In all cases where the patient is too ill or forbidden to sit up in bed, a feeding cup with a curved spout should be used. The nurse’s hand should be passed beneath the pillow, and the head and pillow gently raised together. Where there is extreme prostration a glass tube, bent at a right angle, one end of which is placed in the cup containing the food and the other in the patient’s mouth, will enable him to take liquids with scarcely any effort.
If the patient is in a state of delirium, or unconscious, endeavor to arouse him somewhat before giving him his food. Sometimes merely putting the spoon in his mouth is enough, but at other times you will require to get it well back on the tongue. In such cases, watch carefully to see that the liquid is swallowed before attempting to give a second spoonful.
When it comes to the convalescent patient the food is no less important than during the time of illness. Serve it on a tray, covered with a fresh napkin, have the dishes and spoons clean and shining, and be careful not to slop things into the saucers. Take the tray from the room as soon as the meal is ended, for uneaten food sometimes becomes very obnoxious to the sick person if it remains in sight. To provide food for the sick which is both suitable and attractive sometimes requires great care, judgment and patience, but the effort is worth all the trouble it costs. The aim should be to give what will be at the same time easy to digest and of nutritive value after it is digested. In another department of this work will be found many recipes adapted for invalids.
Medicine should be given at regular hours, and careful attention should be paid to the directions as to the time when the doses are to be given, as, for instance, before or after meals. The exact quantity ordered should be given, as even a slight error may defeat the results intended. Never give any medicine without looking at the label, being absolutely certain that you have the right one. Never allow a bottle to stand uncorked, for many mixtures lose their strength when exposed to the air.
TEMPERATURE AND PULSE
We follow Mr. Curran again in his clear statement of the importance of temperature in disease. Every household should have a clinical thermometer to use in taking the temperature of the patient in the event of sickness. The average normal temperature in adults is from 98.4 to 98.6 degrees. There is a daily variation of sometimes 1.5 degrees, the highest point being reached in the evening. Exercise, diet, climate and sleep cause deviation from the standard. Almost every disease, however, carries with it an abnormal variation in temperature. If the rising temperature does not always show what the disease is, it does show what it probably is not. For instance, a rapid rise of three of four degrees above the healthy standard does not mean typhoid fever, but may mean measles or scarlet fever, and in whooping-cough and smallpox, the highest temperature precedes those diseases from two to four days. In diphtheria there is this rise before anyone thinks of looking at the throat. Increase of temperature calls for cooling remedies, external and internal, and degrees of temperature below the standard require warming and sustaining treatment.
An increase of temperature beginning each day a little earlier is a bad sign; one beginning later promises well. A decrease of fever beginning each day earlier is a good sign, but if later each day, is a bad one. A very high temperature, say 105 degrees, is dangerous in itself, but more so if it has come on gradually as the last of a series. A fall of temperature below normal is far more dangerous than a much greater corresponding rise. One degree below normal is more an indication of a bad condition than two and one-half above normal. In convalescence if there is no rise of temperature after eating there is no nourishment secured from the food; if there is a sudden or high rise of more than one degree the food was too stimulating or bulky. To be beneficial in convalescence food must increase the temperature a quarter to half a degree and this must almost subside when digestion is over, though leaving a gradual improvement in the average daily temperature.
Temperature from 106 degrees upward and from 95 degrees downward is extremely dangerous and virtually a sign of fatal ending. As the temperature increases or decreases from normal toward these extremes, it consequently becomes more threatening. Temperature should be taken by placing the bulb of the clinical thermometer in the rectum or under the tongue.
There is a close connection between the temperature and the pulse, both of which guide the judgment in matters of health. The pulse is most rapid at birth, and becomes constantly slower until old age, ranging from a maximum at the beginning of 130 to 150 pulsations a minute to a minimum at the end of life of 50 to 65 pulsations. The average pulse through the period of adult life is from 70 to 75 beats per minute. It is considered that every rise of temperature of one degree above normal corresponds with an increase of ten beats of the pulse per minute.
We have already spoken of the importance of the bath in health. Baths have their equal importance in sickness, and their direct effect upon many diseases. All the vital organs are affected through the skin, and by keeping it in a healthy condition the circulation of the blood, the action of the kidneys and bowels and all the digestive processes are promoted, many diseases warded off, and the assimilation of food aided. In many fevers, for instance, a sponge bath with water a few degrees cooler than the normal temperature of the body will give great comfort and relieve and reduce the temperature materially. A warm bath with water about at the temperature of the body, or a degree or two less, produces no shock to the system but makes the pulse beat a little faster and causes a little more activity of circulation.