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.