CHAPTER XIV

FORM IV: SENIOR GRADE (Continued)

HOUSEHOLD SANITATION

As the principles of sanitation are based on a knowledge of bacteria, the facts concerning these microscopic plants, which were taught in the lesson on the "Preservation of Food", have only to be reviewed and extended.

The following topics should he quickly reviewed:

1. Description of bacteria
2. Occurrence of bacteria
3. Favourable conditions for bacteria
4. Multiplication of bacteria
5. Useful bacteria
6. Harmful bacteria.

It is with the harmful bacteria that our lesson on sanitation deals. The pupils already know that some kinds belonging to this class cause the decay of food, and now they are ready to be told that other harmful kinds of microscopic plants gain entrance to our bodies and cause disease. Concerning these, the following outline of facts should be taken:

1. MEANS OF BACTERIA ENTERING THE BODY

(1) Through the respiratory organs

(2) Through the digestive tract

(3) Through the broken skin.

2. COMMON DISEASE-PRODUCING BACTERIA

(1) Those entering the respiratory organs.—Mumps, scarlet fever, whooping-cough, diphtheria, measles, pneumonia

(2) Those entering the digestive tract.—Typhoid, cholera, tuberculosis

(3) Those coming through cuts, etc.—Skin diseases like ringworm, blood poisoning, lockjaw (tetanus).

Sink and sewer connection
T—Trap. W—Waste Pipe. H.D.—House drain. S.—Sewer.

If housekeepers do not exercise care, these disease-producing bacteria may enter the home, and finding there all the conditions which they require, they will multiply, and become a menace to the family.

3. METHODS OF SANITATION

Since bacteria are too small to be seen, it is very hard to deal with them. The housekeeper has the following ways of protecting the household:

(1) By having all drain pipes trapped:

(2) By keeping the house free from lodging places for bacteria:

(a) Keep the house clean and free of dust.

(b) Wash garbage pails and sinks daily and scald them and drain pipes at least once a week.

(d) Wash and sterilize the soiled clothing once a week.

(e) Keep the cellar well aired and clean; allow no decaying material to remain in it.

(f) Keep the door-yards clean; allow no scraps of food, cleaning water, or sweepings to be thrown near the house.

(3) By keeping the supply of food from disease-producing bacteria:

(a) Use screens to keep out flies, which transfer bacteria from their bodies to food.

(b) Wash fresh fruit and vegetables before using.

(4) By keeping the bodies of the family strong and healthy, so that if bacteria gain an entrance they will be resisted and overcome:

(a) Provide well-balanced, nutritious food.

(b) Supply suitable clothing to protect the body.

4. DISPOSAL OF WASTE IN VILLAGES AND RURAL DISTRICTS

(1) Burn all combustible material.

(2) Bury tins, broken dishes, etc.

(3) Feed refuse food to animals or empty it into a pit dug for the purpose, and cover with a layer of earth from time to time.

(4) Throw slop water at a distance from the house and well, and plant stalky growths like sunflowers, which absorb the waste.

5. METHODS OF DISINFECTING

Where bacterial disease is known to exist, the utmost care should be taken to subject everything that has come in contact with the patient to a process which will kill the disease-producing plants. Only two ways of doing this are known:

(1) Subject the bacteria to extreme heat which will kill them—

(a) Burn everything that can be burned.

(b) Boil bed and body linen.

(d) Scald or bake utensils.

(2) Use chemicals to destroy the germs—

(a) Use chemical solutions to wash surfaces, materials, or utensils.

(b) Seal the rooms and burn chemicals to produce vapours which will destroy bacteria.

Note.—Directions for the use of chemicals are given under the lesson on "Home Nursing".

HOME NURSING

This part of the work does not require a special equipment, though it is an advantage to have one. An ingenious teacher, with the co-operation of her pupils, will invent plans for providing whatever is necessary for demonstration. Pupils living near the school can supply many of the needed materials.

A doll and doll's bed may be used to teach bed making and the changing of bed-clothing while the patient is in bed. The doll may also be used to illustrate the method of giving a patient a bath in bed and of changing the body clothing, if such information is desired.

In some cases, a manual training pupil might construct the bed, and the sewing class the mattress, bed-clothing, and doll's underwear. If this were the property of the school, the girls could take turns in making the bed every day and in laundering the clothing at home once a week.

It is desirable that the instruction in home nursing be given in two lessons. These may be outlined as follows:

LESSON I

THE SICK ROOM

1. Location.—The room should be on the sunny side of the house and be as large and airy as possible. The top floor is quieter, but necessitates many steps.

2. Furniture.—All furniture should admit of easy cleaning. Small rugs are better than a carpet, as they can be easily removed for cleaning. In infectious diseases, only bare necessities should be kept in the room.
The bed should be single and placed so as to be accessible from both sides. It should be high enough to prevent the nurse stooping. The bed-clothing should be of light weight and washable.
A bedside table should be provided, also a couch for the nurse. A screen will be found useful to prevent draughts and to shade the light.

3. Ventilation.—A thermometer should be used, and the temperature kept at 65 degrees to 68 degrees, or, in special diseases, according to the doctor's orders.
An abundant supply of fresh air should be provided day and night. To secure this, there must be two openings, one to admit pure, fresh air, and the other to let out the impure air. These openings are preferably on opposite sides of the room and at different heights. If there is only one window, it should be made to open at both top and bottom. In extreme cases, an adjoining room may be aired and, after the fresh air is warm, it may be admitted to the sick room.

4. Care.—The room should be kept very clean and neat. All cleaning should be quietly done, so as not to annoy or disturb the patient. The floor, wood-work, and furniture should be dusted with a damp cloth.
Flowers should be removed at night and should have fresh water daily.
No food or medicine should he left in the room. Soiled dishes or clothing should be removed as soon as possible and, in cases of infectious diseases, placed in water containing a disinfectant.
All excreta should be taken away immediately and, if necessary, disinfected before being emptied.

METHODS OF DISINFECTING

1. Dishes or clothing.—(1) Make a solution using one part of carbolic acid to twenty parts of water (six teaspoonfuls to a pint of water) and let it stand for half an hour. Soak the articles in this for two hours. (2) Use formalin according to directions. (3) Use bichloride tablets according to directions. (This turns clothes yellow.)

Note.—These solutions must be renewed every twenty-four hours, if exposed to the air.

2. Excreta.—Cover the excreta with one of the above solutions and allow it to stand for half an hour before emptying.

LESSON II

THE PATIENT

1. Care of the bed.—The bed of a sick person should be kept specially clean and fresh. The linen should be changed every day, or oftener if soiled. Where the supply of linen is limited, or where there is pressure of work, a good airing and sunning may occasionally take the place of laundering.
In making the bed, it should be kept in mind that the under sheet requires unusual tucking in at the head, to prevent its slipping down and becoming wrinkled. The upper sheet should receive extra attention at the foot, as it is apt to pull up.
When changing the sheets with the patient in bed, work as deftly and quietly as possible. Have the clean sheets warmed and the room comfortably heated. Begin with the under sheet as follows:

(1) To change the under sheet.—Turn the patient over on the side away from you and fold the soiled sheet in flat folds close to the body. Lay the clean sheet on the side of the bed near you, tuck it in, and fold half of it against the roll of soiled sheet, so that both can be slipped under the body at once. Turn the patient back to the opposite side, on the clean sheet, pull out the soiled sheet, and tuck the clean one smoothly in place.

(2) To change the upper sheet.—Loosen all the clothes at the foot of the bed. Spread a clean sheet and blanket, wrong side up, on top of the other bedclothes. Pin the clean clothes at the head of the bed or get the patient to hold them. Gradually slip down and draw out the soiled sheet and blanket. Tuck all in place.

2. Care of the diet.—Recovery from sickness in many cases depends more upon the right kind of food than on medicine. The importance of proper diet should have been impressed on the minds of the pupils by their lessons on food, in the Junior Grade of Form IV. They may now be shown that, in sickness, the responsibility of the choice of food is transferred from the patient to the doctor or nurse. Hence it is most important that a person acting as nurse should be trained in food values and proper methods of cooking. She should also be capable of exercising daintiness and artistic skill in serving, so that the appearance of the food may tempt the patient to eat it.

Invalid's tray

Milk Diet.—Milk, butter-milk, koumyss, kephyr.

Note.—Lime-water may be given with sweet milk, one part to three of milk.

Liquid Diet.—Milk diet, beef juice or beef-tea, broths, gruels, and sometimes jelly.
Light Diet.—Soup, white meat of fowl, white fish, oysters, soft-cooked eggs, custard, milk puddings, fruit, gelatine jellies.
Full Diet.—Any food that is not particularly hard to digest.

Note.—Plenty of water should be given in all diets.

POULTICES

A poultice is used to reduce inflammation and should be as large as the affected part.

The kinds in ordinary use are:

1. Mustard poultice, used as a counter irritant.

2. Linseed, bread, or potato poultice, used to soothe.

Directions for a mustard poultice:

1. For a very strong poultice, mix pure mustard to a paste with warm water; spread on a piece of cheesecloth or muslin, leaving a margin of an inch; fold over the margin, and cover with thicker cotton or paper.

2. For milder poultices use flour to reduce the mustard as follows:

(1) 1 part flour to 1 part mustard

(2) 2 parts flour to 1 part mustard

(3) 3 parts flour to 1 part mustard.

Directions for linseed, bread, or potato poultices:

Use boiling water to mix the above to the consistency of thick porridge, and spread as in the mustard poultice, excepting that the layer of poultice is made much thicker, in order to retain the moisture and heat.

FOMENTATIONS

These are much the same in their effects as poultices, but are sometimes more convenient.

Directions for fomentations:

Spread a towel over a large basin, place a flannel in the towel and pour boiling hot water over it. Fold the towel over the flannel, gather the dry ends of the towel in either hand, and wring. Carry to the patient, shake out the flannel, and apply.