Sickroom accessories
Sickroom accessories.—These are of a varied character, and will be described under separate headings.
Poultices. Linseed.—The great art of poultice-making consists in applying it to the patient sufficiently hot, and, therefore, it is advisable to warm all the materials before beginning. Put the linseed (crushed or meal) before the fire or in the oven for 20 minutes to heat. Use by preference a tin bowl, and scald it with boiling water; then pour in as much boiling water as will be needed for the poultice, sprinkle in the hot linseed with one hand, and stir vigorously with a knife to the required thickness. To judge of this requires some practice. A poultice should be somewhat moister, if applied to an open wound, than if it is intended to relieve some internal pain; but in no case ought it to be sufficiently moist to stick in patches to the skin of the patient. The next step is to take a square of rag or paper ½ in. larger all round than the poultice is intended to be; spread the linseed on this about ½ in. thick, leaving the edges clear; fold the rag over on each side, and apply at once, covering with a pad of cotton wool and a layer of indiarubber or oil silk to keep the heat in. It is a good plan to oil the face of the poultice with a feather, as this effectually keeps it from sticking to the skin, even if it is not well mixed, and it is better than to put the poultice into a muslin. If, however, the muslin is preferred, on no account should a bag be made, for the poultice cools while it is being put in. A large piece of old linen, folded over at the back, like a parcel, keeps the linseed in, and makes at the same time a pad to cover it. Failing linseed meal, you can use either oatmeal or bran; if oatmeal, then boil it with the water like porridge. A poultice should be larger than appears absolutely necessary. It is intended to allay pain and inflammation, and as the pain probably extends beyond the inflamed part, a large poultice should be made to cover the inflamed part. Dr. Atkinson says that meal deprived of its oil is far better than that from which the oil has not been extracted. The latter does not retain its heat as long, and, unless covered by some fabric, is not so easily removed as the poultice made from the former. The exhausted meal takes up more water, and retains its heat longer. In making a poultice, the meal should be thoroughly stirred with a spoon while boiling water is gradually added, and when of proper (rather soft) consistence, should be spread on linen. The ability to bear the heat on the back of the hand is a good test of the degree to be used. The poultice should be applied directly to the skin, without intervening fabric, and be covered on the outside with good oiled-silk. A teaspoonful of laudanum may be sprinkled on the surface to increase its anodyne effects, or in place of water may be used a boiling infusion of camomile or poppy-heads. When the skin is inflamed, 3 grs. sulphate zinc or alum may be added to each oz. of water. A solution of 1-40 of carbolic acid may be used instead of simple water in the case of sloughing wounds. Once in 4 hours is a good rule to follow in changing poultices on the chest, the front and back being covered by separate poultices, and only one should be removed at a time. A fresh one should be ready when the change is made. Frequent changes are most grateful in cases of abdominal pain.
To relieve spasm, as in colic—intestinal, biliary, or renal; to relieve inflammation of the pleura (lining membrane of the chest), the lungs, the liver, or other organs, it is essential to apply the poultice as hot as possible, while protecting the skin from being scalded. In order to do this, a flannel bag should be prepared, a convenient size being 12 in. by 8; this should be closed at 3 edges and open at the fourth; one side of it should be 1-1½ in. longer than the other, and it is convenient also to have 4 tapes attached at the points which form the corners when the bag is closed, in order to keep the poultice in position. Besides this, another strip of flannel should be prepared of the same breadth as the length of the bag, and long enough to wrap round it once or oftener. Crushed linseed, bowl, and spoon should be got together, and the spoon and bowl thoroughly heated by means of boiling water; the poultice should then be made with perfectly boiling water, and rather soft. As soon as it is ready, it should be poured into the bag, previously warmed by holding it before the fire; the flap which is formed by the longest side of the bag should now be turned down and fastened in its place by a few long stitches with a needle and thread; it should then be quickly wrapped in the strip of flannel (also previously warmed), and fastened in situ, if necessary, by means of the tapes. It may be covered outside with a sheet of cotton wool. In this way the poultice may be applied boiling hot to the skin without burning; the 2 layers of flannel which are at first dry allow the heat to pass very gradually indeed to the skin; as the moisture of the poultice soaks through them they become better conductors, and the heat passes more quickly, but the increase is so gradual as not to cause any painful sensations whatever, but only one of soothing and comfort. The poultice also naturally keeps much longer hot, and the necessity for changing it arises much less frequently. The difference between the effect of a poultice made in the ordinary way and in the manner just described is sometimes exceedingly striking. It is, perhaps, less marked in cases of inflammation than in those of spasm.
Bread.—In a small and perfectly clean saucepan have a teacupful of boiling water. Add breadcrumbs, or the crumb of a stale loaf: 1½-2 oz. will be sufficient for this quantity of water, and let it soak over the fire for about 5 minutes. Then turn it into a piece of rag, and spread it of suitable size and evenly. This plan ensures its being hot.
Mustard.—If a mustard poultice is wanted it can be made in the same way as linseed, save by adding a certain proportion of dry mustard to the linseed. Some persons prefer to boil a little mustard in the water that is to be used. Dr. Tyson, of Philadelphia, recommends the addition of molasses to mustard in making plasters. This furnishes a mild persistent counter-irritant which can be worn for hours. Leaves of so-called “mustard paper” may be made as follows: The mustard must be deprived of all fatty matters; the adhesive agent must contain neither alcohol, resin, nor fatty matter; nor must it be of the nature of a plaster. Submit the mustard farina to strong pressure, and wash with sulphide of carbon or petroleum essence. Spread on paper an adhesive liquid formed of a solution of 4-5 parts caoutchouc in 100 parts mixed carbon sulphide and petroleum essence. Sprinkle over the freshly coated paper by means of a sieve, the prepared mustard. Pass between two rollers, and afterwards gently warm to promote volatilisation of the liquid solvents used. Cut to pattern as required.
Court Plaster.—This is generally bought. To make it, soak isinglass in a little warm water for 74 hours, then evaporate nearly all the water by gentle heat, dissolve the residue in a little proof spirits of wine, and strain the whole through a piece of open linen. The strained mass should be a stiff jelly when cool. Now stretch a piece of silk or sarcenet on a wooden frame, and fix it tight with tacks or pack-thread. Melt the jelly and apply it to the silk thinly and evenly, with a badger-hair brush. A second coating must be applied when the first has dried. When both are dry, apply over the whole surface 2 or 3 coatings of the balsam of Peru. Plaster thus made is very pliable and never breaks.
To make it without silk, mix enough collodion with castor oil to render it elastic when dry, the oil having profusely been rubbed with some zinc oxide. Into this mixture dip glass plates, and, after drying, redip and redry 2 or 3 times, or until a film of suitable thickness is obtained. Upon this paint the usual solution of isinglass to give it adhesiveness, and, after again drying, separate it from the glass.
Applying cold to the Head.—Take one fold of cotton or linen rag, soak it in cold water, the colder the better, squeeze dry and apply it as rapidly as possible. Do not take a large piece of cloth folded several times, and keep squeezing it in your hand till it is quite hot and then put on. One fold of cloth, the thinner the better, dipped often in the cold water and rapidly applied gives great relief in headaches, for example. If you can procure ice put a piece in the water. Ice is sometimes ordered to be kept constantly on the head; to keep it from melting, wrap it up in flannel, or put it in sawdust, and in a cool place. To break ice, use a large needle. Ice-bags can be bought for 3s.-4s., or it may be put in a bladder and applied to the part, or a bag may be made of guttapercha and chloroform. By putting a little chloroform along the edges and folding them over, you can make a very useful bag for ice; the ice should be broken in small pieces before being put in the bag, and be removed as soon as it melts.
Fomentations.—A very good, perhaps the best, plan is to put a piece of flannel, folded 4 or 5 times thick to the required size, into a potato-steamer over boiling water. In this way it soon becomes hot, and little or no wringing is necessary. Where a potato-steamer is not to be had, however, the following plan should be adopted. Take a strong towel or cloth, or a piece of ticking, and pin or tack a deep hem in each end. Into these run two short, strong sticks—anything will serve: a couple of iron spoons, and even a small poker, such as is called a “curate,” though this last is rather long for choice. Lay the towel, or “wringer,” as it is technically called, over a large basin, so that the sticks hang outside; place the folded flannel in the middle, and pour boiling water over. The flannel can easily be wrung dry by one pair of hands, and if it is not made by the bed side, it can be carried there without fear of cooling in the wringer. Sometimes opium or turpentine is to be added. The quantity of either to be used will be prescribed by the doctor, and it should be sprinkled on the side of the flannel that is to go next the skin, immediately before applying it to the patient. The flannel should be covered with wool and oil-silk, just as a poultice is covered. Fomentations are, in many cases, as efficacious as poultices, and they possess, besides, the advantage of being easier to make, and of costing practically nothing, since the flannels can be used repeatedly. For the very poor, the cost of linseed for poultices is often a serious item. There is no danger of scalding if the flannel is squeezed so dry that it cannot drip nor wet the palm of the hand.
Another plan is described as follows: Take your flannel folded to a required thickness and size, dampened quite perceptibly with water, but not enough to drip, and place it between the folds of a large newspaper, having the edges of the paper lap well over the cloth, so as to give no vent to the steam. Thus prepared, lay it on the stove or register, and in a moment steam is generated from the under surface, and has permeated the whole cloth, heating it to the required temperature.
Blisters.—Blisters and leeches should only be used under medical direction. Before the application of either, the part should be well washed with soap and warm water. Then, in the case of the blister, it has only to be slightly warmed before the fire and left on until “it rises,” and a good-sized vesicle has formed (which will usually be in about 8-10 hours), when the water must be let out by snipping the skin with the point of a sharp scissors—a perfectly painless operation—and the blistered surface dressed with spermaceti ointment spread on soft lint.
Leeches.—Leeches can generally be induced to bite by putting a few drops of milk or blood on the spots they are intended to take. They will usually fall off of themselves when filled, but if they remain on too long they must not be pulled off, but a little salt shaken on them, which will soon make them let go. Another simple and easy way of detaching leeches is to drop a few drops of camphor julep (mist. camph.) on the part, when they will soon relinquish their hold. The bleeding from their bites will also generally stop without interference. If it should continue to an undesirable degree, the nurse may nearly always stop it by making gentle pressure over the bite with her finger, or applying a little powdered alum or the muriated tincture of iron (tinctura ferri perchloridi). Never leave a patient for the night until all bleeding has completely ceased. The bleeding may be increased, when desired, by fomenting with warm water.
Enemas.—A nurse is often required to administer an enema or injection—which in many conditions of disease is a most valuable method of treatment. Be careful not to disturb or uncover the patient until quite certain that you have arranged ready to hand everything that will be required. Almost any variety of injection apparatus answers the purpose sufficiently well, but in using the rubber ones care must be taken to squeeze out all air from the bulb before commencing, else the air will be forced in by the first compression. The most convenient position for the patient is lying on the left side. Then the nozzle of the instrument, having been well greased and warmed, should be passed slowly and carefully into the bowel, the point being directed slightly backwards. On no account whatever must the least force be used. If there is any difficulty or pain in introducing the tube to the required distance, the nurse must wait for a minute or two, when, in all probability, the opposing muscle having become relaxed, it will pass in easily and without pain. The injection should then be given very slowly and quietly, and without any jerking or irregularity of motion, especially if it be desired that it should be long retained; it must be stopped immediately if the patient calls out that he can bear no more. Enemata are generally either nutrient or purgative; but occasionally other medicines are given in this way. The nutrient are of extreme value, as it sometimes happens that, when nourishment can be taken in no other way, sufficient may be supplied by this means to tide over the period of danger. A good nutritive enema may be made as follows: The yolks of 2 fresh eggs well battered in about ½ pint strong beef tea, or in 2 tablespoonfuls (half a canister) of Brand’s extract of beef, dissolved in warm milk. About ½ wineglassful port wine, or 1 tablespoonful brandy may be added in cases of extreme exhaustion. It should be given at about blood heat—100° F. An active purgative enema may be made with: 4 tablespoonfuls castor oil, 1 teaspoonful oil of turpentine, and about 1 pint well-strained gruel, or soap and water. An enema of plain soap and water often answers very well.
Clinical Thermometer.—In trifling ailments its use is for reference; in serious attacks it may give immediate warning that the physician is required; and even while the doctor is in attendance he often wishes observations regarding the temperature to be taken several times a day, in his absence, for his guidance and information. Following are a few illustrations of the uses to which the clinical thermometer may be put by any intelligent person. The natural temperature of the human body is 98·4°F. and the little arrow on the thermometer indicates this normal degree of heat, so that when the index rests at the arrow, the natural temperature is proved to be present. It is the variations above or below the arrow that mark the presence of disease.
The agony of colic is well known, but it is generally of little danger in the absence of inflammation. In peritonitis (inflammation of the bowels), the temperature runs quickly up to over 101° F.; in colic it scarcely rises more than a degree, if even thus far, above the natural temperature. A severe pain in the side causes pleurisy to be suspected. If the temperature is normal, there is no pleurisy, and the pain is probably neuralgic. Diarrhœa may continue for a few days, and the patient feels so out of sorts that typhoid fever seems to have set in; but all the specific forms, such as typhoid, typhus, scarlet fever, diphtheria, or measles, are accompanied by such an increase of body heat as will probably send up the record to 101° F., or possibly 3-4° higher. A child with persistent vomiting, sore throat, and high temperature will probably in a day or so show the rash of scarlet fever. In any case, when a temperature remains above 100-101° F. for more than 1-2 days, without obvious cause, the doctor should be consulted. If the child has disordered stomach or sustained a chill, the thermometer will record fever; but, after a purgative in the one case and a tepid or hot bath in the other, the increased heat will be found to be gone, and with it any alarm which may have been felt. In the course of an inflammation or fever, the friends can be informed by the medical man what degree of heat he expects, and should this be exceeded the doctor should be informed of the fact. Indeed the clinical thermometer is invaluable, especially to families at a distance from their medical adviser. It can be obtained from any instrument maker for 7s. 6d.-12s. 6d., or more. Its application is a very easy matter. The bulb containing the mercury should be placed in the mouth or arm-pit; care should be had in the last case that clothes do not intervene between the instrument and the arm, and that it is so placed in the arm-pit as to be completely surrounded by skin. The patient must then press the arm gently to the side so as to retain the instrument, and in 5 minutes the thermometer will show the body’s temperature.
Dollond, 1 Ludgate Hill, London, E.C., sells an improved Lens Clinical Thermometer. The importance of the “lens” front cannot be over estimated, for with such a thermometer there is no difficulty in reading off the temperature even in the dull light of a sickroom, for the thin thread of mercury is magnified quite twenty times its size. This thermometer is made with a contraction in the tube near the bulb, which prevents the mercury returning, until shaken down. The price of this thermometer is 7s. 6d.
W. H. Harling, 47 Finsbury Pavement, London, E.C., is the maker of an excellent clinical thermometer with lens front, which registers the temperature in the space of a single minute. It is furnished with a metal case having a bayonet fastening, and costs only 8s. 6d. The same maker supplies also ordinary clinical thermometers, in cases, at prices ranging from 3s. 6d. upwards. Other sickroom requisites are noticed on p. [1007].
When used to take the temperature of patients suffering from infectious disease, the thermometer should be disinfected by being washed in “Sanitas” or carbolic acid solution after each time of using. In taking the temperature under the tongue, the index should be “set” as directed, and the bulb should be placed as far back under the tongue as convenient and agreeable; the mouth should then be kept shut, and the patient should breathe through the nose: 3 minutes are sufficient for taking the tongue-temperature. In the arm-pit the thermometer should be left for 5 minutes and the fore-arm should be made to lie across the chest, so that the thermometer may thus be made to rest in a sheltered position.
Temperatures should be taken in ordinary cases at 8 A.M. and 8 P.M.; 2 o’clock is a convenient hour for a third observation. Variations in temperature occur in healthy persons, but such change does not usually amount to more than 2° or 3° F. What is to be regarded as deserving of attention under the ordinary circumstances of life is a fall below 97°, or a rise above 99·5°. In fevers, as a rule, the temperature does not rise above 106°; but in fever a heat of 108°, continuing even for a very short time, would be regarded as a most dangerous symptom. A very high or very low temperature must be looked upon as dangerous; should it be excessive either way, the case will probably prove fatal. A very sudden change is suspicious, and very frequently dangerous. In children, however, the presence of indigestible food in the intestinal canal may suffice to cause a rapid rise in the temperature. After the temperature has been stationary for some time, or has commenced to fall, a fresh rise may herald the advent of some complication, or the approach of a new disease. An unexpected fall may denote hæmorrhage, exhausting diarrhœa, or the perforation of the peritoneum or pleura (lining membranes of the abdomen and chest). A considerable rise during the course of a disease which is not generally regarded as febrile—viz., in tetanus, epilepsy, and cholera—usually precedes death.
Making a Medical Coil.—Procure a well-seasoned walnut board about 21½ in. long, 3 in. wide, and ⅜ in. thick. From this cut one length 12 in. long for the base board a, and 3 pieces 3 in. square (like b) for the coil heads; when cut, a fillet 8 in. long must be nailed or screwed on the two sides of the base board (as shown in a); these fillets should be ¼ in. square section. Corresponding square nicks must be cut of two of the square heads (as shown at x in c). All the woodwork when thus squared and finished should be soaked for ¼ hour in melted paraffin wax, and then rubbed dry while still warm.
Obtain a thin brass tube (known in the trade as “triblet tubing”) about ½ in. diameter, 4½ in. long; turn up a short plug and button to fit one end of this tube and serve as a handle (see d). This may be fastened to the tube by driving in 3 fine brass brads, and filing off the heads flush with the tube.
109. Home-made Medical Coil
Cut up about 100 lengths of straight iron wire (best soft annealed) No. 22 gauge, say, about 4½ in. in length; fill the brass tube with them as tight as you can fit them; cut them all to the same length (they must protrude a little beyond the tube). Now draw out about 2 in. of the iron bundle and wrap it tightly round with twine, leaving about ½ in. free. Draw more out, and continue wrapping until you have wrapped to within ½ in. at each end of the bundle. Tie the string, and withdraw the bundle from the brass tube. Melt a little solder in a ladle, dip the ends of the iron bundle into soldering fluid (zinc dissolved in hydrochloric acid), and then at once into the melted solder. Allow the bundle to cool; file off the superfluous solder, so that the bundle will just enter freely into the tube. It should appear like e when the string has been removed.
The next operation is to make a good stout paper tube, also about 4½ in. in length, into which the brass tube d can slide easily. To make this, put a few turns soaped writing paper round the tube No. 1, then roll and glue seven turns of good stout brown paper, 4½ in. in length, round this writing paper, or else it will be difficult to draw out the tube. This paper tube f must be allowed to dry thoroughly while still on the brass tube d. When quite dry, it must be slipped off, the writing paper lining drawn out, and then it must be soaked for a few minutes in melted paraffin wax.
The iron bundle should also be allowed to stand in melted paraffin wax for some time, and then stood up to drain in a warm place. This will prevent rusting. When quite cold, all superfluous paraffin having been removed, a strip of brown paper, ½ in. wide, is rolled round one extremity of the iron bundle, until it is of such a diameter as to fit tightly into the paper tube f. This paper strip must be cut off at this point and glued tightly round the end of the iron bundle. The brass tube d is then slipped over the iron bundle until it just reaches the little paper collar just made. The brass tube and bundle together are pushed, button end first, into the paper tube f; and when the paper collar round the iron bundle is just about to enter the paper tube, it is to be well served with hot glue and forced into the tube. The whole must now be allowed to dry and set thoroughly.
Taking one of the 3 in. heads (the one which has not any nicks in the sides), bore a centre hole with a brace and centre bit, just large enough for the paper tube f, with its iron core, to fit tightly (see b). Putting a little thin good hot glue round the free extremity (the end opposite to that at which the brass enters), push it into the hole in the square head, until it projects about ⅛ in. on the other side. This must be allowed to dry thoroughly before proceeding to the next operation.
Now proceed to wind the primary coil. To this end, take about ½ lb. No. 24 silk-covered copper wire, and wind it round the tube, as shown at g, from end to end, in continuous layers, taking care to put a sheet of paraffined paper between each layer, and also to baste each layer with melted paraffin wax before winding on another. About 4 layers will thus be got on, and an even number of layers must be aimed at, so as to get the 2 ends of the wire at the same extremity, and able to fasten them under the binding screw y. To effect this, before screwing down the said screws, the ends of the copper wire are stripped of their covering and wound once round the screw of the binder. Free ends of wire, at least 6 in. in length, must be left for attachments, &c. This is shown at h.
This primary coil, with its iron core, sliding brass tube regulator, &c. may now be fastened to the base board by means of 2 screws from underneath, as shown at i, at 4 in. from one end, and therefore 8 in. from the other. One of the free ends of the primary wire is brought to one of the binding screws v, while the other connects to the clapper z. A short piece of wire connects the platinum screw pillar w, to the other binding screw, which is not visible, as it is behind the platinum pillar. At this point it will be well to try the working of the primary coil. For this purpose, couple up the 2 binding screws on the base board with a good bichromate cell. Connect the two binding screws u in i, with the 2 brass handles intended for use. Screw up the platinum screw w till the clapper z begins to vibrate. Now hold the handles in your hand. As long as the brass tube j is entirely over the iron core, little or no sensation is perceptible. If an assistant pulls out the tube, little by little, the current will be found to increase in strength until the regulator tube is quite out.
The secondary coil now demands attention. A paper tube, precisely similar to b, but of such a size as to slide easily over the primary coil i is prepared, and paraffined. This must be cut exactly the length of the coil k, leaving the knob j projecting. The 2 square pieces of board in which the nicks were cut (c) must then have central holes cut in them to take this paper tube, and then glued, one at each end of the said tube, as shown. Two small binding screws are then to be inserted in the centre of the upper edge of each square. A bung is now placed in each end of the tube, and a ¼ in. iron rod pushed through both, to serve as an axle. This is then mounted on 2 standards, as shown at n; and beginning by attaching one end of the uncovered wire to the binding screw m, about ½ lb. No. 36 silk-covered copper wire is now carefully coiled on, being most diligent in avoiding kinks, breaks, or flaws of every description. Each layer must be paraffined and separated from its neighbour by paraffined paper. When the quantum of wire has been laid on, the finishing end is connected to the binding screw in n. The last coil should be covered with paraffined paper, and finally covered with a jacket of good silk velvet. The secondary coil is then complete, and may be slid in its place over the primary coil o. When it is quite over the primary, the secondary current will be at its strongest, if the metal tube regulator is drawn out; it will be weaker as the metal tube regulator is more and more inserted; or may be even more delicately regulated by sliding the secondary coil itself more or less over the primary. The secondary coil, while the primary is being excited with a freshly made pint bichromate, will give a ½ in. spark when the regulator is out and the secondary coil right over the primary. This will pass easily through a dozen persons. (S. R. Bottone.)
There are various other sickroom appliances demanded in special cases which do not require description here. Most may be had of such well-known firms as Salmon, Ody & Co., 292 Strand, and Savory and Moore, 143 New Bond Street.