A Practical Physiology: A Text-Book for Higher Schools

by Albert F. Blaisdell

Additional Experiments.

Experiment 189. To illustrate the importance of the resonating cavity of the nose in articulation. Pinch the nostrils, and try to pronounce slowly the words “Lincoln,” “something,” or any other words which require the sound of m, ln, or ng.

Fig. 154.

Experiment 190. To illustrate the passage of air through the glottis. Take two strips of India rubber, and stretch them over the open end of a boy’s “bean-blower,” or any kind of a tube. Tie them tightly with thread, so that a chink will be left between them, as shown in Fig. 154. Force the air through such a tube by blowing hard, and if the strips are not too far apart a sound will be produced. The sound will vary in character, just as the bands are made tight or loose.

Experiment 191. “A very good illustration of the action of the vocal bands in the production of the voice may be given by means of a piece of bamboo or any hollow wooden tube, and a strip of rubber, about an inch or an inch and a half wide, cut from the pure sheet rubber used by dentists.
“One end of the tube is to be cut sloping in two directions, and the strip of sheet rubber is then to be wrapped round the tube, so as to leave a narrow slit terminating at the upper corners of the tube.
“By blowing into the other end of the tube the edges of the rubber bands will be set in vibration, and by touching the vibrating membrane at different points so as to check its movements it may be shown that the pitch of the note emitted depends upon the length and breadth of the vibrating portion of the vocal bands.”[^[51]]—Dr. H. P. Bowditch.

Note. The limitations of a text-book on physiology for schools do not permit so full a description of the voice as the subject deserves. For additional details, the student is referred to Cohen’s The Throat and the Voice, a volume in the “American Health Primer Series.” Price 40 cents.

Chapter XIII.
Accidents and Emergencies.

358. Prompt Aid to the Injured. A large proportion of the accidents, emergencies, and sudden sicknesses that happen do not call for medical or surgical attention. For those that do require the services of a physician or surgeon, much can be often done before the arrival of professional help. Many a life has been saved and much suffering and anxiety prevented by the prompt and efficient help of some person with a cool head, a steady hand, and a practical knowledge of what to do first. Many of us can recall with mingled admiration and gratitude the prompt services rendered our families by some neighbor or friend in the presence of an emergency or sudden illness.

In fact, what we have studied in the preceding chapters becomes tenfold more interesting, instructive, and of value to us, if we are able to supplement such study with its practical application to the treatment of the more common and less serious accidents and emergencies.

While no book can teach one to have presence of mind, a cool head, or to restrain a more or less excitable temperament in the midst of sudden danger, yet assuredly with proper knowledge for a foundation, a certain self-confidence may be acquired which will do much to prevent hasty action, and to maintain a useful amount of self-control.

Space allows us to describe briefly in this chapter only a few of the simplest helps in the more common accidents and emergencies which are met with in everyday life.[^[52]]

359. Hints as to what to Do First. Retain so far as possible your presence of mind, or, in other words, keep cool. This is an all-important direction. Act promptly and quietly, but not with haste. Whatever you do, do in earnest; and never act in a half-hearted manner in the presence of danger. Of course, a knowledge of what to-do and how to do it will contribute much towards that self-control and confidence that command success. Be sure and send for a doctor at once if the emergency calls for skilled service. All that is expected of you under such circumstances is to tide over matters until the doctor comes.

Fig. 155.—Showing how Digital Compression should be applied to the Brachial Artery.

Do not presume upon any smattering of knowledge you have, to assume any risk that might lead to serious results. Make the sufferer comfortable by giving him an abundance of fresh air and placing him in a restful position. Do all that is possible to keep back the crowd of curious lookers-on, whom a morbid curiosity has gathered about the injured person. Loosen all tight articles of clothing, as belts, collars, corsets, and elastics. Avoid the use of alcoholic liquors. They are rarely of any real service, and in many instances, as in bleeding, may do much harm.

360. Incised and Lacerated Wounds. An incised or cut wound is one made by a sharp instrument, as when the finger is cut with a knife. Such a wound bleeds freely because the clean-cut edges do not favor the clotting of blood. In slight cuts the bleeding readily ceases, and the wound heals by primary union, or by “first intention,” as surgeons call it.

Lacerated and contused wounds are made by a tearing or bruising instrument, for example, catching the finger on a nail. Such wounds bleed but little, and the edges and surfaces are rough and ragged.

If the incised wound is deep or extensive, a physician is necessary to bring the cut edges together by stitches in order to get primary union. Oftentimes, in severe cuts, and generally in lacerations, there is a loss of tissue, so that the wound heals by “second intention”; that is, the wound heals from the bottom by a deposit of new cells called granulations, which gradually fill it up. The skin begins to grow from the edges to the center, covering the new tissue and leaving a cicatrix or scar with which every one is familiar.

361. Contusion and Bruises. An injury to the soft tissues, caused by a blow from some blunt instrument, or a fall, is a contusion, or bruise. It is more or less painful, followed by discoloration due to the escape of blood under the skin, which often may not be torn through. A black eye, a knee injured by a fall from a bicycle, and a finger hurt by a baseball, are familiar examples of this sort of injury. Such injuries ordinarily require very simple treatment.

The blood which has escaped from the capillaries is slowly absorbed, changing color in the process, from blue black to green, and fading into a light yellow. Wring out old towels or pieces of flannel in hot water, and apply to the parts, changing as they become cool. For cold applications, cloths wet with equal parts of water and alcohol, vinegar, and witch-hazel may be used. Even if the injury is apparently slight it is always safe to rest the parts for a few days.

When wounds are made with ragged edges, such as those made by broken glass and splinters, more skill is called for. Remove every bit of foreign substance. Wash the parts clean with one of the many antiseptic solutions, bring the torn edges together, and hold them in place with strips of plaster. Do not cover such an injury all over with plaster, but leave room for the escape of the wound discharges. For an outside dressing, use compresses made of clean cheese-cloth or strips of any clean linen cloth. The antiseptic corrosive-sublimate gauze on sale at any drug store should be used if it can be had.

Wounds made by toy pistols, percussion-caps, and rusty nails and tools, if neglected, often lead to serious results from blood-poisoning. A hot flaxseed poultice may be needed for several days. Keep such wounds clean by washing or syringing them twice a day with hot antiseptics, which are poisons to bacteria and kill them or prevent their growth. Bacteria are widely distributed, and hence the utmost care should be taken to have everything which is to come in contact with a wounded surface free from the germs of inflammation. In brief, such injuries must be kept scrupulously neat and surgically clean.

Fig. 156.—Dotted Line showing the Course of the Brachial Artery.

The injured parts should be kept at rest. Movement and disturbance hinder the healing process.

362. Bites of Mad Dogs. Remove the clothing at once, if only from the bitten part, and apply a temporary ligature above the wound. This interrupts the activity of the circulation of the part, and to that extent delays the absorption of the poisonous saliva by the blood-vessels of the wound. A dog bite is really a lacerated and contused wound, and lying in the little roughnesses, and between the shreds, is the poisonous saliva. If by any means these projections and depressions affording the lodgment can be removed, the poison cannot do much harm. If done with a knife, the wound would be converted, practically, into an incised wound, and would require treatment for such.

If a surgeon is at hand he would probably cut out the injured portion, or cauterize it thoroughly. Professional aid is not always at our command, and in such a case it would be well to take a poker, or other suitable piece of iron, heat it red hot in the fire, wipe off and destroy the entire surface of the wound. As fast as destroyed, the tissue becomes white. An iron, even at a white heat, gives less pain and at once destroys the vitality of the part with which it comes in contact.

If the wound is at once well wiped out, and a stick of solid nitrate of silver (lunar caustic) rapidly applied to the entire surface of the wound, little danger is to be apprehended. Poultices and warm fomentations should be applied to the injury to hasten the sloughing away of the part whose vitality has been intentionally destroyed.

Any dog, after having bitten a person, is apt, under a mistaken belief, to be at once killed. This should not be done. There is no more danger from a dog-bite, unless the dog is suffering from the disease called rabies or is “mad,” than from any other lacerated wound. The suspected animal should be at once placed in confinement and watched, under proper safeguards, for the appearance of any symptoms that indicate rabies.

Should no pronounced symptoms indicate this disease in the dog, a great deal of unnecessary mental distress and worry can be saved both on the part of the person bitten and his friends.

363. Injuries to the Blood-vessels. It is very important to know the difference between the bleeding from an artery and that from a vein.

If an artery bleeds, the blood leaps in spurts, and is of a bright scarlet color.

If a vein bleeds, the blood flows in a steady stream, and is of a dark purple color.

If the capillaries are injured the blood merely oozes.

Bleeding from an artery is a dangerous matter in proportion to the size of the vessel, and life itself may be speedily lost. Hemorrhage from a vein or from the capillaries is rarely troublesome, and is ordinarily easily checked, aided, if need be, by hot water, deep pressure, the application of some form of iron styptic, or even powdered alum. When an artery is bleeding, always remember to make deep pressure between the wound and the heart. In all such cases send at once for the doctor.

Fig. 157.—Showing how Digital Compression should be applied to the Femoral Artery.

Do not be afraid to act at once. A resolute grip in the right place with firm fingers will do well enough, until a twisted handkerchief, stout cord, shoestring, suspender, or an improvised tourniquet[^[53]] is ready to take its place. If the flow of blood does not stop, change the pressure until the right spot is found.

Sometimes it will do to seize a handful of dry earth and crowd it down into the bleeding wound, with a firm pressure. Strips of an old handkerchief, underclothing, or cotton wadding may also be used as a compress, provided pressure is not neglected.

In the after-treatment it is of great importance that the wound and the dressing should be kept free from bacteria by keeping everything surgically clean.

364. Where and how to Apply Pressure. The principal places in which to apply pressure when arteries are injured and bleeding should always be kept in mind.

Experiment 192. How to tie a square knot. If the student would render efficient help in accidents and emergencies, to say nothing of service on scores of other occasions, he must learn how to tie a square or “reef” knot. This knot is secure and does not slip as does the “granny” knot. The square knot is the one used by surgeons in ligating vessels and securing bandages. Unless one knew the difference, the insecure “granny” knot might be substituted.
A square knot is tied by holding an end of a bandage or cord in each hand, and then passing the end in the right hand over the one in the left and tying; the end now in the left hand is passed over the one in the right and again tied.

Fig. 158.—Showing how a Square Knot may be tied with a Cord and a Handkerchief.

If in the finger, grasp it with the thumb and forefinger, and pinch it firmly on each side; if in the hand, press on the bleeding spot, or press with the thumb just above and in front of the wrist.

For injuries below the elbow, grasp the upper part of the arm with the hands, and squeeze hard. The main artery runs in the middle line of the bend of the elbow. Tie the knotted cord here, and bend the forearm so as to press hard against the knot.

For the upper arm, press with the fingers against the bone on the inner side, and just on the edge of the swell of the biceps muscle. Now we are ready for the knotted cord. Take a stout stick of wood, about a foot long, and twist the cord hard with it, bringing the knot firmly over the artery.

For the foot or leg, pressure as before, in the hollow behind the knee, just above the calf of the leg. Bend the thigh towards the abdomen and bring the leg up against the thigh, with the knot in the bend of the knee.

365. Bleeding from the Stomach and Lungs. Blood that comes from the lungs is bright red, frothy, or “soapy.” There is rarely much; it usually follows coughing, feels warm, and has a salty taste. This is a grave symptom. Perfect rest on the back in bed and quiet must be insisted upon. Bits of ice should be eaten freely. Loosen the clothing, keep the shoulders well raised, and the body in a reclining position and absolutely at rest. Do not give alcoholic drinks.

Blood from the stomach is not frothy, has a sour taste, and is usually dark colored, looking somewhat like coffee grounds. It is more in quantity than from the lungs, and is apt to be mixed with food. Employ the same treatment, except that the person should be kept flat on the back.

366. Bleeding from the Nose. This is the most frequent and the least dangerous of the various forms of bleeding. Let the patient sit upright; leaning forward with the head low only increases the hemorrhage. Raise the arm on the bleeding side; do not blow the nose. Wring two towels out of cold water; wrap one around the neck and the other properly folded over the forehead and upper part of the nose.

Add a teaspoonful of powdered alum to a cup of water, and snuff it up from the hand. If necessary, soak in alum water a piece of absorbent cotton, which has been wound around the pointed end of a pencil or penholder; plug the nostril by pushing it up with a twisting motion until firmly lodged.

367. Burns or Scalds. Burns or scalds are dangerous in proportion to their extent and depth. A child may have one of his fingers burned off with less danger to life than an extensive scald of his back and legs. A deep or extensive burn or scald should always have prompt medical attendance.

In burns by acids, bathe the parts with an alkaline fluid, as diluted ammonia, or strong soda in solution, and afterwards dress the burn.

In burns caused by lime, caustic potash, and other alkalies, soak the parts with vinegar diluted with water; lemon juice, or any other diluted acid.

Remove the clothing with the greatest care. Do not pull, but carefully cut and coax the clothes away from the burned places. Save the skin unbroken if possible, taking care not to break the blisters. The secret of treatment is to prevent friction, and to keep out the air. If the burn is slight, put on strips of soft linen soaked in a strong solution of baking-soda and water, one heaping table spoonful to a cupful of water. This is especially good for scalds.

Fig. 159.—Dotted Line showing the Course of the Femoral Artery.

Carron oil is one of the best applications. It is simply half linseed-oil and half lime-water shaken together. A few tablespoonfuls of carbolic acid solution to one pint may be added to this mixture to help deaden the pain. Soak strips of old linen or absorbent cotton in this time-honored remedy, and gently apply.

If carbolized or even plain vaseline is at hand, spread it freely on strips of old linen, and cover well the burnt parts, keeping out the air with other strips carefully laid on. Simple cold water is better than flour, starch, toilet powder, cotton batting, and other things which are apt to stick, and make an after-examination very painful.

Fig. 160.—Showing how Hemorrhage from the Femoral Artery may be arrested by the Use of an Improvised Apparatus (technically called a Tourniquet).

368. Frost Bites. The ears, toes, nose, and fingers are occasionally frozen, or frost-bitten. No warm air, warm water, or fire should be allowed near the frozen parts until the natural temperature is nearly restored. Rub the frozen part vigorously with snow or snow-water in a cold room. Continue this until a burning, tingling pain is felt, when all active treatment should cease.

Pain shows that warmth and circulation are beginning to return. The after effects of a frost bite are precisely like those of a burn, and require similar treatment. Poultices made from scraped raw potatoes afford much comfort for an after treatment.

369. Catching the Clothing on Fire. When the clothing catches fire, throw the person down on the ground or floor, as the flames will tend less to rise toward the mouth and nostrils. Then without a moment’s delay, roll the person in a carpet or hearth-rug, so as to stifle the flames, leaving only the head out for breathing.

If no carpet or rug can be had, then take off your coat, shawl, or cloak and use it instead. Keep the flame as much as possible from the face, so as to prevent the entrance of the hot air into the lungs. This can be done by beginning at the neck and shoulders with the wrapping.

370. Foreign Bodies in the Throat. Bits of food or other small objects sometimes get lodged in the throat, and are easily extracted by the forefinger, by sharp slaps on the back, or expelled by vomiting. If it is a sliver from a toothpick, match, or fishbone, it is no easy matter to remove it; for it generally sticks into the lining of the passage. If the object has actually passed into the windpipe, and is followed by sudden fits of spasmodic coughing, with a dusky hue to the face and fingers, surgical help must be called without delay.

If a foreign body, like coins, pencils, keys, fruit-stones, etc., is swallowed, it is not wise to give a physic. Give plenty of hard-boiled eggs, cheese, and crackers, so that the intruding substance maybe enfolded in a mass of solid food and allowed to pass off in the natural way.

371. Foreign Bodies in the Nose. Children are apt to push beans, peas, fruit-stones, buttons, and other small objects, into the nose. Sometimes we can get the child to help by blowing the nose hard. At other times, a sharp blow between the shoulders will cause the substance to fall out. If it is a pea or bean, which is apt to swell with the warmth and moisture, call in medical help at once.

372. Foreign Bodies in the Ear. It is a much more difficult matter to get foreign bodies out of the ear than from the nose. Syringe in a little warm water, which will often wash out the substance. If live insects get into the ear, drop in a little sweet oil, melted vaseline, salt and water, or even warm molasses.

If the tip of the ear is pulled up gently, the liquid will flow in more readily. If a light is held close to the outside ear, the insect may be coaxed to crawl out towards the outer opening of the ear, being attracted by the bright flame.

373. Foreign Bodies in the Eye. Cinders, particles of dust, and other small substances, often get into the eye, and cause much pain. It will only make bad matters worse to rub the eye. Often the copious flow of tears will wash the substance away. It is sometimes seen, and removed simply by the twisted corner of a handkerchief carefully used. If it is not removed, or even found, in this way, the upper lid must be turned back.

Fig. 161.—Showing how the Upper Eyelid may be everted with a Pencil or Penholder.

This is done usually as follows: Seize the lashes between the thumb and forefinger, and draw the edge of the lid away from the eyeball. Now, telling the patient to look down, press a slender lead-pencil or penholder against the lid, parallel to and above the edge, and then pull the edge up, and turn it over the pencil by means of the lashes.

The eye is now readily examined, and usually the foreign body is easily seen and removed. Do not increase the trouble by rubbing the eye after you fail, but get at once skilled help. After the substance has been removed, bathe the eye for a time with hot water.

If lime gets into the eye, it may do a great amount of mischief, and generally requires medical advice, or permanent injury will result. Until such advice can be had, bathe the injured parts freely with a weak solution of vinegar and hot water.

374. Broken Bones. Loss of power, pain, and swelling are symptoms of a broken bone that may be easily recognized. Broken limbs should always be handled with great care and tenderness. If the accident happens in the woods, the limb should be bound with handkerchiefs, suspenders, or strips of clothing, to a piece of board, pasteboard, or bark, padded with moss or grass, which will do well enough for a temporary splint. Always put a broken arm into a sling after the splints are on.

Fig. 162.—Showing how an Umbrella may be used as a Temporary Splint in Fracture of the Leg.

Never move the injured person until the limb is made safe from further injuries by putting on temporary splints. If you do not need to move the person, keep the limb in a natural, easy position, until the doctor comes.

Remember that this treatment for broken bones is only to enable the patient to be moved without further injury. A surgeon is needed at once to set the broken bone.

Fig. 163.—Showing how a Pillow may be used as a Temporary Splint in Fracture of the Leg.

375. Fainting. A fainting person should be laid flat at once. Give plenty of fresh air, and dash cold water, if necessary, on the head and neck. Loosen all tight clothing. Smelling-salts may be held to the nose, to excite the nerves of sensation.

376. Epileptic and Hysterical Fits, Convulsions of Children. Sufferers from “fits” are more or less common. In epilepsy, the sufferer falls with a peculiar cry; a loss of consciousness, a moment of rigidity, and violent convulsions follow. There is foaming at the mouth, the eyes are rolled up, and the tongue or lips are often bitten. When the fit is over the patient remains in a dazed, stupid state for some time. It is a mistake to struggle with such patients, or to hold them down and keep them quiet. It does more harm than good.

See that the person does not injure himself; crowd a pad made from a folded handkerchief or towel between the teeth, to prevent biting of the lips or tongue. Do not try to make the sufferer swallow any drink. Unfasten the clothes, especially about the neck and chest. Persons who are subject to such fits should rarely go out alone, and never into crowded or excited gatherings of any kind.

Hysterical fits almost always occur in young women. Such patients never bite their tongue nor hurt themselves. Placing a towel wrung out in cold water across the face, or dashing a little cold water on the face or neck, will usually cut short the fit, speaking firmly to the patient at the same time. Never sympathize too much with such patients; it will only make them a great deal worse.

377. Asphyxia. Asphyxia is from the Greek, and means an “absence of pulse.” This states a fact, but not the cause. The word is now commonly used to mean suspended animation. When for any reason the proper supply of oxygen is cut off, the tissues rapidly load up with carbon dioxid. The blood turns dark, and does not circulate. The healthy red or pink look of the lips and finger-nails becomes a dusky purple. The person is suffering from a lack of oxygen; that is, from asphyxia, or suffocation. It is evident there can be several varieties of asphyxia, as in apparent drowning, strangulation and hanging, inhalation of gases, etc.

The first and essential thing to do is to give fresh air. Remove the person to the open air and place him on his back. Remove tight clothing about the throat and waist, dash on cold water, give a few drops of ammonia in hot water or hot ginger tea. Friction applied to the limbs should be kept up. If necessary, use artificial respiration by the Sylvester method (sec. 380).

The chief dangers from poisoning by noxious gases come from the fumes of burning coal in the furnace, stove, or range; from “blowing out” gas, turning it down, and having it blown out by a draught; from the foul air often found in old wells; from the fumes of charcoal and the foul air of mines.

378. Apparent Drowning. Remove all tight clothing from the neck, chest, and waist. Sweep the forefinger, covered with a handkerchief or towel, round the mouth, to free it from froth and mucus. Turn the body on the face, raising it a little, with the hands under the hips, to allow any water to run out from the air passages. Take only a moment for this.

Lay the person flat upon the back, with a folded coat, or pad of any kind, to keep the shoulders raised a little. Remove all the wet, clinging clothing that is convenient. If in a room or sheltered place, strip the body, and wrap it in blankets, overcoats, etc. If at hand, use bottles of hot water, hot flats, or bags of hot sand round the limbs and feet. Watch the tongue: it generally tends to slip back, and to shut off the air from the glottis. Wrap a coarse towel round the tip of the tongue, and keep it well pulled forward.

The main thing to do is to keep up artificial respiration until the natural breathing comes, or all hope is lost. This is the simplest way to do it: The person lies on the back; let some one kneel behind the head. Grasp both arms near the elbows, and sweep them upward above the head until they nearly touch. Make a firm pull for a moment. This tends to fill the lungs with air by drawing the ribs up, and making the chest cavity larger. Now return the arms to the sides of the body until they press hard against the ribs. This tends to force out the air. This makes artificially a complete act of respiration. Repeat this act about fifteen times every minute.

Fig. 164.—The Sylvester Method. (First movement—inspiration.)

All this may be kept up for several hours. The first sign of recovery is often seen in the slight pinkish tinge of the lips or finger-nails. That the pulse cannot be felt at the wrist is of little value in itself as a sign of death. Life may be present when only the most experienced ear can detect the faintest heart-beat.

When a person can breathe, even a little, he can swallow. Hold smelling-salts or hartshorn to the nose. Put one teaspoonful of the aromatic spirits of ammonia, or even of ammonia water, into a half-glass of hot water, and give a few teaspoonfuls of this mixture every few minutes. Meanwhile do not fail to keep up artificial warmth in the most vigorous manner.

379. Methods of Artificial Respiration. There are several well-established methods of artificial respiration. The two known as the Sylvester and the Marshall Hall methods are generally accepted as efficient and practical.

Fig. 165.—The Sylvester Method. (Second movement—expiration.)

380. The Sylvester Method. The water and mucus are supposed to have been removed from the interior of the body by the means above described (sec. 378).

The patient is to be placed on his back, with a roll made of a coat or a shawl under the shoulders; the tongue should then be drawn forward and retained by a handkerchief which is placed across the extended organ and carried under the chin, then crossed and tied at the back of the neck. An elastic band or small rubber tube or a suspender may be used for the same purpose.

The attendant should kneel at the head and grasp the elbows of the patient and draw them upward until the hands are carried above the head and kept in this position until one, two, three, can be slowly counted. This movement elevates the ribs, expands the chest, and creates a vacuum in the lungs into which the air rushes, or in other words, the movement produces inspiration. The elbows are then slowly carried downward, placed by the side, and pressed inward against the chest, thereby diminishing the size of the latter and producing expiration.

These movements should be repeated about fifteen times each minute for at least two hours, provided no signs of animation show themselves.

381. The Marshall Hall Method. The patient should be placed face downwards, the head resting on the forearm with a roll or pillow placed under the chest; he should then be turned on his side, an assistant supporting the head and keeping the mouth open; after an interval of two or three seconds, the patient should again be placed face downward and allowed to remain in this position the same length of time. This operation should be repeated fifteen or sixteen times each minute, and continued (unless the patient recovers) for at least two hours.

Fig. 166.—The Marshall Hall Method. (First position.)

If, after using one of the above methods, evidence of recovery appears, such as an occasional gasp or muscular movement, the efforts to produce artificial respiration must not be discontinued, but kept up until respiration is fully established. All wet clothing should then be removed, the patient rubbed dry, and if possible placed in bed, where warmth and warm drinks can be properly administered. A small amount of nourishment, in the form of hot milk or beef tea, should be given, and the patient kept quiet for two or three days.

Fig. 167.—The Marshall Hall Method. (Second position.)

382. Sunstroke or Heatstroke. This serious accident, so far-reaching oftentimes in its result, is due to an unnatural elevation of the bodily temperature by exposure to the direct rays of the sun, or from the extreme heat of close and confined rooms, as in the cook-rooms and laundries of hotel basements, from overheated workshops, etc.

There is sudden loss of consciousness, with deep, labored breathing, an intense burning heat of the skin, and a marked absence of sweat. The main thing is to lower the temperature. Strip off the clothing; apply chopped ice, wrapped in flannel to the head. Rub ice over the chest, and place pieces under the armpits and at the sides. If there is no ice, use sheets or cloths wet with cold water. The body may be stripped, and sprinkled with ice-water from a common watering-pot.

If the skin is cold, moist, or clammy, the trouble is due to heat exhaustion. Give plenty of fresh air, but apply no cold to the body. Apply heat, and give hot drinks, like hot ginger tea. Sunstroke or heatstroke is a dangerous affliction. It is often followed by serious and permanent results. Persons who have once suffered in this way should carefully avoid any risk in the future.

Chapter XIV.
In Sickness and in Health.

383. Arrangement of the Sick-room. This room, if possible, should be on the quiet and sunny side of the house. Pure, fresh air, sunshine, and freedom from noise and odor are almost indispensable. A fireplace as a means of ventilation is invaluable. The bed should be so placed that the air may get to it on all sides and the nurse move easily around it. Screens should be placed, if necessary, so as to exclude superfluous light and draughts.

The sick-room should be kept free from all odors which affect the sick unpleasantly, as perfumery, highly scented soaps, and certain flowers. Remove all useless ornaments and articles likely to collect dust, as unnecessary pieces of furniture and heavy draperies. A clean floor, with a few rugs to deaden the footsteps, is much better than a woolen carpet. Rocking-chairs should be banished from the sick-room, as they are almost sure to disturb the sick.

A daily supply of fresh flowers tends to brighten the room. Keep the medicines close at hand, but all poisonous drugs should be kept carefully by themselves and ordinarily under lock and key. A small table should be placed at the bedside, and on it the bell, food tray, flowers and other small things which promote the comfort of the patient.

The nurse should not sleep with the patient. Sofas and couches are not commonly comfortable enough to secure needed rest. A cot bed is at once convenient and inexpensive, and can be readily folded and put out of sight in the daytime. It can also be used by the patient occasionally, especially during convalescence.

384. Ventilation of the Sick-room. Proper ventilation is most essential to the sick-room, but little provision is ordinarily made for so important a matter. It is seldom that one of the windows cannot be let down an inch or more at the top, a screen being arranged to avoid any draught on the patient. Remove all odors by ventilation and not by spraying perfumery, or burning pastilles, which merely conceal offensive odors without purifying the air. During cold weather and in certain diseases, the patient may be covered entirely with blankets and the windows opened wide for a few minutes.

Avoid ventilation by means of doors, for the stale air of the house, kitchen smells, and noises made by the occupants of the house, are apt to reach the sick-room. The entire air of the room should be changed at least two or three times a day, in addition to the introduction of a constant supply of fresh air in small quantities.

385. Hints for the Sick-room. Always strive to look cheerful and pleasant before the patient. Whatever may happen, do not appear to be annoyed, discouraged, or despondent. Do your best to keep up the courage of sick persons under all circumstances. In all things keep in constant mind the comfort and ease of the patient.

Do not worry the sick with unnecessary questions, idle talk, or silly gossip. It is cruel to whisper in the sick-room, for patients are always annoyed by it. They are usually suspicious that something is wrong and generally imagine that their condition has changed for the worse.

Symptoms of the disease should never be discussed before the patient, especially if he is thought to be asleep. He may be only dozing, and any such talk would then be gross cruelty. Loud talking must, of course, be avoided. The directions of the physician must be rigidly carried out in regard to visitors in the sick-room. This is always a matter of foremost importance, for an hour or even a night of needed sleep and rest may be lost from the untimely call of some thoughtless visitor. A competent nurse, who has good sense and tact, should be able to relieve the family of any embarrassment under such circumstances.

Do not ever allow a kerosene light with the flame turned down to remain in the sick-room. Use the lamp with the flame carefully shaded, or in an adjoining room, or better still, use a sperm candle for a night light.

Keep, so far as possible, the various bottles of medicine, spoons, glasses, and so on in an adjoining room, rather than to make a formidable array of them on a bureau or table near the sick-bed. A few simple things, as an orange, a tiny bouquet, one or two playthings, or even a pretty book, may well take their place.

The ideal bed is single, made of iron or brass, and provided with woven wire springs and a hair mattress. Feather-beds are always objectionable in the sick-room for many and obvious reasons. The proper making of a sick-bed, with the forethought and skill demanded in certain diseases, is of great importance and an art learned only after long experience. The same principle obtains in all that concerns the lifting and the moving of the sick.

Sick people take great comfort in the use of fresh linen and fresh pillows. Two sets should be used, letting one be aired while the other is in use. In making changes the fresh linen should be thoroughly aired and warmed and everything in readiness before the patient is disturbed.

386. Rules for Sick-room. Do not deceive sick people. Tell what is proper or safe to be told, promptly and plainly. If a physician is employed, carry out his orders to the very letter, as long as he visits you. Make on a slip of paper a note of his directions. Make a brief record of exactly what to do, the precise time of giving medicines, etc. This should always be done in serious cases, and by night watchers. Then there is no guesswork. You have the record before you for easy reference. All such things are valuable helps to the doctor.

Whatever must be said in the sick-room, say it openly and aloud. How often a sudden turn in bed, or a quick glance of inquiry, shows that whispering is doing harm! If the patient is in his right mind, answer his questions plainly and squarely. It may not be best to tell all the truth, but nothing is gained in trying to avoid a straightforward reply.

Noises that are liable to disturb the patient, in other parts of the house than the sick-room, should be avoided. Sounds of a startling character, especially those not easily explained, as the rattling or slamming of distant blinds and doors, are always irritating to the sick.

Always attract the attention of a patient before addressing him, otherwise he may be startled and a nervous spell be induced. The same hint applies equally to leaning or sitting upon the sick-bed, or running against furniture in moving about the sick-room.

387. Rest of Mind and Body. The great importance of rest for the sick is not so generally recognized as its value warrants. If it is worry and not work that breaks down the mental and physical health of the well, how much more important is it that the minds and bodies of the sick should be kept at rest, free from worry and excitement! Hence the skilled nurse does her best to aid in restoring the sick to a condition of health by securing for her patient complete rest both of mind and body. To this end, she skillfully removes all minor causes of alarm, irritation, or worry. There are numberless ways in which this may be done of which space does not allow even mention. Details apparently trifling, as noiseless shoes, quietness, wearing garments that do not rustle, use of small pillows of different sizes, and countless other small things that make up the refinement of modern nursing, play an important part in building up the impaired tissues of the sick.

388. Care of Infectious and Contagious Diseases. There are certain diseases which are known to be infectious and can be communicated from one person to another, either by direct contact, through the medium of the atmosphere, or otherwise.

Of the more prevalent infectious and contagious diseases are scarlet fever, diphtheria, erysipelas, measles, and typhoid fever.

Considerations of health demand that a person suffering from any one of these diseases should be thoroughly isolated from all other members of the family. All that has been stated in regard to general nursing in previous sections of this chapter, applies, of course, to nursing infectious and contagious diseases. In addition to these certain special directions must be always kept in mind.

Upon the nurse, or the person having the immediate charge of the patient, rests the responsibility of preventing the spread of infectious diseases. The importance must be fully understood of carrying out in every detail the measures calculated to check the spread or compass the destruction of the germs of disease.

389. Hints on Nursing Infectious and Contagious Diseases. Strip the room of superfluous rugs, carpets, furniture, etc. Isolate two rooms, if possible, and have these, if convenient, at the top of the house. Tack sheets, wet in some proper disinfectant, to the outer frame of the sick-room door. Boil these sheets every third day. In case of diseases to which young folks are very susceptible, send the children away, if possible, to other houses where there are no children.

Most scrupulous care should be taken in regard to cleanliness and neatness in every detail. Old pieces of linen, cheese-cloth, paper napkins, should be used wherever convenient or necessary and then at once burnt. All soiled clothing that cannot well be burnt should be put to soak at once in disinfectants, and afterward boiled apart from the family wash. Dishes and all utensils should be kept scrupulously clean by frequent boiling. For the bed and person old and worn articles of clothing that can be destroyed should be worn so far as possible.

During convalescence, or when ready to leave isolation, the patient should be thoroughly bathed in water properly disinfected, the hair and nails especially being carefully treated.

Many details of the after treatment depend upon the special disease, as the rubbing of the body with carbolized vaseline after scarlet fever, the care of the eyes after measles, and other particulars of which space does not admit mention here.