 affections of ,,acute1 heart1 kidneys1 etc4 ,very apt to occur in ,,septic epidemics due to milk contaminated by a patient suffering from the disease4 ---------------------------------------- ----------------------- ,,whooping ,after effects often very severe and disease ,,cough causes great debility4 ,relapses are apt to occur4 ,second attack rare4 ,specially infectious for first week or two4 ,if a child vomits after a paroxysm of coughing1 it is probably suffering from whooping cough4 ,great variation in type of disease4 ,often fatal in young children4 #c ,immunes are those who have had the diseases or in smallpox1 who have been successfully vaccinated within a year4 ,,disinfection3 ,the cleansing and disinfection of the person includes washing the entire body and the hair with soap and water2 thorough brushing of the teeth2 rinsing the mouth2 gargling the throat1 and douching and spraying the nose with an antiseptic solution2 and finally1 a complete change of clothing 7or a change of underwear and a thorough shaking and brushing of the outer garments out of doors before these are put on again74 7,facing p4 #bdg7 ,it may be added that the ways by which poliomyelitis1 or infantile paralysis1 is spread are not definitely known at the time of writing4 ,we are justified1 however1 in believing that investigation now in progress will make exact information available in the near future4 ,the weight of present opinion inclines to the view that poliomyelitis is exclusively a human disease1 and is spread by personal contact1 whatever other causes may be found to contribute to its spread4 ,in personal contact we mean to include all the usual opportunities1 direct or indirect1 immediate or intermediate1 for the transference of body discharges from person to person1 having in mind as a possibility that the infection may occur through contaminated food4 ,the incubation period has not been definitely established in human beings4 ,the information at hand indicates that it is less than two weeks1 and probably in the great majority of cases between #c and #h days4--7,report of ,special ,committee on ,infantile ,paralysis1 ,american ,journal of ,public ,health1 ,november #aiaf47 ,,disinfection ,specific directions for disinfecting in every kind of communicable disease would be too extended to be given here4 ,in each case the attendant should learn from the doctor just how that particular disease is communicated1 just what discharges1 utensils1 linen1 etc41 need to be disinfected1 and just what disinfectants he prefers to have used4 ,the following general methods are now in use1 but it must be remembered that from time to time new methods are devised and new disinfectants are discovered4 ,,care ,,of ,,nose ,,and ,,throat ,,discharges4--,the care of handkerchiefs has already been described on page #bci4 ,cloths or cotton used to wipe the eyes or to receive any other bodily discharge including vomitus1 should be collected in the same way and burned4 ,everyone should be taught in early childhood to cover the nose and mouth with a handkerchief during coughing and sneezing2 if the patient has not already learned to do so he must be taught now4 ,if the amount of expectoration is great1 waterproof receptacles should be provided1 which should be burned with their contents4 ,,care ,,of ,,discharges ,,from ,,the ,,bowels ,,and ,,bladder4--,at the present time the following preparations are commonly used to disinfect stools and urine3 #e solution of carbolic acid2 chloride of lime solution1 made freshly whenever needed by mixing thoroughly pound of chloride of lime with one gallon of water2 and unslaked lime to which is added hot water4 ,the amount of carbolic solution used should be about equal in bulk to the amount of material to be disinfected2 the chloride of lime solution should be at least twice1 and the unslaked lime at least one-eighth the bulk4 ,fecal masses should be broken up so that the disinfectant may reach every part2 they may be stirred with tightly twisted toilet paper1 which should be left in the bedpan and disinfected with the stools4 ,if these substances are used1 disinfection is considered complete at the end of an hour1 and the contents of the bedpan may then be emptied into the toilet with safety4 ,it may be necessary to provide two bedpans so that one may be available for use while the contents of the other is being disinfected4 ,bedpans and urinals should be boiled daily and kept thoroughly clean at all times4 ,in places having no sewerage system1 disinfected discharges may be emptied into a trench situated at a distance from the well1 and then covered with earth4 ,as an extra precaution1 the disinfected discharges may be mixed with sawdust or kerosene and burned in the trench4 ,directions for installing a sanitary privy may be found in ,bulletin #fh of the ,united ,states ,public ,health ,service4 ,,bath ,,water and water that has been used for cleansing the teeth and mouth may be disinfected in the same way as urine1 or it may be emptied into a suitable receptacle and boiled ten minutes4 ,,care ,,of ,,the ,,hands4--,disinfectants for the hands should be used in addition to scrubbing with soap and water1 not as a substitute4 ,the hands may be disinfected after scrubbing by soaking them for three minutes in one of the following solutions3 alcohol #gj1 carbolic acid solution #b1 or a solution made by adding one teaspoonful of lysol or of creolin to a pint of water4 ,these disinfectants are poisons if taken internally2 the bottles must be carefully labeled and kept in a safe place4 ,it is a good plan to wear rubber gloves when handling infective material2 the gloves should afterward be boiled for ten minutes4 ,,care ,,of ,,utensils4--,a sufficient number of dishes1 spoons1 tumblers1 basins1 etc4 must be reserved for the patient's exclusive use2 these utensils must be washed separately and dried with towels not used for other dishes4 ,mistakes frequently occur by which other persons use the patient's dishes1 and in consequence his dishes should not be kept in the cupboard with other dishes2 if no other safe place can be found1 they had better stay in the patient's room covered with a clean cloth or napkin4 ,the dishes should be scalded daily and at the termination of the illness they must be boiled briskly for ten minutes before they are returned to general use4 ,food left on the patient's tray should be burned2 it should not be eaten by any one else1 nor placed in the pantry or refrigerator with other food4 ,,care ,,of ,,linen4--,a satisfactory way to disinfect towels1 night gowns1 bed linen1 etc4 is to place the articles immediately in a wash boiler filled with cold water to which a little washing soda has been added1 and then to boil them in the same water for twenty minutes2 they can afterward go safely into the regular laundry4 ,the boiling may be done once a day2 articles soiled in the meantime may be left to soak in the cold water and soda4 ,,disinfection ,,of ,,the ,,person4--,the cleansing and disinfection of the person includes washing the entire body and the hair with soap and water2 thorough brushing of the teeth2 rinsing the mouth2 gargling the throat1 and douching and spraying the nose with an antiseptic solution2 and finally1 a complete change of clothing 7or a change of underwear7 and a thorough shaking and brushing of the outer garments out-of-doors before these are put on again4--7,new ,york ,state ,department of ,health47 ,,termination ,,of ,,quarantine4--,after the patient has recovered1 he and the attendant should1 if the doctor thinks it necessary1 disinfect themselves as directed above before they mingle again with other people4 ,the exact time when it is safe for a person to come out of quarantine and resume ordinary life varies in different diseases4 ,moreover1 opinion differs in regard to quarantine periods for the same diseases1 so that the regulations of ,boards of ,health in different cities show wide variations4 ,it is of course impossible to say at just what moment every patient1 or even the majority of patients1 will stop expelling germs4 ,quarantine periods are intended to protect the community as completely as possible without causing unnecessary hardship to individuals4 ,in any given case1 the local regulations should be strictly observed but release from quarantine is not a guarantee that the patient is not still discharging germs1 and extreme care should still be taken to prevent the spread of saliva and other discharges4 ,,terminal ,,disinfection4--,a room that has been occupied by a patient with a communicable disease should be thoroughly cleaned at the termination of the illness4 ,dishes1 utensils1 bed linen1 etc4 should be cared for in the ways already described4 ,the floor1 bedstead1 and other furniture should be washed with hot water1 soap1 and washing soda4 ,the walls1 windows1 etc41 should be wiped with a cloth wrung out of hot water1 soap suds1 and soda4 ,the mattress1 unless badly soiled with discharges1 should be scrubbed with the same solution and a stiff brush1 and left out-of-doors in the sunshine for a day or two1 or until dry4 ,if badly soiled1 it is best to destroy the mattress unless the ,board of ,health has facilities for steam sterilization4 ,ordinary washing is all that is generally required for blankets1 but if badly soiled they should be sterilized by steam or burned4 ,the room should then be thoroughly sunned and aired for a day or two1 with the windows wide open both day and night4 ,sunning and airing are among the most important measures in disinfecting a room1 and should not be slighted4 ,if there has been gross pollution1 as when a careless consumptive persists in spitting on the floor and walls1 it may be necessary to remove the old paint and paper and have the room done over4 ,the room may safely be occupied after all these measures have been taken4 ,,fumigation4--,many ,boards of ,health have abandoned fumigation after communicable diseases1 except after those which like typhus and yellow fever1 are carried by vermin or insects4 ,dry formaldehyde gas1 which was formerly used for fumigation1 has a violent effect on mucous membranes1 but its power to kill bacteria1 even on surfaces1 appears to be weak1 while its penetrating power is not sufficient to disinfect bedding1 carpets1 upholstered furniture1 and other fabrics4 ,since fumigation is costly1 troublesome1 and ineffectual there seems to be no good reason for using it4 ,moreover1 its use gives a false sense of security1 so that really effective measures like sunning1 airing1 and scrubbing are likely to be neglected4 ,theory and practice of disinfection1 it is clear1 have radically changed in recent years4 ,modern knowledge requires concurrent disinfection1 or the destruction of germs from the moment when symptoms are first noticed2 all the time1 day and night1 this disinfection must go on with unremitting care4 ,today wet sheets are not hung in doorways nor are chemicals left about in open dishes to disinfect quite harmless air1 but scrupulous cleanliness at all stages of disease is recognized as one of the most important measures1 if not the most important measure1 in disinfection4 ,,exercises #a4 ,summarize the ways in which infectious diseases are spread4 #b4 ,what is meant by the incubation period8 ,state the length of the incubation period in measles2 ,liberty measles2 whooping-cough2 scarlet fever2 chicken-pox2 diphtheria2 mumps2 typhoid fever4 #c4 ,name some of the early symptoms common to most infectious diseases4 ,if such symptoms appear1 what should be done while waiting for the doctor to come8 #d4 ,discuss the importance1 prevention1 and treatment of common colds4 #e4 ,what measures should be taken to isolate a patient who is suffering from a communicable disease8 #f4 ,what special care should the attendant of a patient with a communicable disease give to her own clothing and person8 #g4 ,why are the children's diseases more serious in reality than they are commonly supposed to be8 #h4 ,describe the symptoms of each of the following3 ,measles1 scarlet fever1 chicken-pox1 mumps1 whooping-cough1 and diphtheria4 #i4 ,how should bowel and bladder discharges be disinfected8 #aj4 ,how should dishes and other utensils be disinfected8 #aa4 ,how should linen be disinfected8 #ab4 ,describe measures necessary for concurrent disinfection4 #ac4 ,describe measures necessary for terminal disinfection4 ,,for ,,further ,,reading ,preventive ,medicine and ,hygiene--,rosenau4 ,the ,new ,public ,health--,hill1 ,chapters ,,vii-,,xvii4 ,essentials of ,medicine--,emerson1 ,chapters ,,xii-,,xv4 ,health and ,disease--,roger ,i4 ,lee1 ,chapter ,x-,,xiv4 ,disease and ,its ,causes--,councilman1 ,chapters ,v-,,ix4 ,publications of the ,new ,york ,state ,department of ,health1 ,albany1 entitled3 ,the ,teacher and ,communicable ,disease2 ,a ,method for the ,control of ,communicable ,diseases in ,schools2 ,regulations and ,instructions for ,cleansing and ,disinfection2 ,the ,conduct of an ,isolation ,period for ,communicable ,disease in a ,home2 ,tuberculosis2 ,typhoid ,fever2 ,scarlet ,fever2 ,measles2 ,whooping-cough2 ,diphtheria2 ,poliomyelitis1 ,acute ,anterior 7,infantile ,paralysis72 ,smallpox2 ,septic ,sore ,throat2 ,venereal ,diseases4 7,any of the above pamphlets will be sent upon receipt of a three cent stamp47 ,,chapter ,,xiii ,,common ,,ailments ,,and ,,emergencies ,this chapter describes a few home treatments for the relief of slight ailments and injuries1 together with some measures that may be employed in emergencies4 ,for more extended instructions in these subjects the student should consult the ,red ,cross ,text-book on ,first ,aid4 ,,conditions ,,in ,,which ,,the ,,nervous ,,system ,,is ,,involved ,,headache4--,headache is not a disease in itself1 but a symptom common to many different disorders4 ,among the abnormal conditions often causing headaches are fatigue1 eyestrain1 indigestion1 constipation1 neuralgia1 rheumatism1 anmia1 acute infections1 and other disorders4 ,treatment should consist in finding the cause and removing it if possible2 clearly no one remedy can cure so many different causes4 ,a physician should be consulted if headaches are of frequent occurrence1 but in many cases rest and attention to other hygienic requirements are all that is needed4 ,during an attack of headache a hot foot bath may give relief1 or a mustard paste or cold applications on the back of the neck1 or an ice bag or cold compress on the forehead4 ,,sleeplessness1 like headache1 has many possible causes1 and effective treatment consists in finding and removing them4 ,pain or discomfort of any kind1 fatigue1 overwork1 and worry are common causes4 ,sleeplessness easily becomes a habit that may persist after its cause has been removed2 hence a person who has formed the habit of sleeplessness should patiently strive to break the old habit and to substitute a better4 ,a careful hygienic rgime is essential for the patient1 exercise in the open air1 and cultivation of a hopeful and tranquil spirit4 ,the diet should be liberal1 but light and unstimulating2 tea and coffee should be omitted1 certainly during the latter part of the day4 ,the patient should spend rather a dull evening1 avoiding excitement and mental exertion that is difficult1 even though pleasurable4 ,he should retire early4 ,a hot tub or foot bath1 and a hot drink at bed time may help to produce sleep4 ,the bedroom should be dark1 cool1 and well ventilated1 the bed comfortable and the covers light but warm4 ,the patient should be told that rest is the most important thing for him1 and that he should not try too hard to sleep nor worry if unsuccessful4 ,the patient should try to banish from his mind1 at bed time1 thoughts that are distressing1 and even those that are especially interesting4 ,by using patience and persistence most persons can regain the power of sleeping even when habits of sleeplessness have been long established4 ,,fainting is a partial or total loss of consciousness due to a diminished supply of blood in the brain4 ,it may follow bleeding1 exhaustion from heat1 fatigue from prolonged standing and the like1 or strong emotional disturbance1 like fear or surprise4 ,fainting is less common than it formerly was2 it now occurs most frequently among persons suffering from anmia1 heart weakness1 or special susceptibility4 ,symptoms of fainting are pale face1 cold perspiration1 rapid1 feeble pulse1 and shallow1 sighing respiration4 ,treatment consists in removing the patient into cool1 fresh air1 applying cold water to the face and keeping the head low4 ,for a person who feels faint but has not lost consciousness1 this treatment will probably prove sufficient2 if1 however1 he becomes unconscious1 place him so that the head is lower than the body1 loosen the clothing1 especially the clothing about the neck1 apply cold water to the face and chest1 and see that fresh air is plentiful4 ,when the patient is sufficiently conscious to swallow1 give a teaspoonful of aromatic spirits of ammonia in half a glass of water and keep him quiet until he has entirely recovered4 ,a person who is unconscious from any cause always requires immediate attention4 ,in emergency work elevate the patient's head if his face is flushed1 and keep it low if his face is pale4 ,do not try to arouse an unconscious patient by shaking him and calling to him1 in the first place because it is useless to do so1 and in the second1 because consciousness will return spontaneously if his condition improves4 ,,convulsions4--,in every case of convulsions a doctor is needed at the earliest possible moment4 ,convulsions in adults are very serious2 in babies and small children although serious they are less alarming1 since they may follow comparatively slight disturbances1 particularly disturbances of digestion4 ,treatment for babies and children with convulsions consists first in keeping the child as quiet as possible1 and next in measures to draw blood from the brain toward the surface of the body4 ,the child should first be undressed1 moving him as little as possible1 and put to bed between warm blankets4 ,cold should be applied to his head by a compress or ice bag1 and hot water bag should be placed near his feet4 ,an enema should then be given4 ,a warm tub bath is sometimes used to apply heat1 if the convulsion has not subsided by the time the child is undressed4 ,if the bath is given the temperature of the water should not be above #ajf1 and should be tested by a thermometer4 ,if no thermometer is available1 the water should be tested with the elbow rather than the hand1 and cold water should be added if it feels uncomfortably warm4 ,there is great danger of scalding a child during the excitement inevitably caused by a convulsion4 ,although haste is needed when a child has convulsions1 yet quiet is essential1 since the slightest movement tends to increase the convulsions or to start them again4 ,as soon as the convulsions are over the child should be removed from the bath and put to bed between warm blankets4 ,even after the symptoms have completely subsided1 the greatest care should be taken to keep the child quiet4 ,he should be handled and disturbed as little as possible4 ,the bath should be repeated if convulsions begin again4 ,the doctor1 when he comes1 will probably order a dose of castor oil2 and therefore1 if it is impossible to obtain a doctor at once1 the dose should be given4 ,,shock 7in the medical sense of the word7 or collapse1 is a serious condition in which a patient's vitality and all his bodily processes are profoundly depressed4 ,generally shock occurs only after a severe injury or a long exhausting illness4 ,since1 however1 some persons are peculiarly susceptible to it1 the possibility of shock must be kept in mind in treating even slight injuries4 ,the probability of shock is somewhat increased if patients are allowed to see their own wounds4 ,injured persons should always sit or lie down while wounds1 however slight1 are dressed4 ,symptoms of shock are pallor1 pinched1 anxious expression1 dilated pupils1 cold clammy skin1 feeble breathing1 and rapid1 weak pulse4 ,the patient may be mentally normal1 or irrational1 or unconscious1 but more frequently he appears stupid1 and though conscious1 he pays no attention to what is going on4 ,unfortunately this condition is sometimes mistaken for sleepiness1 and he is left alone to sleep just when active measures are most needed4 ,if a patient shows any symptom of shock the doctor should be summoned immediately1 but no time should be lost in beginning treatment1 since the condition may be critical4 ,it should be remembered1 however1 that panic and confusion may alarm a patient who is conscious1 and thus increase the shock4 ,the patient should be covered warmly1 and undressed under blankets1 without exposure or avoidable moving4 ,his head should be low1 and as quickly as possible hot water bags should be placed near but not upon him4 ,if the patient is conscious and able to swallow he should be given hot coffee or aromatic spirits of ammonia1 one teaspoonful in half a glass of water4 ,the legs and arms should be rubbed from the extremities toward the heart1 but care should be taken to avoid touching or moving injured parts4 ,the patient should stay in bed1 warmly covered and closely watched for some time after he has apparently recovered4 ,helping a patient into bed is not necessarily the first thing to be done in every case of sudden illness4 ,great harm may be done by the injudicious moving of injured persons1 and often it is safer to make a person comfortable with pillows and blankets where he happens to be1 certainly until a sufficient number of people can be found to lift him properly4 ,clothing should be removed carefully1 and one should not hesitate to cut it away if undressing is painful or necessitates much moving4 ,,stimulants1 in emergency work1 are frequently misused4 ,they should not be given when the head has been injured1 when bleeding is profuse1 or when the face is red and the pulse strong4 ,neither should attempts be made to give fluids of any kind to patients not sufficiently conscious to swallow4 ,safe stimulants to use are black coffee1 tea1 or aromatic spirits of ammonia4 ,alcoholic liquors should not be given unless prescribed by a physician4 ,,sunstroke ,,and ,,heat ,,exhaustion are both caused by excessive heat either indoors or out1 but they differ both in symptoms and in treatment4 ,sunstroke or heat stroke1 usually begins with acute pain in the head1 followed almost immediately by loss of consciousness4 ,the skin is dry and very hot1 the face is red or purple1 the pupils are dilated1 the breathing is difficult1 the pulse is slow1 and the temperature high4 ,treatment consists in sending for the doctor1 removing the patient to a cool place1 undressing him and applying cold1 especially to the head and spine1 or still better1 placing him in a very cold bath4 ,the body should be rubbed constantly in the direction of the heart4 ,stimulants should not be given4 ,symptoms of heat exhaustion1 on the other hand1 resemble those of shock4 ,the doctor should be summoned1 and the patient should be removed to a cool and quiet place1 where he should stay warmly covered in a reclining position4 ,stimulants should be given1 hot water bags applied1 and the other measures for treating shock should be employed4 ,,conditions ,,in ,,which ,,the ,,digestive ,,tract ,,is ,,affected ,,nausea ,,and ,,vomiting are frequently caused by injudicious eating1 especially when a person is worried or fatigued4 ,a doctor should be consulted if either one occurs often1 or if vomiting is accompanied by pain1 prostration1 diarrha1 fever1 or other acute symptoms4 ,a person who is nauseated should lie down in a cool1 quiet place4 ,hot fomentations may be applied to the abdomen1 or a mustard paste over the stomach4 ,soda mints or a teaspoonful of baking soda may be given dissolved in hot water1 and unless diarrha is present a ,seidlitz powder or other saline cathartic may be given4 ,a large quantity of warm water may be given to wash out the stomach2 it is more effectual if salt or mustard is added1 in the proportion of one teaspoonful to a glass of water4 ,,hiccough1 which is usually caused by digestive disturbances1 is not serious in healthy people1 and can generally be stopped by holding the breath1 or by drinking water4 ,if these measures are not effectual1 salt or mustard in water as already described or a teaspoonful of the syrup of ipecac1 may be given to produce vomiting4 ,if the hiccough still continues1 medical advice should be obtained4 ,,diarrh,a is ordinarily caused by an infection1 or by an offending substance in the intestines4 ,the offending substance should be removed before attempts are made to check the diarrha4 ,when a baby has diarrha four things should be done--all food should be withheld2 boiled water should be given freely2 bowel movements should be saved for the doctor to see2 and unless a doctor can be found immediately1 castor oil should be given1 from one-half to one teaspoonful according to the age of the child4 ,similar treatment should be given to older children4 ,adults should take one tablespoonful of castor oil and drink boiled water freely1 but they should take no food until the doctor comes4 ,,constipation has been discussed on pages #aic and #eb4 ,,colic is a sharp1 intermittent pain in the abdominal region2 it is caused in many instances by indigestion or chilling4 ,the following remedies may relieve it3 a hot water bag1 an emetic1 as salt or mustard in luke-warm water1 a ,seidlitz powder or other saline cathartic1 soda mints1 or a teaspoonful of syrup of ginger in hot water4 ,unless it feels sore or tender1 the abdomen may be rubbed up1 on the right side1 across1 just below the waist1 and down1 on the left side4 ,babies may be given a few teaspoonfuls of warm water1 or an enema of salt and water4 ,colic may be serious4 ,the doctor should be summoned at once if the patient seems exhausted1 if the pain is severe1 if pain is increased rather than relieved by pressure1 if the abdomen feels sore1 especially on the right side1 or if sharp abdominal pain is accompanied by fever1 vomiting1 and stubborn constipation4 ,if the above-mentioned symptoms are present1 no food1 drink1 or medicine should be given until the doctor comes4 ,,conditions ,,in ,,which ,,the ,,eyes ,,or ,,ears ,,are ,,affected ,,styes generally accompany eyestrain or poor general health4 ,the cause should be found and treated2 and especial attention should be given to correcting eyestrain1 indigestion1 and constipation4 ,hot applications may be used1 but if pus gathers1 the stye should be treated by a physician4 ,,foreign ,,bodies ,,in ,,the ,,eye may sometimes be removed by blowing the nose violently1 by yawning several times1 or by drawing the upper lid down over the lower4 ,the eye should not be rubbed4 ,if it proves impossible to dislodge the object by these methods or by others similar1 the patient's eyelid should be turned back in the following way3 ,let the patient sit with his head back in a low chair placed in a good light1 and stand behind him holding his head between your side and upper arm4 ,in this position the patient's head is held firmly while both of the operator's hands are free4 ,next draw down the lower lid1 and remove the object1 if visible1 on the corner of a clean handkerchief4 ,to turn back the upper lid1 grasp the eyelashes firmly1 draw the lid down1 out1 and then up over a match or pencil placed across the middle line of the lid and held in your other hand4 ,then wipe the object carefully away if it is visible4 ,irritation that persists after the foreign body has been removed may be relieved by a cold compress continued for an hour or more1 or by a drop or two of castor oil placed under the lid4 ,if attempts to remove the foreign body prove unsuccessful1 if the injury is severe1 or if irritation continues after several hours1 apply a cold compress1 bandage it firmly so that the eyeball is kept at rest1 and seek the aid of a physician4 ,,disorders ,,affecting ,,the ,,ears4--,permanent deafness may result from neglecting disorders of the ears4 ,ear-ache1 discharge from the ear1 swelling in or about it1 pain or tenderness behind it1 all require medical attention and no time should be lost in securing it4 ,to relieve pain the patient may lie with the ear on an ice bag1 but nothing whatever should be put into the ear before the doctor comes1 except when an insect has entered the ear1 and causes acute distress by the noise of its beating wings4 ,if such an accident has occurred1 the patient should lie on the unaffected side1 and warm sweet oil should be dropped very gently into the affected ear by means of a medicine dropper4 ,the insect generally drowns in the oil and floats to the opening of the ear canal4 ,after it has been removed1 the patient should lie on the affected side so that the oil may drain out of the ear4 ,no attempts should be made to remove foreign bodies from the ear or nose1 unless they can be reached easily with the fingers4 ,hair pins1 crochet hooks and similar instruments should never be used for this purpose4 ,it is best for a doctor to remove foreign objects because unskillful attempts are likely to move them further in4 ,,conditions ,,in ,,which ,,the ,,skin ,,is ,,affected ,,prickly-,,heat1 which affects babies and children more often than adults1 is an eruption caused by heat and moisture1 and aggravated by flannel underwear4 ,it may be prevented by keeping the skin dry and cool1 and it may be relieved by bathing the skin with alcohol and water1 about one part of alcohol to three of water1 and by using after the bath a powder made of two parts of starch to one of boracic acid1 or any good talcum powder4 ,,insect ,,bites ,,and ,,stings4--,the sting1 if still in the wound1 should first be removed1 and then ammonia should be applied1 since the poison is generally acid4 ,applications of cold water1 alcohol and water1 or wet salt may relieve the subsequent burning and itching1 but ammonia is generally most effective4 ,,ivy ,,poisoning may be treated by applying cloths wet in a strong solution of baking soda or of boracic acid1 or by applications of carbolized vaseline or ichthyol4 ,severe cases should have medical attention4 ,scratching and rubbing seem to spread the inflammation1 and special care should be taken not to rub the face or eyes with infected hands4 ,susceptible people should avoid the plant if possible4 ,,other ,,emergencies ,,chills may be the result of infection or of exposure to cold4 ,an early diagnosis of the trouble is so desirable that it is well to send for a doctor even when symptoms are not severe4 ,if a person has a chill his temperature should be taken at once2 fever and chill together probably indicate invasion by bacteria4 ,when chills follow exposure to cold the patient should go to bed between warm blankets1 his body should be briskly rubbed1 and hot water bags and a hot drink should be given4 ,if he prefers1 he may take a hot bath before going to bed4 ,,croup is caused by a spasmodic closure of the larynx so that breathing is impeded4 ,the child who develops croup may have a slight cold1 but frequently shows no symptoms until he wakes in the night with a hoarse ringing cough and difficult breathing4 ,true croup1 though often distressing1 is seldom serious1 even when the symptoms are so severe that the child appears to be partly suffocated4 ,an emetic should be given at once1 preferably syrup of ipecac1 one teaspoonful followed by warm water1 or ten drops every #ae minutes until the child vomits freely4 ,hot fomentations may be applied to the throat and chest in order to hasten relaxation of the muscular spasm1 and water should be kept boiling near the bed in a teakettle or uncovered saucepan4 ,the child should stay in a warm room during the following day4 ,whenever a child develops a croupy cough his throat should be examined4 ,a physician should be summoned if the throat is red and especially if the redness is associated with rise in temperature4 ,cases of diphtheria have been overlooked by neglecting such symptoms4 ,,bleeding ,in the vast majority of cases1 bleeding can be stopped by elevating the injured part and applying pressure over the wound4 ,one should1 however1 remember that loss of blood is not the only danger presented by an open wound1 for pus-producing germs1 if they make their entrance1 may cause an infection which may be as serious as the bleeding itself4 ,hence in dealing with open wounds of any sort one should always keep in mind the danger of infection as well as the danger from loss of blood4 ,,treatment ,,of ,,slight ,,wounds4--,loss of blood from slight wounds is seldom so serious as the danger of infection2 therefore small cuts1 pin pricks1 scratches1 etc4 should be encouraged to bleed by pressure near the wound in order to expel the germs that may have entered4 ,after the wound has bled a little1 tincture of iodine should be applied by means of a cotton swab both to the wound itself and also to the surrounding skin4 ,after the wound has thus been disinfected it should be covered with a sterile dressing2 a sterile or aseptic dressing is material in which all bacterial life has been destroyed4 ,gauze from a ,first ,aid dressing or from a packet of sterile gauze should be used for this compress1 or gauze may be cut from a sterile bandage4 ,the compress serves two purposes3 it protects the wound from infection1 and if applied with pressure it checks further bleeding4 ,the compress should be securely bandaged in place1 or its edges may be fastened with adhesive plaster or collodion4 ,neither of the two latter should cover the wound itself4 ,the outside bandage may be changed when soiled1 but the compress itself should not be disturbed until the wound has healed4 ,it is a mistake to dress wounds oftener than necessary1 since handling them always increases the chance of introducing germs4 ,most children1 like ,tom ,sawyer1 delight in wounds1 but they should be prevented if possible both from inspecting and from exhibiting them4 ,if heat1 swelling1 redness1 or pain develop in a wound after a day or two1 a doctor should be consulted2 and not a minute should be lost if the patient has a chill or if red streaks appear extending from the wound in the general direction of the heart4 ,until the doctor comes the wounded part should be elevated and covered with cold applications wet in alcohol #be1 or in a solution of common salt1 a teaspoonful to a pint of water4 ,several points should be remembered in dressing wounds4 ,in the first place the mouth1 which is full of germs1 is not a good place for cut fingers4 ,moreover1 wounds should not be touched by anything1 especially the fingers1 either washed or unwashed1 nor should the scissors1 fingers or other object be allowed to touch the surface of the dressing that is to be placed directly upon a wound4 ,unless they contain gross dirt wounds should not be washed with water1 since washing introduces another chance of infection and accomplishes nothing except a tidy appearance1 which is not essential4 ,furthermore1 it should be remembered that exposure to the air will not infect a wound1 and therefore time should be taken to find a suitable dressing4 ,when a sterile dressing is quite impossible to obtain1 the cleanest material available should be used2 one of the best substitutes for a sterile dressing is the inner surface of a handkerchief or napkin that has not previously been unfolded since it was ironed4 ,it is a common mistake to tie up a wound in the first article presented1 which is usually a generous by-stander's soiled handkerchief4 ,the same precautions in regard to cleanliness should be taken in dressing wounds that are known to be contaminated1 since even into an infected wound it is possible to introduce more germs and more virulent ones4 ,,nosebleed usually stops of itself1 but if it is obstinate the patient should sit erect with the head back1 and cold compresses should be placed on the nose and at the back of the neck4 ,pressure should be made on the upper lip by means of the fingers1 or by a firm roll of paper or cotton placed under the upper lip4 ,salt or vinegar in water1 a teaspoonful of either one to a cup of water1 may be snuffed up the nose4 ,the treatment should be continued for ten or fifteen minutes1 or until bleeding stops2 if the bleeding persists a doctor is needed4 ,,profuse ,,menstruation should be treated by keeping the patient quiet in bed with the head low and the feet slightly elevated4 ,any marked increase1 whether by amount1 duration1 or shortening of the interval between the periods ought to receive attention and be brought to the physician's notice 7,latimer74 ,painful menstruation may be relieved by rest in bed1 mental as well as physical1 by hot drinks and by the application of heat4 ,rest1 and hygienic living persistently practised1 will relieve most menstrual abnormalities4 ,the common practice of using patent remedies and alcoholic liquors for disordered menstruation cannot be too strongly condemned4 ,,other ,,injuries ,,sprains4--,a sprain is caused by twisting1 stretching1 or tearing the tissues about a joint4 ,the first sharp pain comes from the injury to the tissues2 subsequent pain is caused by the pressure of accumulated fluid4 ,the other symptoms are those characteristic of inflammation4 ,when a sprain is slight1 the affected part should be elevated and kept at rest for the first twenty-four hours4 ,either heat or cold should be applied1 or heat and cold alternately2 a good treatment is to soak the part in hot water and afterward to allow cold water to run upon it from the tap4 ,gentle rubbing with a circular motion helps to reduce the swelling4 ,if the joint must be used it should be bandaged tightly4 ,injuries to joints should never be neglected2 and severe sprains always require medical attention1 since in addition to the sprain a bone may be broken4 ,a severely sprained joint should be elevated1 treated with hot or cold applications1 and kept at rest until it has been examined by a physician4 ,,bruises4--,bruises need no attention unless they are extensive or painful4 ,the skin should be kept clean and if possible unbroken1 since injured tissues are less resistant to infection than tissues in their normal state4 ,applications of cold water or of equal parts of cold water and alcohol may relieve the pain1 but cold should not be used upon bruises that are extensive4 ,a compress bandaged tightly in place may help to prevent swelling and discoloration4 ,,burns ,,and ,,scalds4--,injuries from dry heat are called burns1 and those from moist heat are called scalds4 ,both are painful1 and both are dangerous if extensive or deep4 ,burns and scalds require medical attention if the injured area is extensive1 if a large blister is formed1 if the skin is destroyed or charred1 and if symptoms of shock appear4 ,shock often follows burns or scalds even when the injury is comparatively slight4 ,treatment of slight burns1 where the skin is reddened but not destroyed1 has for its main object the exclusion of air4 ,one of the following may be applied3 dry baking soda1 or baking soda made into a paste with water1 picric acid gauze moistened in water1 boracic acid ointment1 vaseline1 sweet oil1 or castor oil2 if none of these is obtainable1 lard1 cream1 the white of an egg or unsalted butter may be used4 ,old muslin or linen bandaged lightly in place1 should be used to cover the burn4 ,the same treatment is used for sunburn1 and also for small burns where blisters form4 ,a blister1 if it forms1 should not be punctured2 but if it is accidentally broken the skin of the blister should not be removed4 ,it should be remembered that a broken blister is an open wound1 and therefore liable to infection4 ,,brush ,,burn is a name given to injuries where the surface of the skin has been removed4 ,they include the scraped arms and legs which are common accidents in childhood4 ,in order to dress a brush burn1 particles of dirt should first be removed preferably by means of forceps that have been boiled1 and the surrounding skin should then be cleansed with soap and water4 ,the injured part should next be flushed with sterile salt solution1 made by boiling water five minutes and adding to it salt in the proportion of one teaspoonful to a pint of water4 ,if the dirt is difficult to remove a soap compress should be applied4 ,to prepare the compress several thicknesses of gauze or muslin should be boiled in a strong solution of castile or green soap for ten minutes4 ,the compress should remain in place several hours1 and may be repeated if necessary4 ,after the wound has been thoroughly cleansed1 it should be dressed with old muslin that has been saturated in castor oil or spread with boracic ointment4 ,,exercises #a4 ,name some common causes of headache and of sleeplessness1 and outline rational treatment for each of these disorders4 #b4 ,describe symptoms and treatment of shock2 of fainting2 of convulsions in children4 #c4 ,describe the treatment of all disturbances of the digestive tract mentioned in this book4 #d4 ,what should be done if a foreign body has entered the eye8 if one has entered the ear8 ,what should be done for a person who has a stye8 for a person with pain in or near the ear8 #e4 ,how would you treat a sprain8 #f4 ,describe treatment for burns and scalds4 #g4 ,distinguish between heat stroke and heat prostration1 and tell what treatment should be given in each case4 #h4 ,what are the two principal dangers from slight wounds1 and how should one guard against them8 ,show how you would dress a small cut4 #i4 ,what should you do for a person with nose bleed8 ,,for ,,further ,,reading ,american ,national ,red ,cross ,text ,book on ,first ,aid--,lynch4 ,immediate ,care of the ,injured--,morrow4 ,prompt ,aid to the ,injured--,doty4 ,,chapter ,,xiv ,,special ,,points ,,in ,,the ,,care ,,of ,,children1 ,,convalescents1 ,,chronics1 ,,and ,,the ,,aged ,in many cases of sickness institutional care has marked advantages4 ,it may be the only solution when adequate provision for the sick is impossible at home2 and it is often a necessity when a patient requires special equipment or apparatus1 expert nursing1 and medical attention within reach both day and night4 ,on the other hand1 it would not be desirable even if it were possible for all sick persons to be cared for in institutions4 ,care at home when it is adequate may be more successful than equally skillful care given elsewhere1 since the sick quite as much as the well are injured by long separation from normal family life4 ,most children1 because they need the attention of their own mothers1 most convalescent and chronic patients1 and most aged persons are cared for at home2 and in the great majority of cases no better place for them could be found4 ,since patients of these four groups have needs peculiar to themselves1 some special points in caring for them are considered in this chapter4 ,,children ,ability to observe quickly and accurately is seldom more needed than it is by a woman who cares for children4 ,no one expects babies to explain their troubles1 but people forget that small children are unable to describe their physical sensations with any degree of accuracy1 although discomfort or sickness may show itself in all degrees of ill temper and bad conduct4 ,for these exhibitions many a suffering child has been punished1 where an older and more articulate person would have received considerate attention4 ,children1 like babies1 have a low resistance to disease4 ,moreover1 they react quickly both to favorable and to unfavorable surroundings4 ,hence slight causes sometimes produce pronounced or even violent symptoms in children without giving cause for great anxiety1 although the same symptoms if exhibited by adults1 might indicate critical illness4 ,on the other hand the recuperative power of children is high1 and their recoveries are sometimes surprisingly rapid4 ,it is a mistake1 when a child has completely recovered from an acute but brief illness1 to coddle him for weeks afterward merely because a grown person in similar circumstances would have failed to regain his strength4 ,when a child is sick in bed1 especial efforts should be made to insure adequate ventilation without chilling him4 ,children always lose heat rapidly because the body surface is proportionately large2 when they are ill1 therefore1 it is especially necessary to keep them well covered1 to see that their hands and feet are warm1 and to avoid chilling them during their baths4 ,but overheating must also be avoided1 since all children1 sick or well1 who are too warmly dressed or who stay in rooms that are too warm1 become weak and irritable and more susceptible than others to colds and other respiratory disorders4 ,the child's skin should be kept clean and dry1 but he should not be disturbed nor handled unnecessarily4 ,sick children require very simple food at short intervals4 ,variety is not so necessary for a child as for an adult1 unless the child has been allowed to form bad habits of eating4 ,sick children should not be indulged unnecessarily1 either in regard to their food or in other ways4 ,however1 attempts made during an illness to change the habits of a badly trained child are unwise because usually unsuccessful2 parents who sow the wind by neglecting to train their children when they are in good health may as well make up their minds to reap a veritable whirlwind when the children are ill4 ,even when children are well trained it is difficult and sometimes impossible to prevent them from forming bad habits during sickness4 ,yet the labor of training a child reaps perhaps at no other time a richer reward than it does when the child is ill1 and his recovery might be seriously impeded by unwillingness to accept necessary food1 medicine1 or treatment4 ,,physical ,,defects are faults in the structure of the body2 adenoid growths1 imperfect eyes1 abnormally curved spines1 and defective teeth are examples4 ,most physical defects can be cured in childhood by treatment or by slight operations4 ,if untreated they frequently lead to sickness or to serious impairment of the body1 and if neglected until adult life their injurious consequences are generally beyond remedy1 even when the defects themselves can be repaired4 ,some indications of common physical defects are given below2 they ought to be more generally known than they are4 ,if a child exhibits one or more of the symptoms mentioned1 he ought to be given a complete physical examination by a competent physician1 and treatment1 if needed1 should begin without delay4 ,the idea that children will outgrow these defects without treatment is erroneous4 ,better1 however1 than waiting until symptoms appear is the modern way of giving every child a physical examination at stated intervals1 a practice already common in public schools where effective health work is carried on4 ,,eyestrain frequently comes from imperfections in the shape of the eye2 these imperfections can almost always be corrected by glasses4 ,when a child is suffering from eyestrain1 the eyes themselves may show indications of trouble2 they may be blood-shot1 the lids may itch or be crusted or inflamed1 or styes may appear4 ,in other cases the symptoms of eyestrain have no apparent connection with the eyes2 such symptoms are headache1 nausea1 vomiting1 indigestion1 fatigue1 irritability1 poor scholarship1 and nervous exhaustion4 ,if a child shows any of these symptoms1 or if he rubs his eyes1 frowns1 squints1 wrinkles his forehead1 sits bent over his book1 or develops round shoulders1 there is sufficient reason for having his eyes examined by an oculist4 ,examination by an optician should not be considered sufficient4 ,,enlarged ,,tonsils ,,and ,,adenoids4--,the tonsils are masses of spongy tissue situated at the back of the mouth1 on either side of the opening into the throat4 ,if enlarged they may seriously interfere with breathing1 and if diseased they frequently harbor the germs causing many acute infections1 as well as germs of rheumatism and most of the heart disease originating in early life4 ,therefore the tonsils ought to be removed if they are diseased or greatly enlarged1 but there is ordinarily no good reason for removing normal tonsils4 ,adenoids are situated at the back of the nose1 and like the tonsils are composed of spongy tissue4 ,adenoids sometimes become so enlarged that they interfere with the passage of air through the nose1 thus predisposing to catarrh1 colds1 and other respiratory diseases1 to high palate with irregular teeth1 to inflammation of the middle ear leading to deafness1 to diminished mental activity1 and to general poor health4 ,if a child breathes through his mouth1 if he snores at night1 keeps his mouth open and has a dull1 apathetic expression1 his nose and throat should be examined1 and if advisable his tonsils and adenoids should be removed4 ,,defective ,,hearing4--,permanent deafness among children in the great majority of cases comes from trouble in the throat or nose2 hence the most effective measure to prevent deafness is to make sure that every child's nose1 throat1 and mouth are in a normal condition4 ,sensitive or timid children try to hide infirmities of any kind1 but deaf children seem peculiarly unable to explain their difficulties4 ,no one1 says ,cornell1 has ever recorded that a small child complained of inability to hear4 ,a child's ears should be examined if he breathes through his mouth1 if he stoops habitually1 if he is persistently inattentive1 or if he is vague or stupid in carrying out directions4 ,a child who appears normal at times and inattentive or stupid at other times should also be examined1 since he may be deaf in one ear4 ,temporary deafness may come from accumulated wax in the ear4 ,the wax should be removed by a doctor2 inexpert attempts are likely to cause serious injury to the ear drum4 ,intermittent deafness may be caused by enlarged tonsils and adenoids4 ,children thus affected are not infrequently punished for seeming disobedience4 ,such children are especially liable to street accidents4 ,,defective ,,teeth have been considered on page #dd4 ,,posture4--,in childhood the bones are soft and yield with comparative ease to continued strains2 hence they often become deformed by bad positions assumed in sitting1 standing1 or in using the body in other ways4 ,the postures habitually assumed by a child should be noticed and good postures should be insisted upon4 ,but it is not enough to admonish him4 ,the various causes tending to encourage bad positions should be corrected2 among them are insufficient illumination of books and work1 defective eyesight or hearing1 obstructions in breathing1 muscular weakness1 and low general vitality4 ,children should have their chairs and tables suited to their size for their work both at home and in school4 ,illustration3 ,,fig4 #bh4--;,,incorrect ,,sitting ,,postures4 7,from ,cornell1 ,health and ,medical ,inspection of ,school ,children4 ,f4 ,a4 ,davis ,co41 ,philadelphia47 ,illustration3 ,,fig4 #bi4--;,,incorrect ,,sitting ,,postures4 7,from ,cornell1 ,health and ,medical ,inspection of ,school ,children4 ,f4 ,a4 ,davis ,co41 ,philadelphia47 ,illustration3 ,,fig4 #cj4--;,,incorrect ,,sitting ,,postures4 7,from ,cornell1 ,health and ,medical ,inspection of ,school ,children4 ,f4 ,a4 ,davis ,co41 ,philadelphia47 ,illustration3 ,,fig4 #ca4--;,,incorrect ,,and ,,correct ,,standing ,,postures4 7,from ,cornell1 ,health and ,medical ,inspection of ,school ,children1 ,f4 ,a4 ,davis ,co41 ,philadelphia47 ,the adjustable chairs and desks now used in schools are a marked improvement upon the school furniture which has caused so many deformities in the past4 ,illustration3 ,,fig4 #cb4--,,round ,,shoulders4 7,goldthwait1 from ,pyle's ,personal ,hygiene47 ,one of the serious deformities caused by habitual faulty posture is curvature of the spine4 ,a curvature not only injures a child's appearance and thus handicaps him in later life1 but it brings strains and pressure upon the organs of the chest and abdomen which may seriously impair his health4 ,as curvatures often pass unnoticed in their early stages1 every child should be inspected occasionally when all his clothing has been removed1 to see whether the weight is borne evenly on both feet1 whether the development of the two sides is uniform1 and whether the head and shoulders are properly carried4 ,it should be noticed when the child stands1 whether one shoulder is higher than the other1 whether one shoulder blade projects more than the other1 whether one hip is higher than the other1 and whether one hand is lower than the other when the arms are hanging at the sides4 ,the child should walk both toward and away from the observer1 who should notice whether the child uses the two sides of his body in the same way1 and whether he drags or shuffles his feet or has other abnormalities of gait4 ,illustration3 ,,fig4 #cc4--,,lateral ,,curvature4 7,from ,bancroft's ,posture of ,school ,children4 ,the ,macmillan ,co41 ,new ,york47 ,illustration3 ,,fig4 #cd4--,,wing ,,shoulder ,,blades ,,in ,,forward ,,shoulders4 7,from ,bancroft's ,posture of ,school ,children4 ,the ,macmillan ,co41 ,new ,york47 ,if abnormalities are found1 a physician should be consulted4 ,often corrective exercises are all that is needed1 and no one should put braces of any kind upon a child unless they have been prescribed by a physician4 ,no attempt should be made to correct the common tendency of children to toe in or walk pigeon-toed4 ,toeing-in is a natural manner of walking during the formative period and tends to strengthen the arch of the foot1 while toeing-out tends to weaken the arch and to cause flat foot or broken arches4 ,,predisposition ,,to ,,nervousness4--,heredity plays an important rle in the predisposition to nervousness1 so that children of nervous parents are particularly likely to show nervous instability4 ,it is1 however1 difficult to say in a given case how much of his nervousness a child inherits and how much he acquires by imitating the irritability1 the out-breaks of temper1 and the other evidences of imperfect emotional control displayed by his nervously disposed parents4 ,on the other hand1 even children of nervous predisposition sometimes overcome their defects to some extent by imitating parents who have acquired self-control4 ,children predisposed to nervousness should be watched with special care1 but they should not be allowed to realize that they are the objects of unusual solicitude4 ,they need the most favorable surroundings that can be obtained1 and their general health should be maintained at the highest possible level4 ,any condition that lowers vitality tends to increase their troubles2 nervousness may be caused among children of good inheritance1 and increased among others1 by poor nutrition1 lack of exercise and play out-of-doors1 fatigue1 loss of sleep1 eyestrain1 adenoid growths1 and the poisons of infectious diseases4 ,it is characteristic of many nervous children that they are too easily stimulated2 they may be excitable1 restless1 unnaturally quick in moving1 over-sensitive to pain and discomfort1 easily fatigued1 irritable in temper1 and unable to control the emotions4 ,they frequently make involuntary motions like grimacing and winking the eyes4 ,children of low nervous tone1 however1 are not necessarily excitable4 ,a nervous child may be muscularly weak1 awkward in gait1 listless1 dull1 clumsy1 forgetful1 and inattentive4 ,such children often suffer from cold hands and feet and from profuse perspiration4 ,much can be done for these unfortunate children by removing the cause of their troubles if possible1 by giving them simple and wholesome surroundings1 by suiting their occupations to their strength1 by eliminating mental strain1 particularly during the adolescent period1 and by training them to control their minds as well as their bodies4 ,in addition to the hardening of the body1 the education of the child should include measures which increase the resistance of the child against pain and discomforts of various sorts4 ,every child1 therefore1 should undergo a gradual process of 'psychic hardening' and be taught to bear with equanimity the pain and discomfort to which everyone sooner or later cannot help but be exposed4 ,what ,i have said about clothing1 cold baths1 walking in all weather and at all temperatures1 play and exercise in the open air1 has a bearing on this point1 for a child who has formed good habits in these various directions will have learned many lessons in the steeling of his mind to bear pain and to ignore small discomforts4--7,barker3 ,principles of ,mental ,hygiene ,applied to the ,management of ,children ,predisposed to ,nervousness47 ,,convalescent ,,patients ,after serious or prolonged illness the vitality is generally low and all bodily processes are likely to be depressed4 ,during convalescence1 therefore1 the digestion is feeble1 the muscles are weak so that fatigue follows slight exertion1 and the sluggish condition of the circulation renders the patient especially sensitive to cold4 ,since the nervous system also becomes depressed and irritable1 a convalescent patient is easily excited1 easily discouraged1 and quickly fatigued by mental effort4 ,he finds the simplest decisions hard to make1 and his emotions difficult to control2 indeed1 many a patient who has borne acute pain with unflinching courage becomes peevish at this stage1 weeps easily1 and expects more expression of sympathy than is good for him4 ,some persons naturally make quick recoveries1 while others recuperate slowly4 ,a long and tedious convalescence1 it should be remembered1 is the patient's misfortune rather than his fault4 ,in restoring a convalescent patient to normal living it is imperative to proceed slowly4 ,food should be increased gradually both in variety and in amount2 but the patient's appetite is not always a safe guide1 and it may need to be encouraged or to be restrained4 ,both mental and physical exertion should begin only under careful supervision1 and should increase by slow degrees4 ,the patient should sleep as much as possible1 should take long intervals of rest1 and should continue no occupation to the point of fatigue4 ,a patient who has been ill in a hospital or who has had at home the exclusive services of a nurse or an attendant1 often finds the period following his return or following the nurse's departure an exceedingly difficult transition4 ,the family should not expect or allow him to resume too many duties at a time when the mere acts of bathing and dressing may demand all the strength he has4 ,many convalescents are obliged1 or think they are obliged1 to take up regular work again before their strength is fully restored4 ,there is generally no economy in so doing2 indeed1 time is saved in the end by waiting until recovery is complete before undertaking full work4 ,important as it is to build up the patient's physical strength1 it is hardly less important to direct his thoughts away from himself and his sickness1 and to help him renew his interest in normal living4 ,during his illness he has of necessity relied upon the judgment and support of other persons1 and his pain and discomfort have forced him to think constantly of himself and his many needs4 ,the habit of sickness is readily broken by some persons1 particularly by those whose nervous exhaustion has not been great and whose interests outside themselves are naturally keen4 ,but the sick point of view has remarkable tenacity1 and other patients1 unless circumstances or deliberate efforts redirect their thoughts1 will look upon themselves as invalids to the end of time4 ,hopefulness promotes health1 while discouragement1 apprehension1 and unhappiness lower the tone of the whole system4 ,hence set backs1 failures1 delays1 and relapses should not be dwelt upon1 but signs of progress should be mentioned2 judiciously however1 since overdone attempts to cheer a patient seldom fail to have the opposite effect4 ,if objects or situations that suggest undesirable thoughts are eliminated1 the less often those thoughts tend to recur4 ,therefore1 in order to break the habit of sickness1 old thoughts must be gradually banished and new ones must be substituted4 ,sick-room appliances should be put out of sight as soon as they are no longer needed1 and the patient may profit by moving into a different bed room4 ,a few days spent away from home as soon as his strength permits often prove effective in breaking up sickness associations2 the patient is generally encouraged when he finds that he can sleep in a different bed1 endure some fatigue1 and exist without daily visits from the doctor4 ,even a day spent at a different house in the same town sometimes directs the patient's thoughts into fresh channels4 ,gradually1 but as quickly as safety allows1 he should take his place in the normal family life and cease to be treated as an exception4 ,merely eliminating associations with sickness1 however1 is not enough2 and exhorting a patient to forget himself and to become interested in something seldom accomplishes anything1 especially if he is so depleted by illness that the thought of everyday activities suggests only weariness and pain4 ,a person so weak that he is thoroughly fatigued by dressing himself should not be expected to view with enthusiasm the prospect of a full day's work4 ,much1 however1 may be accomplished by providing something that the patient really likes to do1 and deliberate efforts must be made to stimulate his interest in some occupation1 however simple it may be4 ,occupations for invalids are more than a means to pass away the time2 they are also of distinct curative value4 ,the patient's interest is not always easy to arouse1 and some ingenuity may be needed in the beginning2 sometimes interest is best aroused by working at some handicraft in his presence1 and finally offering1 as a favor1 to teach him to do it also4 ,his interest in any occupation is invariably increased if a well person not only directs but shares in the work4 ,care should be taken to select occupations suited to the patient's physical condition1 to his age1 tastes1 and mental development4 ,two or three occupations are better than one1 so that he may change from one to another before any one becomes tedious4 ,work requiring fine motions1 close attention1 or concentrated thought should be used for short periods1 only1 and no work should be continued to the point of fatigue4 ,the patient should not be allowed to feel that he must finish a certain amount in a certain time4 ,even poor work is better than none1 and a patient should always be encouraged by judicious praise4 ,games and puzzles are useful to some extent1 but an aimless occupation is not so beneficial as one which has a tangible product1 particularly a product that is useful as well as beautiful4 ,occupations frequently possible for invalids and convalescents include knitting1 crocheting1 many kinds of needle work1 clay modeling1 basketry1 stenciling1 weaving1 book-binding1 metal work1 and photography4 ,manuals are now available giving directions for these and many other handicrafts4 ,sick children often enjoy collecting stamps1 post marks1 and other objects1 making scrap books1 sewing1 weaving1 knitting1 paper folding1 and various other kindergarten occupations4 ,,chronic ,,patients ,the whole field of caring for the sick offers nowhere greater opportunity for fine and finished work than it offers in the case of chronic invalids4 ,it is an achievement of which an artist might be proud to make a chronic patient comfortable in body1 happy in mind1 and agreeable to others4 ,moreover1 since success can never be attained by one who wearies in well doing1 the care given to a chronic invalid tests not only the attendant's skill but also her moral and spiritual quality4 ,care of a chronic patient has for its aims maintaining the patient's health1 rendering him as happy and comfortable in mind and body as it is possible for him to be1 and providing whatever special treatment and attention his case requires4 ,in order to maintain his health constant attention must be given to diet1 to hygiene of the sick room1 and indeed to all his surroundings4 ,in many chronic illnesses1 such as rheumatism and kidney disease1 the diet is prescribed by the doctor2 in every case care should be taken that the patient is not overfed or underfed1 that the food is suited to his digestive powers1 that foods causing flatulence are eliminated1 particularly if the patient's trouble is heart disease1 and not the least important requirement1 that he derive as much pleasure from his food as possible4 ,the regular daily care of the patient and of his room1 already described in this book1 should be scrupulously carried out1 and no less scrupulously during the tenth year than it was during the tenth day4 ,cleanliness in every detail is absolutely essential to the patient's welfare2 no one is more unpleasant either to himself or to others than a chronic patient who is neglected4 ,patients who are constantly in bed1 it should be remembered1 and paralyzed patients in particular1 are peculiarly susceptible to pressure sores4 ,if a patient is able1 it is extremely important for him to sit up in a chair part of the day4 ,sitting up should never be omitted because it involves the expenditure of time and trouble for the attendant4 ,it is often said that for most people some personal experience of sickness is beneficial2 it can safely be said1 however1 that no one benefits from spending any considerable portion of his life in a state of helplessness and suffering4 ,behavior and character itself are determined by influences constantly coming into the mind from daily surroundings and associations with other people3 one who recalls this fact needs only a moment's reflection to realize how ill adapted to healthy development of mind and character are the limited lives of the sick4 ,especially unfortunate is the situation of chronic invalids1 shut off as they are from the objective interests and activities of normal life1 deprived of all practice in making the salutary small adjustments and sacrifices required in every day living with other people1 and self-centered as they necessarily tend to become from the inevitable focusing of attention upon their own discomforts and pain4 ,on the whole1 a surprisingly large number of invalids successfully resist the disintegrating effects of sickness upon character4 ,but it is nevertheless true1 as ,dr4 ,weir ,mitchell says1 that ,sickness ennobles a few but debases many4 ,a selfish invalid has more than once destroyed the happiness of an entire family1 or spoiled the life of one member of it by monopolizing her whole time and attention4 ,families should remember that their injudicious sacrifices seldom bring enduring happiness or contentment to the patient himself2 indeed1 in the long run such sacrifices generally injure him even more than they injure his victims4 ,clearly much must and should be sacrificed by members of a family to the needs of an invalid2 but in general it may be said that a sacrifice is injudicious if it relieves the patient of activity or responsibility that he can support without injury1 if it makes him more dependent in mind or body1 if it results in restricting his attention to himself and his affairs1 or if it increases his tendency to make demands on others4 ,purposeful activity of some sort and the necessity for contributing to the welfare of others are essential parts of a wholesome life4 ,if these essentials are entirely eliminated from the life of an invalid1 the patient's greatest needs are probably left unsatisfied1 even though the physical care he receives may be perfect in every detail4 ,all that was said in regard to occupations for invalids applies with particular force to occupations for chronic patients1 since however valuable manual occupations may be as a means to bring about recovery1 they are still more valuable in furnishing interest and purpose in a life whose only prospect is a succession of weary1 useless years4 ,handicapped patients sometimes learn occupations that yield a financial return1 and ability to earn even a little stimulates self respect and mental health1 whether the money is needed or not4 ,the important point1 however1 is that the finished product should have a recognized use4 ,in addition to enabling the patient to make things with his hands1 a way should be found if possible by which he may contribute to the group of people with whom he lives4 ,if a way can be discovered for him to do so1 the opportunity should not be denied him nor should his service fail to be noted and appreciated1 even if it is nothing more than telling a story to a restless child4 ,,care ,,of ,,the ,,aged ,at the end of life1 as at its beginning1 every individual especially needs the interest and protection of his own family4 ,in ordinary circumstances neither a baby nor an aged person can be cared for so fittingly or so successfully in any other place as he can be in his own home4 ,with advancing years is to be expected a general slowing down of all the powers4 ,in old age both body and mind show characteristic changes1 and particularly changes causing lowered resistance and diminished vigor4 ,if the manner of living is adapted to these changes1 both happiness and usefulness may be prolonged4 ,but so gradually do the changes often come that they may escape notice for a long time1 and the younger generation in looking back sometimes realizes with regret how much earlier measures might have been taken to prolong the usefulness and to mitigate the discomforts of aged parents and friends4 ,old people are keenly sensitive to cold1 since the circulation gradually becomes less vigorous and they take little exercise4 ,keeping them warm both in bed and out adds more perhaps to their comfort than any other one measure4 ,they should have warm underclothing and soft shawls and other extra wraps4 ,a real service will be rendered by the person who invents a suitable and dignified wrap for old or feeble men1 who dislike the informality of sweaters and feel disgraced by shawls4 ,old persons should and can be kept warm in bed1 by providing them with hot water bags1 with warm night clothes including stockings1 by using woollen or outing flannel sheets if necessary1 and by providing a sufficient number of light but warm bed covers4 ,it is not always understood that many covers do not remedy the deficiencies of a thin mattress4 ,if a thick mattress or two thin mattresses cannot be provided1 a thick comforter or even many layers of newspaper should be placed between the mattress and the springs1 and another thick comforter should be placed between the mattress and the lower sheet4 ,rubbing the body with warm olive oil often affords great comfort1 by improving the circulation and thus increasing the sensation of warmth1 and also by relieving the tendency of the skin to become dry and cracked4 ,poor circulation at night may cause cramps in the muscles of the legs2 the cramps can usually be relieved by warmth and gentle rubbing4 ,old people frequently wish their rooms to be very hot1 both by day and by night1 even as hot as #hj or #he1 but if it is possible to keep them warm in any other way the temperature of the room should be kept at #gj4 ,well ventilated rooms are highly important for old people as for all others of low resistance1 and it is entirely possible for their rooms to be warm and yet well ventilated4 ,aged persons should be carefully guarded from chill1 exposure1 crowds1 and infected persons4 ,like little children they are peculiarly susceptible to the respiratory diseases1 which cause many of the deaths commonly attributed to old age4 ,digestion usually becomes weaker than in earlier years1 and less food is needed4 ,it should be simple1 hot1 and divided into four or five meals rather than three4 ,old people often wake at an early hour1 and hot nourishment will prevent them from growing weak and faint while waiting for the family breakfast4 ,both constipation and looseness of the bowels are common ailments in old age4 ,so far as possible the bowels should be regulated by means of diet2 but muscular weakness resulting in inability to control the bowels should not be mistaken for and treated as diarrha4 ,it is unwise for old people to undertake unaccustomed or sudden muscular exertion1 since the muscular system including the heart muscle grows weak and is generally unable to endure great strain4 ,the bones1 moreover1 grow brittle and heal with difficulty if broken1 so that persons of advanced years no matter how active should avoid walking on icy pavements1 climbing on chairs to reach high shelves1 and placing themselves in other insecure positions4 ,assistance must be tactfully given1 however1 as active old people are inclined to resent it4 ,on the other hand1 old people should be encouraged to continue moderate and safe activities1 and to take regular exercises suited to their strength4 ,although increasing muscular weakness tends to make most old people indolent1 it is far better for them both in mind and in body to remain as active as they can without danger of too great fatigue4 ,at all events1 they should be prevented if possible from becoming bedridden4 ,since in old age sight1 hearing1 and other special senses become less acute1 one should remember that an old person may not notice the odor of escaping gas1 the light of a smouldering match1 or the sound of an approaching motor car1 and that he must be specially guarded from such dangers of every day life4 ,on account of their dulled perceptions old people are sometimes unjustly considered to be less intelligent than they really are4 ,young people moreover should be told1 if an aged person is untidy and careless in personal habits1 that the apparent negligence is caused by dulled perceptions and diminished muscular control for which old people are no more responsible than they are for failing eyesight or for inability to hear4 ,families should also realize that changes in mind and character are beyond an aged person's control and that they should not be made the cause for remonstrance or arguing4 ,just as the arteries harden with advancing years1 as the bones become brittle and as other tissues become less flexible1 so changes are likely to occur in the nervous system4 ,it is not surprising when the brain substance like other tissues is becoming less flexible1 that the powers of attention should weaken1 that memory for recent events should diminish1 or that other mental powers should fail4 ,changes in disposition are not uncommon3 previously controlled persons sometimes become querulous and exacting1 while excitable and irritable persons become more placid4 ,with most old people emotions become less intense2 feeble old people hardly realize great joy or great sorrow1 and seldom look forward to death with apprehension4 ,among the most important changes that occur in the nervous system is its gradual loss in power to respond to new demands4 ,new habits are difficult or impossible to form1 and old habits are hard to break4 ,attempts to break the habits of a life time are therefore dangerous1 and radical changes in old people's ways of living are attended by risk as well as by unhappiness4 ,such loss of adaptability in the nervous system makes it increasingly difficult for old people to assimilate new ideas and to understand new points of view4 ,the feeling that the world is strange and that the next generation has gone on without them accounts for the tragic loneliness of many old people4 ,clearly it is for those who are younger and more flexible to bridge the gulf between the generations by their understanding and their sympathy4 ,physical care to whatever extent it is needed should be given to all old people as soon as they are unable to care for themselves1 and thought should be given to adapting their surroundings and ways of living to their strength and needs1 just as they should be adapted to the strength and needs of chronic patients4 ,but a warning should be given against managing old people too much4 ,it is hard for people who have managed their own lives successfully for many years to be managed1 even for their own good4 ,indeed1 it is questionable kindness to deprive old people of all freedom of action1 even if following their own inclinations occasionally has disastrous results4 ,few persons would wish to prolong their lives if long life involved being thwarted in every desire1 and sometimes real kindness consists in allowing old people to do certain things that are not good for them4 ,keeping them warm and letting them do as they please will go far to make old people happy4 ,many of the changes in old age reverse the developing process of childhood4 ,in youth and age extremes meet1 and the care of the aged presents certain marked similarities to the care of little children4 ,both require simple food1 occupations suited to their strength1 and protection from infections1 from fatigue1 and from nervous strain2 both are dependent1 more or less helpless1 and for their happiness both need the affectionate care of their own families4 ,but in one respect their needs are fundamentally different4 ,in childhood formation of proper habits is all important1 and in caring for children the future effect of every word and act must be taken into consideration4 ,old people1 on the other hand1 since they live largely in the past and their habits are irrevocably formed1 may be indulged without harm in ways that would demoralize a child2 with a clear conscience one may make them happy in ways both great and small4 ,this difference makes possible one of the greatest pleasures that come to one who cares for the helpless and the sick1 for of all enduring satisfactions few are greater than the power to fill with comfort and happiness the closing days of life4 ,,exercises #a4 ,what is meant by a physical defect8 ,name some of the most common defects4 #b4 ,name some permanent injuries to the body caused by defective teeth2 by diseased or enlarged tonsils and adenoids2 by faulty posture4 #c4 ,describe some common symptoms of eye strain in children2 of enlarged tonsils and adenoids2 of deafness4 #d4 ,name several possible causes of round shoulders1 and explain why urging a round-shouldered child to hold himself erect is seldom enough to make him correct his posture4 #e4 ,what measures should be taken to overcome nervousness in children8 #f4 ,describe in detail the health work carried on in the public schools of your city or town4 ,considering the important part played by uncorrected physical defects in causing permanent physical disability among adults1 do you think in the long run it is cheaper or more expensive for a community to spend money in protecting the health of school children8 #g4 ,discuss the particular needs of convalescent and of chronic patients4 #h4 ,explain the effect of activity upon recovery1 and explain why it is desirable for invalids to have occupation4 #i4 ,what special needs should be provided for in caring for old people8 ,,for ,,further ,,reading ,invalid ,occupations--,tracy4 ,occupation ,therapy--,dunton4 ,handicrafts for the ,handicapped--,hall and ,buck4 ,when ,mother ,lets ,us ,make ,toys--,rich4 ,amusements for ,convalescent ,children--,new ,york ,state ,department of ,health1 ,albany4 ,essentials of ,medicine--,emerson1 ,chapter ,,ix4 ,civics and ,health--,allen4 ,how to ,live--,fisher and ,fisk1 ,chapter ,,iii1 ,section ,,ii2 and ,supplementary ,notes1 ,section ,,iii4 ,health ,work in the ,schools--,hoag and ,terman4 ,medical ,inspection of ,schools--,gulick and ,ayres4 ,the ,hygiene of the ,child--,terman4 ,posture of ,school ,children--,bancroft4 ,,chapter ,,xv ,,questions ,,for ,,review ,i4 ,show how you would3 #a4 ,make an unoccupied bed4 7,notice the number of minutes it takes you to do it well47 #b4 ,remove all the covers from an unoccupied bed and leave the bed to air4 #c4 ,open a bed to receive a patient4 ,,ii4 ,show how you would3 #a4 ,change all the linen and remake an occupied bed4 7,how long did it take you87 #b4 ,turn a patient from his back to his side1 and the reverse4 #c4 ,remove1 shake1 and readjust a patient's pillows4 #d4 ,move a patient from one bed to another4 #e4 ,prepare a weak patient to sit up in a chair1 and assist him from the bed to the chair4 #f4 ,assist a weak patient from the chair to the bed4 #g4 ,arrange pillows and back rest for a patient to sit up in bed2 and also how you would remove the pillows and back rest4 ,,iii4 ,show how you would3 #a4 ,lift a patient who has slipped down toward the foot of the bed1 and show what you would do to prevent him from slipping down4 #b4 ,prevent bed covers from resting upon a sensitive foot1 leg1 abdomen1 or arm4 #c4 ,describe and demonstrate every device you would use and every thing you would do to prevent pressure sores4 #d4 ,arrange pillows to support the arms of a person sitting up in bed4 #e4 ,arrange a table or a substitute for a table to support the book or work of a patient sitting up in bed4 #f4 ,arrange the light for a patient who is allowed to read in bed4 ,,iv4 #a4 ,assemble all the articles you would use in giving a bed bath4 7,how long did it take you87 #b4 ,show how to give a complete bed bath4 7,how long did it take you8 ,did you have to stop the bath to fetch anything you had forgotten87 #c4 ,what special care would you give to the mouth and teeth8 to the finger and toe nails8 to the hair8 to badly tangled hair8 ,how would you cleanse the mouth of a helpless patient8 #d4 ,show how to shampoo the hair of a bed patient4 #e4 ,show how you would give a bath to a baby4 #f4 ,show everything that you would do to prepare a patient for the night4 ,v4 #a4 ,show how to take the temperature1 pulse1 and respiration4 #b4 ,show how to cleanse a clinical thermometer4 #c4 ,show how to give a foot bath 7a7 to a patient out of bed1 7b7 to a patient in bed4 #d4 ,show how you would give a cool sponge bath to a feverish patient4 #e4 ,show how to give1 remove1 and cleanse a bed-pan4 #f4 ,show how to fill and apply a hot water bag2 an ice bag4 #g4 ,show how to prepare and apply a mustard paste2 a mustard leaf2 a flaxseed poultice2 hot fomentations2 cold compresses4 #h4 ,show how to measure and administer a fluid medicine2 pills or tablets4 #i4 ,show how to prepare and administer a salt and water enema to a grown person2 to a baby4 #aj4 ,show how to prepare steam inhalations4 #aa4 ,show how to apply an ointment2 a liniment4 ,,vi4 #a4 ,show how you would feed a helpless patient who is lying down4 #b4 ,show how you would feed a patient who is able to sit up but unable to use his hands4 #c4 ,prepare a liquid nourishment tray4 #d4 ,set a tray for light diet2 for full diet4 #e4 ,show how to place a tray for a patient unable to sit up but able to feed himself2 for a patient sitting up in bed4 #f4 ,what personal care should be given a patient just before meals8 just after meals8 #g4 ,how would you modify the diet of a patient inclined to constipation8 to diarrha8 ,,vii4 #a4 ,describe effective household methods for removing dust4 #b4 ,demonstrate the cleaning of a refrigerator4 #c4 ,show how to ventilate a sick room while protecting the patient from direct draughts4 #d4 ,show how to clean a sick room with a minimum of disturbance to the patient4 #e4 ,explain how a patient with communicable disease should be isolated4 #f4 ,demonstrate the daily care of a room occupied by a patient with communicable disease4 #g4 ,explain methods of concurrent disinfection4 #h4 ,explain methods of terminal disinfection4 #i4 ,tell how the following should be disinfected3 discharges from the nose1 throat1 eyes1 ears1 bowels1 bladder1 wounds1 and sores2 bed and personal linen2 blankets2 mattresses2 dishes2 utensils1 especially bedpans and urinals2 clothing and person of the attendant1 especially the hands2 furniture1 rugs1 and woodwork4 ,,viii4 #a4 ,name some of the most obvious symptoms of sickness4 #b4 ,name some symptoms that would lead you to take a patient to a doctor2 to send for a doctor2 to send for a doctor in haste4 #c4 ,name some symptoms that are dangerous to neglect even though the patient feels fairly well4 #d4 ,what are some of the symptoms of physical defects in children8 ,name some conditions that are frequently caused by unremedied defects4 #e4 ,name some diseases commonly ushered in by symptoms resembling those of a cold in the head4 #f4 ,what symptoms would lead you to isolate a patient8 #g4 ,give as many illustrations as you can of the part played by good and bad habits in determining health and sickness4 ,,ix4 #a4 ,how would you dress a cut8 a burn8 a sprain8 #b4 ,what would you do for a person suffering from colic8 nausea8 diarrha8 chill8 #c4 ,what are the symptoms of shock8 heat stroke8 heat prostration8 ,what treatment would you give in each case8 #d4 ,what would you do for a fainting person8 for a person suffering from nose bleed8 from earache8 from a cinder in the eye8 #e4 ,what course of action would you advise for a person troubled with sleeplessness8 frequent headaches8 excessive irritability8 unusual depression of spirits8 unfounded suspicions of other persons' motives8 a tendency to have the feelings hurt easily8 inability to control the emotions8 ,x4 #a4 ,why is it better to prevent sickness than to cure it8 #b4 ,name the essentials of good hygienic conditions for babies1 for children1 for grown people1 for the aged4 #c4 ,how much of the sickness in the ,united ,states is preventable8 #d4 ,if part of the sickness is preventable1 why is it not prevented8 #e4 ,what constitutes adequate care of the sick8 #f4 ,what proportion of the young men in your community who were drafted have been rejected for physical disability8 ,how many were rejected for disabilities that might have been prevented8 ,,xi4 7,answers to the following questions can generally be obtained from local health officers47 #a4 ,what are the duties and powers of your local board of health8 #b4 ,how much did your city or town spend per person last year on health protection8 ,how does this amount compare with the amount spent per person for police protection8 for fire protection8 #c4 ,who inspects the water supply in your town8 the milk supply8 the food supply8 #d4 ,in your city1 what was the number of deaths per #ajj1jjj of the population from tuberculosis each year for the last five years8 from typhoid fever8 #e4 ,is there a tuberculosis sanitarium in your city or county8 ,are nurses employed to supervise tuberculosis patients who remain at home8 #f4 ,what provision does your community make for patients suffering from other communicable diseases8 #g4 ,what measures are taken in your community to instruct school children in matters of health8 to instruct grown persons8 #h4 ,how does your community provide medical and nursing care for persons unable to pay part or all of the cost of such service8 ,,xii4 ,explain why the following common beliefs are erroneous or unfounded3 #a4 ,that a damp cellar causes diphtheria4 #b4 ,that night air is harmful4 #c4 ,that one should stuff a cold and starve a fever4 #d4 ,that almost everyone needs a tonic in the spring4 #e4 ,that the health of one's family would be endangered if a tuberculosis hospital were placed on the next block4 #f4 ,that clearing up the back yard will protect the children of a family from infantile paralysis4 #g4 ,that odorless and tasteless water is necessarily free from harmful germs4 #h4 ,that all children should have the children's diseases1 and have them as early as possible4 #i4 ,that boils are a benefit to the system by removing impurities from the blood4 #aj4 ,that tomatoes cause cancer4 #aa4 ,that consumption is inherited4 #ab4 ,that dirt breeds disease4 #ac4 ,that diseases come up drains4 #ad4 ,that if a teaspoonful of medicine does you good1 a tablespoonful will do you more good4 #ae4 ,that instinct teaches a mother how to care for her baby4 #af4 ,that low heeled shoes1 though suitable for boys and men1 cause broken arches in women and girls4 #ag4 ,that in one's own case1 the rule that everyone needs regular meals1 regular hours of sleep1 and daily exercise out of doors1 may be safely violated4 ,,appendix ,the ,new ,york ,city ,department of ,health has kindly permitted us to include the following circulars of information issued by the ,division of ,child ,hygiene4 ,,department ,,of ,,health ,,the ,,city ,,of ,,new ,,york ,,instructions ,,to ,,parents ,,regarding ,,the ,,care ,,of ,,the ,,mouth ,,and ,,teeth4 ,the physical examination of school children shows that in many instances the teeth are in a decayed and unhealthy condition4 ,decayed teeth cause an unclean mouth4 ,toothache and disease of the gums may result4 ,neglect of the first teeth is a frequent cause of decay of the second teeth4 ,if a child has decayed teeth1 it cannot properly chew its food4 ,improperly chewed food and an unclean mouth cause bad digestion1 and consequently poor general health4 ,if a child is not in good health1 it cannot keep up with its studies in school4 ,it is more likely to contract any contagious disease1 and it has not the proper chance to grow into a robust1 healthy adult4 ,if the child's teeth are decayed1 it should be taken to a dentist at once4 ,the teeth should be brushed after each meal1 using a tooth brush and tooth powder4 ,the following tooth powder is recommended3 #b oz4 powdered precipitated chalk4 oz4 powdered ,castile soap1 #a dram powdered orris root4 ,thoroughly mix4 ,this prescription can be filled by any druggist at a cost not to exceed fifteen cents4 ,,department ,,of ,,health ,,city ,,of ,,new ,,york ,instructions to ,parents ,regarding the ,care of the ,nose ,the physical examination of school children shows that in many instances they breathe through the mouth because they cannot breathe properly or sufficiently through the nose4 ,this may be due to bad habits in regard to keeping the nose clean1 or1 in a majority of instances1 to a growth which is known as adenoids and which stops up the back of the nose4 ,in either case1 the air is not breathed through the nose1 and the child becomes what is known as a mouth breather4 ,constant breathing through the mouth causes the child to become pale1 restless in its sleep and dull in its actions4 ,the child often speaks as though it had a cold in the head4 ,frequently there is an almost constant discharge from the nose4 ,mouth breathing renders a child especially liable to contract tuberculosis and other infectious diseases2 in fact1 the child has very little resistance to disease of any kind4 ,every child should be given a handkerchief1 and be taught to thoroughly blow the nose several times each day4 ,if1 after doing this regularly1 the child is still unable to breathe properly through the nose1 it is probable that an adenoid growth is present4 ,such children should be taken to the family physician or to a dispensary for further advice and treatment4 ,do not wait too long in the hope that the child will outgrow the condition1 for the effect of adenoid growths persisting throughout childhood may injure the person for life4 ,have your child's throat and nose examined one month after measles1 scarlet fever1 or diphtheria4 ,,department ,,of ,,health ,,city ,,of ,,new ,,york ,instructions to ,parents on the ,care of ,children's ,hair and ,scalp ,children affected with vermin of the head are excluded from school4 ,the following directions will cure the condition3 ,mix one-half pint of sweet oil and one-half pint of kerosene oil4 ,shake the mixture well and saturate the hair with the mixture4 ,then wrap the head in a large bath towel or rubber cap so that the head is entirely covered2 the head must remain covered from six to eight hours4 7,tincture of larkspur may be used instead of oil mixture4 ,the directions for use are the same47 ,after removing the towel1 the head should be shampooed as follows3 ,to two quarts of warm water add one teaspoonful of sodium carbonate 7washing soda74 ,wet the hair with this solution and then apply ,castile soap and rub the head thoroughly about ten minutes4 ,wash the soap out of the hair with repeated washings of clear warm water4 ,dry the hair thoroughly4 ,nits3 ,if the head is shampooed regularly each week as above described1 it will cure and prevent the condition of nits4 ,,department ,,of ,,health ,,city ,,of ,,new ,,york ,,diet ,,for ,,child ,,from #ab,,th ,,to #ah,,th ,,month ,,first ,,meal--,,on ,,rising4 7#a7 #a to #b ounces juice of a sweet orange or ,pulp of #f stewed prunes or #a ounce pineapple juice4 7#b7 #h ounces milk with either zwieback1 or toasted biscuits or stale toasted bread4 ,note3 ,fruit must be given either hour before or hour after milk4 ,,second ,,meal--,,during ,,forenoon4 ,milk alone or with zwieback4 ,,noon ,,meal4 7#a7 #f ounces soup or #c ounces beef juice4 ,note3 ,soup may be made of chicken1 beef or mutton4 7#b7 ,stale bread may be added to the above4 ,,fourth ,,meal--,,afternoon4 ,milk or toasted bread and milk4 ,,evening ,,meal4 7#a7 #d ounces thick gruel mixed with #d ounces top half milk4 ,taken with zwieback4 ,note3 ,gruel may be made of oatmeal1 farina1 barley1 hominy1 wheatena1 or rice4 7#b7 ,apple sauce or ,prune jelly4 ,total milk in #bd hours1 #a to #a quarts4 ,note3 #h ounces is equal to a half pint4 ,,department ,,of ,,health ,,city ,,of ,,new ,,york ,,diet ,,for ,,child ,,from #ah,,th ,,to #bd,,th ,,month ,,breakfast4 7#a7 ,juice of one sweet orange or ,pulp of six stewed prunes or ,pineapple juice 7fresh or bottled7 #a ounce4 7#b7 ,a cereal such as cream of wheat1 oatmeal1 farina1 or hominy preparations with top milk 7top #af ounces7 sweetened or salted4 ,a glass of milk1 bread and butter4 ,note3 ,if constipated give the fruit hour before breakfast with water2 if not1 they may be given during the forenoon4 ,raw fruit juice must be given either hour before or hour after milk4 ,,forenoon4 ,a glass of milk with two toasted biscuits or zwieback or graham crackers4 ,,dinner4 7#a7 ,broth or soup made of beef1 mutton1 or chicken1 and thickened with peas1 farina1 sago or rice or ,beef juice with stale bread crumbs2 or clear vegetable soup with yolk of egg or ,egg soft boiled1 with bread crumbs1 or the egg poached1 with a glass of milk4 7#b7 ,dessert3 apple sauce1 prune pulp1 with stale lady-fingers or graham wafers or ,plain puddings3 rice1 bread1 tapioca1 blanc-mange1 junket or baked custard4 ,,supper4 ,glass of milk1 warm or cold2 zwieback and custard or stewed fruit4 ,total milk in #bd hours1 #a quarts4 ,,department ,,of ,,health ,,city ,,of ,,new ,,york ,,diet ,,for ,,child ,,from ,,two ,,to ,,three ,,years ,,breakfast4 7#a7 ,juice of #a sweet orange or ,pulp of #f stewed prunes or #a ounce pineapple juice 7fresh or bottled7 or ,apple sauce4 7#b7 ,a cereal such as oatmeal1 farina1 cream of wheat1 hominy or rice1 slightly sweetened or salted as preferred1 with the addition of top milk 7top #af ounces7 or ,a soft boiled or poached egg with stale bread or toast4 7#c7 ,a glass of milk4 ,note3 ,if constipated give the fruit hour before breakfast with water2 if not1 they may be given during the forenoon4 ,milk and raw fruit juice must not be given at same meal4 ,,dinner4 7#a7 ,broth or soup made of chicken1 mutton or beef1 thickened with arrowroot1 split peas1 rice1 or with addition of the yolk of an egg or toast squares4 7#b7 ,scraped beef or white meat of chicken1 or broiled fish 7small amount7 or ,mashed or baked potatoes with fresh peas or spinach or carrots4 7#c7 ,dessert3 apple sauce1 baked apple1 rice pudding1 junket or custard4 ,,supper4 7#a7 ,a cereal or egg 7if egg is not taken with breakfast7 with stale bread or toast or ,bread and milk or bread and cocoa or bread and custard4 7#b7 ,stewed fruit4 ,,department ,,of ,,health ,,city ,,of ,,new ,,york ,,diet ,,for ,,child ,,from ,,three ,,to ,,six ,,years ,,breakfast4 7#a7 ,fruits3 an orange1 apple1 pear or stewed prunes4 7#b7 ,cereal3 oatmeal1 hominy1 rice or wheat preparations1 well cooked and salted1 with thin cream and sugar or ,egg3 soft boiled1 poached1 omelet or scrambled4 7#c7 ,milk or cocoa4 ,,dinner4 7#a7 ,soup3 beef1 chicken or mutton4 7#b7 ,meat3 chicken or beefsteak or roast beef or lamb chops or fish4 7#c7 ,vegetables3 spinach or carrots or string beans1 peas1 cauliflower tops1 mashed or baked potatoes1 beets or lettuce 7without vinegar7 ,macaroni1 spaghetti4 ,bread and butter--not fresh bread or rolls4 7#d7 ,dessert3 custard1 rice or bread or tapioca pudding1 ice cream 7once a week7 cornstarch pudding 7chocolate or other flavor7 stewed prunes or baked apple4 ,,supper4 7#a7 ,milk toast or graham crackers and milk or ,a thick soup1 as pea1 or cream of celery with bread and butter or ,a cereal and thin cream with bread and butter4 7#b7 ,stewed fruit2 custard or plain pudding2 jam or jelly4 ,,glossary 7,for complete definitions of the following words the student is referred to general and scientific dictionaries7 ,a ,,antiseptic4--,a substance which prevents or hinders the growth of micro-organisms4 ,,antitoxin4--,a substance that neutralizes the action of a toxin4 ,,aseptic4--,free from living germs4 ,,axilla4--,the armpit4 ,b ,,bacillus 7pl4 bacilli74--,a rod-shaped or elongated bacterium4 ,,bacterial4--,relating to bacteria4 ,,bactericide4--,an agent having the power to destroy bacteria4 ,,bacteriological4--,relating to bacteriology4 ,,bacteriology4--,the science dealing with microorganisms4 ,,bacterium 7pl4 bacteria74--,a unicellular vegetable micro-organism4 ,c ,,carrier4--,an apparently healthy person who harbors pathogenic germs in his body4 ,,coccus 7pl4 cocci74--,a bacterium of spherical or nearly spherical shape4 ,,counter-,,irritant4--,a substance or agent which if applied to the skin causes irritation and thereby relieves an abnormal condition in another part of the body4 ,d ,,degeneration4--,a deterioration in cells or tissues of the body so that they become less able to perform their proper functions4 ,,degenerative4--,pertaining to degeneration4 ,,deodorant4--,an agent that destroys odors4 ,,digestive ,,tract4--,the entire alimentary canal1 including the mouth1 sophagus1 stomach1 and the small and large intestines4 ,,diplococcus4--,a form of coccus in which two individuals remain attached after cell division has taken place4 ,,disinfect4--,to destroy the germs of disease4 ,,disinfectant4--,an agent that destroys the germs of disease4 ,,disinfection4--,the process of destroying the germs of disease4 ,e ,,emetic4--,a substance used to induce vomiting4 ,,enema4--,an injection of fluid into the rectum4 ,f ,,fecal4--,pertaining to feces4 ,,feces4--,matter discharged from the bowels2 bowel movement4 ,,fermentation4--,decomposition produced in an organic substance by the action of certain living agents4 ,,fission4--,the process by which a cell divides into two parts4 ,,flagellum 7pl4 flagella74--,a long hair-like appendage1 by the action of which certain micro-organisms are enabled to move4 ,,flex4--,to bend at a joint4 ,,fomentation4--,see ,stupe4 ,g ,,gastric ,,juice4--,the fluid secreted by the glands of the stomach4 ,,germ4--,a minute unicellular organism1 either animal or vegetable2 a micro-organism2 a microbe4 ,,germicide4--,an agent having the power to kill germs4 ,h ,,host4--,an animal or plant in or upon which another organism lives4 ,i ,,immune4--,not susceptible to a particular disease2 also1 a person who is not susceptible to a particular disease4 ,,immunity4--,the state in which an individual is not susceptible to a particular disease4 ,,immunize4--,to render immune4 ,,incubation4--,the interval between exposure to an infectious disease and the first appearance of symptoms4 ,,infect4--,to communicate disease germs4 ,,infection4--,an agent by which disease may be communicated from one individual to another2 also1 an infectious disease4 ,,inoculate4--,to introduce any biological product directly into the tissues of the body4 ,,inoculation4--,the process of inoculating4 ,,intestinal ,,tract4--,the small and large intestines4 ,m ,,microbe4--,see ,germ4 ,,micro-,,organism4--,see ,germ4 ,,mucus4--,the substance secreted by mucous membranes4 ,,mucous ,,membranes4--,the membranes lining certain cavities of the body1 especially the digestive and respiratory tracts4 ,n ,,nutrient4--,one of several chemical groups to which the essential constituents of food belong4 ,o ,,organic4--,derived from or relating to an organism4 ,,organism4--,an individual that is or has been alive4 ,p ,,parasite4--,an individual that lives in or upon another individual4 ,,pasteurization4--,the process of pasteurizing4 ,,pasteurize4--,to subject milk to a temperature of #adb-ade ,fahrenheit for thirty minutes4 ,,pathogenic4--,disease-producing4 ,,pertussis4--,whooping-cough4 ,,proteid4--,one of the complex nitrogenous substances constituting the essential parts of animal and vegetable tissues4 ,,protozo,n 7pl4 protozoa74--,an animal organism composed of a single cell4 ,,pus4--,the fluid product of inflammation2 matter4 ,,putrefaction4--,decomposition of nitrogenous organic matter brought about by micro-organisms and accompanied by a foul odor4 ,r ,,resistance4--,see ,immunity4 ,,respiratory ,,tract4--,the air passages1 including the nose1 mouth1 larynx1 trachea1 bronchial tubes1 and lungs4 ,s ,,saprophyte4--,a vegetable organism that lives on decaying organic matter4 ,,sarcina4--,literally1 a bundle4 ,applied to bacteria grouped in bundles or packets4 ,,septic4--,putrefying or decomposing2 infected by pus-producing bacteria4 ,,sequela4--,a disease or unhealthy condition following another disease or unhealthy condition4 ,,serum4--,the fluid which separates from the clot after blood has coagulated2 especially1 that containing an antitoxin4 ,,sewage4--,any substance containing urine or fecal matter2 also1 the substance which passes through sewers4 ,,spirillum 7pl4 spirilla74--,a variety of bacteria having spirally twisted cells4 ,,spore4--,a resting stage1 characterized by great resistance1 into which certain germs enter when conditions become unfavorable for their growth4 ,,sputum4--,spit2 expectoration4 ,,staphylococcus4--,a variety of bacteria that group themselves in masses resembling bunches of grapes4 ,,sterile4--,free from living germs2 aseptic4 ,,sterilization4--,the process of rendering sterile4 ,,sterilize4--,to render sterile4 ,,streptococcus4--,a variety of bacteria that arrange themselves in chains4 ,,stupe4--,a cloth wrung out of hot water and applied to the surface of the body4 ,,susceptible4--,lacking resistance to a disease4 ,,susceptibility4--,the condition in which resistance to a disease is low4 ,t ,,tetrad4--,a variety of bacteria that arrange themselves in groups of four4 ,,tissue4--,a collection of cells having the same function4 ,,toxin4--,a poison produced by the action of micro-organisms4 ,u ,,unicellular4--,composed of a single cell4 ,,uterus4--,the womb4 ,v ,,vaccinate4--,to inoculate with a poison in order to bring about immunity to a disease4 ,,vaccine4--,any substance which if introduced into the body causes the formation of protective substances4 ,,vomitus4--,vomited substances4 ,,index ,a ,abdomen1 #fh ,abdominal binder1 #fh ,action of drugs1 #bjj ,adenoids1 #bhd ,aged1 care of1 #cjc ,ailments and emergencies1 #beg ,air1 #gb ,alcohol1 #afj ,appliances1 bed cradles1 #agc bedpans1 #agf rubber utensils1 #ach ,applications1 local1 #bbj cold1 dry1 #bca cold1 moist1 #bce hot1 dry1 #bbe bricks1 #bbf flannel1 #bbf salt or sand1 #bbf water bags1 #bbe hot1 moist1 #bbg fomentations1 #bbi poultices1 #bbg stupes1 #bbi ,attendant1 #abg ,b ,bacteria1 #a1 #d1 #e bacilli1 #e coccus1 #d effects produced by1 #c entrance into the body1 #i food of1 #b immunity1 #ac in food1 #ai in water1 #ai methods of study1 #a motion1 #e origin of communicable diseases1 #c parasites1 #c1 #h saprophytes1 #b shape1 #d spirillum1 #d spores1 #g structure and development1 #d where found1 #h ,bacteriology1 #a ,baths1 #db1 #aed bed1 #aef cleansing1 #aga cold tub1 #ig1 #aga daily1 #bd foot1 #afe mustard1 #afe hot1 #ig infant's1 #gh sitz1 #agf tub1 #aed ,bed cradles1 #agc ,bedmaking1 #acb ,bedpan1 #agf ,bed-rooms1 care of1 #hd ,beds1 #acb care of1 #acd dimensions1 #acc rubber pillow cases1 #ach rubber sheets1 #ach selection of1 #acb wooden1 #acb ,bed sores1 #afi ,birth registration1 #fc ,blankets1 #adj ,bleeding1 #bgb ,blindness1 #cc ,breast feeding1 #gc ,bruises1 #bgf ,brush burn1 #bgh ,burns1 #bgg1 #bgh ,c ,cancer1 #aaa ,carriers1 #ag ,charts1 #aj1 #bdf ,chickenpox1 #bcf ,childhood1 see ,infancy1 #fj ,children1 care of1 #bhj with adenoids1 #bhd with defective hearing1 #bhe with defective teeth1 #bhf with enlarged tonsils1 #bhd with eyestrain1 #bhd with incorrect posture1 #bhf with physical defects1 #bhc with predisposition to nervousness1 #bib ,chills1 #bgj ,chronic patients1 care of1 #bii ,circulars of information1 #cah ,department of ,health1 ,city of ,new ,york1 #cah care of hair and scalp1 #cba care of mouth and teeth1 #cah care of nose1 #cbj diet of child twelfth to eighteenth month1 #cbb diet of child eighteenth to twenty-fourth month1 #cbc diet of child two to three years1 #cbd diet of child three to six years1 #cbe ,cleaning room1 #abf ,cleanliness1 personal1 #da ,clothing1 #dg disinfection of1 #ie of infants1 #fh ,coccus1 #d ,cold applications1 #bbj ,cold1 prevention of common1 #bda ,colic1 #bff ,compresses1 cold1 #bcb ,constipation1 #eb1 #aic1 #bff ,convalescents1 care of1 #bid ,convulsions1 #bfj ,counter irritants1 #bcc ,croup1 #bga ,d ,degenerative diseases1 #bj1 #bd ,development of child1 #fd ,diaper1 #fi ,diarrha1 #bff ,diphtheria1 #bde ,disinfectants1 #bea ,disinfection1 #bdh ,drainage1 #dj ,draughts1 #cb ,dust1 effect upon health1 #cf ,e ,ear1 disorders affecting1 #bfh ,emergencies1 #beg ,enemata1 #baj directions for giving1 #baj for baby1 #bab ,environment1 #bi ,eruptive diseases1 #bcf ,excreta1 disinfection of1 #bdi ,excretions1 #eb ,expectoration1 #bdi ,eye1 ailments1 #bfg compresses for1 #bcb foreign bodies in1 #bfg ,eyestrain1 #bhd ,f ,fainting1 #bei ,fatigue1 #ec1 #ajf1 #aha ,feeding of infants1 #gc ,filtration of water1 #ej ,flies1 as carriers of disease germs1 #ch ,floors1 #abj ,fomentations1 #bbi ,food1 #ce1 #dh1 #ahh classification of1 #dh for children1 #gh for infants1 #gb ,foot bath1 #afe ,fumigation1 #bed ,furniture1 #abj ,g ,garbage1 #cg ,glossary1 #cbf-ccj ,growth of child1 #fd ,h ,habits1 #hb ,hair1 care of1 #afc ,handkerchiefs1 #bci ,hands1 #aa1 #ab1 #dc1 #bej ,headache1 #beg ,heat1 application of1 #bbj exhaustion1 #bfd ,heating1 #ed ,heredity1 #bg ,hiccough1 #bfe ,house1 cleanliness of1 #cc ,humidity1 #ca ,hygiene1 oral1 #dd personal1 #ai1 #bh ,i ,immunity1 #ac ,infancy 7and childhood71 hygiene of1 #fj air1 fresh1 #gb baths1 #gh care of eyes1 #hj of mouth1 #ha of nostrils1 #ha of genital organs1 #ha clothing1 #fh cry1 significance of1 #hb diet1 #gd mother's milk1 danger of substitutes1 #gb water1 #ge weaning1 #ge excretions1 #fg exercise1 #hc growth and development1 #fd1 #fe length at birth1 #fd increase1 #fe muscular development1 #fd special senses1 #ff speech1 #ff teeth1 #ff weight at birth1 #fd increase1 #fe habits1 #hb mortality1 #fa nursing bottles1 #ge nipples1 #ge play1 #hd pulse1 #if respiration1 #ii sleep1 #gj toys1 #he ,infection1 #a1 #dc ,inflammation1 #bbj ,inhalation1 #bac ,insects1 #ch1 #bgj ,insect bites and stings1 #bgj ,inunction1 #bad ,isolation1 duration of1 #bdg ,ivy poisoning1 #bgj ,k ,kitchens1 #cd ,l ,light1 #cc1 #abd ,linen1 #bea ,lysol1 #bea ,m ,malaise1 #ajf ,mattress1 #ace care of1 #acf ,measles1 #bdf ,medicines and remedies1 #bjj action of drugs1 #bjj amateur dosing1 #bjb enemata1 #baj inhalation1 #bac inunction1 #bad patent remedies1 #bje sprays and gargles1 #bac suppositories1 #bji ,medicines1 administration of1 #bjf ,menstruation1 profuse1 #bge ,mental condition1 #ajd-aab ,microorganisms1 #i ,milk1 #ea pasteurization1 #ea ,mouth1 care of1 #afj wash1 #ahb ,mustard paste1 #bcc leaves1 #bcc ,n ,nausea1 #bfe ,nipple1 bottle1 #gg care of1 #gg ,non-communicable diseases1 #bj ,nosebleed1 #bgd ,p ,pain1 #aje ,parasites1 #c1 #d1 #h ,patent remedies1 #bje ,patient1 care of1 with communicable disease1 #bcf with colds and slight infections1 #bch with more serious infections1 #bdb changing sheet1 #adg changing1 #adf lifting1 #adf mouth1 #afj moving1 #aeb ,personal hygiene1 #ai ,pillows1 #acg covers1 #ach1 #adj ,poisonous drugs1 #bae ,posture1 #bhf ,poultices1 #bbg1 #bbh ,prenatal care1 #fb ,prickly heat1 #bfi ,protozoa1 #h ,public agencies1 #ajg ,public sanitation1 #ai ,pulse1 #if ,purification of water1 #ej ,q ,quarantine1 termination of1 #beb ,r ,records1 #ajg ,recreation1 #ee ,rectum1 #ic ,respiration1 #ii ,rest1 #ec ,rooms1 #bg ,s ,saprophytes1 #b ,scalds1 #bgg ,scarlet fever1 #bdf ,sewage1 #ci ,sheets1 #acg1 #ach1 #adb ,shock1 #bfa ,sick-room1 model1 #aah ,sleep1 #ee1 #gj ,sleeplessness1 #beh ,small-pox1 #bdf ,special senses in sickness1 #aja ,spores1 #g ,sprains1 #bge ,sprays and gargles1 #bac ,stimulants1 in emergency work1 #bfc ,stupes1 #bbi ,styes1 #bfg ,sunstroke1 #bfd ,suppositories1 #bji ,symptoms1 #hh ,t ,teeth1 #de1 #afj defective1 #bhf treatment1 #df ,temperature1 #ib method of taking1 #ib normal1 #ie ,temperature of baths1 #gi1 #aee of house1 #cj1 #abd sponging for1 #agg variations1 #aad1 #bjf ,thermometer1 clinical1 care of1 #ib ,tonsils1 enlarged1 #bhd ,tuberculosis1 #bg-ajg ,u ,urine1 #ajc ,v ,vaccination1 #ac1 #be ,ventilation1 #bi1 #abc ,vomiting1 #bfe ,w ,water1 #di filtration1 #ej ,weaning1 #ge ,weight1 #fe loss of1 #fd ,whooping cough1 #bdf ,wounds1 #bgb ,transcriber's ,note3 ,punctuation errors 7e4g4 missing period at end of sentence1 missing quotation marks1 etc47 and letters printed upside down have been corrected without note4 ,except where noted1 inconsistencies in hyphenation1 capitalization1 and spelling 7e4g4 travelling and traveling7 have not been changed4 ,the original index had numerous errors1 such as references to terms that do not appear in the text4 ,except where noted below1 it has been left as printed4 ,the following corrections were made3 p4 viii3 ,records1 #aje4 to ,records1 #ajg4 7under ,chapter ,,iv7 p4 ix3 ,care of the ,patients with ,communicable ,diseases to ,care of ,patients with ,communicable ,diseases 7under ,chapter ,,xii7 p4 ix3 ,care of liver1 #bea4 to ,care of linen1 #bea4 7under ,chapter ,,xii7 p4 #ae3 innoculation to inoculation 7,vaccination and inoculation have saved thousands of lives47 p4 #af3 principle to principal 7principal causes which diminish resistance71 to match cited text p4 #cg3 gerns to germs 7through which disease germs7 p4 #dj3 ,from ,the ,human ,mechanism4 to ,from ,the ,human ,mechanism4 7to match format of other captions7 p4 #da3 perferably to preferably 7preferably1 chloride of lime47 p4 #gg3 runnnig to running 7thoroughly cleansed under running water7 p4 #hb3 symptons to symptoms 7other symptoms of distress7 p4 #if3 thay to they 7taken together they are7 p4 #ajh3 #h3cj to #h3cj a4m4 p4 #aaa3 develope to develop 7may develop into cancer7 p4 #aae3 missing degree symbol added 7,at noon his temperature was #aja7 p4 #acb3 illnes to illness 7unless his illness is slight7 p4 #acf3 servicable to serviceable 7makes a serviceable cover7 p4 #aej3 paitent to patient 7ready for the patient47 p4 #aej-aea3 removed duplication of text in captions for ,fig4 #ad and ,fig4 #ae 7,,changing ,,the ,,draw ,,sheet1 and ,,changing ,a ,,patient ,,from ,,one ,,bed ,,to ,,another7 p4 #afa3 erroneous italics removed from patient and her 7even a patient unable to sit up can brush her teeth7 p4 #afg3 added missing bath 7to give a cool sponge bath7 p4 #age3 ahould to should 7the protection of the abdomen should7 p4 #agg3 expecially to especially 7if it is especially difficult or undesirable7 p4 #agg3 patients' to patient's 7between the patient's back and the pan27 p4 #agh3 deoderant to deodorant 7a properly kept pan needs no deodorant7 p4 #ahc3 invarably to invariably 7casual visitors almost invariably offend7 p4 #ahi3 nurtients to nutrients 7pancreatic juice acts upon all three nutrients7 p4 #aie3 solied to soiled 7is always superior to soiled linen47 p4 #bje3 appy to apply 7apply even more strongly to using patent medicines47 p4 #baa3 #aff to #agf 7the directions on page #agf47 p4 #baf3 selzer to seltzer 7seltzer aperient7 p4 #bbf3 slighest to slightest 7there is the slightest possibility of scalding7 p4 #bbg3 accidently to accidentally 7see that the switch is not accidentally7 p4 #bbh3 cohers to coheres 7when the mixture coheres7 p4 #bbi3 annoint to anoint 7anoint it with vaseline7 p4 #bcc3 dicharge to discharge 7,if there is discharge from the eye17 p4 #bdb3 chould to should 7visitors should be rigidly7 p4 #bde3 himelf to himself 7safeguard the patient himself47 ,table between pp4 #bdf-bdg3 diappearance to disappearance 7,two weeks after onset and one week after disappearance7 ,table between pp4 #bdf-bdg3 pa-patient to patient 7after child last saw patient47 p4 #bej3 ,if to ,it 7,it may be necessary to provide two bedpans7 p4 #bff3 #baf to #aic 7discussed on pages #aic and #eb47 p4 #bhj3 etter to better 7no better place7 p4 #cjj3 attenom1 to attention 7constant attention must be given7 p4 #cjj3 rotion to room1 7hygiene of the sick room17 p4 #cja3 salutory to salutary 7making the salutary small adjustments7 p4 #cjh3 querelous to querulous 7sometimes become querulous7 p4 #cbi3 ,putrifying to ,putrefying 7,putrefying or decomposing7 p4 #cca3 bed-cradles to bed cradles 7,index sub-entry1 under ,appliances7 p4 #cca3 ,bed-cradles to ,bed cradles 7,index entry7 p4 #cca3 ,bed-sores to ,bed sores 7,index entry7 p4 #cca3 ,brushburn to ,brush burn 7,index entry7 p4 #ccb3 ,foot-bath to ,foot bath 7,index entry7 p4 #ccc3 ,microrganisms to ,microorganisms 7,index entry7 p4 #ccc3 ,pre-natal to ,prenatal 7,index entry7 p4 #ccd3 oss to loss 7,index entry for ,weight1 loss of7 ,a fold-out table was facing p4 #bdg in the original book4 ,for the plain text versions1 it has been split into several smaller tables1 with the ,,disease column repeated in each section4 ,in the third section1 ,,poliomyelitis has been hyphenated 7,,polio-,,myelitis7 to save space4 ,the footnote pertaining to the table is immediately after it1 not at the end of the chapter as usual4