American Red Cross Text-Book on Home Hygiene and Care of the Sick
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Title: American Red Cross Text-Book on Home Hygiene and Care of the Sick
Author: American National Red Cross
Jane A. Delano
Isabel McIsaac
Anne Hervey Strong
Release date: May 4, 2010 [eBook #32250]
Most recently updated: April 20, 2021
Language: English
Other information and formats: www.gutenberg.org/ebooks/32250
Credits: Heiko Evermann, Fox in the Stars, S.D., and the Online Distributed Proofreading Team
*** START OF THE PROJECT GUTENBERG EBOOK AMERICAN RED CROSS TEXT-BOOK ON HOME HYGIENE AND CARE OF THE SICK ***
AMERICAN RED CROSS TEXT-BOOK
ON
HOME CARE OF THE SICK
***
DELANO
AMERICAN RED CROSS
TEXT-BOOK
ON
HOME HYGIENE
AND
CARE OF THE SICK
BY
JANE A. DELANO, R. N.
Chairman of the National Committee, Red Cross Nursing Service; Director,
Department of Nursing, American Red Cross; Late Superintendent
of the Nurse Corps, U. S. A.; of the Training Schools
for Nurses, Bellevue Hospital, New York City; and of the
Training School for Nurses, Hospital of the University
of Pennsylvania, Philadelphia
REVISED AND REWRITTEN
BY
ANNE HERVEY STRONG, R. N.
Professor of Public Health Nursing, Simmons College, Boston
_This is the Second Edition of the American Red Cross
Text-book in Elementary Hygiene and Home Care of
the Sick by Jane A. Delano and Isabel McIsaac._
PREPARED FOR AND ENDORSED BY
THE AMERICAN RED CROSS
PHILADELPHIA
P. BLAKISTON'S SON & CO.
1012 WALNUT STREET
COPYRIGHT, 1918, BY AMERICAN RED CROSS
THE MAPLE PRESS YORK PA
PREFACE
To the woman who wishes to protect her family from preventable diseases
and is anxious to fit herself in the absence of a trained nurse to give
intelligent care to those who are sick, this revision of the Red Cross
text-book on Elementary Hygiene and Home Care of the Sick is
particularly directed. It should appeal to men and to women who are
interested in maintaining the health of their neighborhoods and
communities and in affording effective coöperation to the public health
authorities. To teachers wishing to impart protective health information
to high school pupils, the book also should be useful as a class text as
well as a guide.
The war, which has caused the withdrawal from private practice of
thousands of physicians and graduate nurses, makes it peculiarly
important to the nation for every adult to have sound knowledge as to
how to prevent contagion and epidemics, especially by precautionary
attention to home and local sanitation. With nurses becoming more
difficult to secure, the safety of the family demands that some member
in each household know enough about elementary nursing to make a patient
comfortable and to carry out accurately the instructions of the
physician.
The work of revision, based upon the latest knowledge of hygiene,
sanitation and methods of home-nursing has been done by Miss Anne Hervey
Strong, Professor of Public Health Nursing, Simmons College, under the
personal direction of the author and the National Committee on Red Cross
Nursing Service. The material has been painstakingly read by Dr. H. W.
Rucker and Dr. Taliaferro Clarke of the United States Public Health
Service, and Lieutenant Colonel Clarence H. Connor, Medical Corps,
United States Army. Indebtedness to Dr. H. M. McCracken, President of
Vassar College and Director of the Red Cross Junior Membership, for his
valuable suggestion as to adapting the book for high school use as well
as for the assistance rendered by his Department, also is gladly
acknowledged.
J. A. D.
ACKNOWLEDGMENT
I wish to express my gratitude to those who have so kindly helped in the
work of preparing the present edition. Thanks are especially due to
Professor Isabel Stewart, Miss Anna C. Jamme, Professor Curtis M.
Hilliard, Professor Maurice Bigelow, Miss Katharine Lord, Miss Josephine
Goldmark, and Miss Evelyn Walker.
A. H. S.
CONTENTS
PREFACE v
INTRODUCTION xi
CHAPTER I
PAGE
CAUSES AND PREVENTION OF SICKNESS 1
Communicable diseases, 1. Micro-organisms and bacteria,
1. Parasites, 3. Structure and development of parasites,
4. Bacteria, 4. Shape, 4. Size, 5. Motion, 5.
Multiplication, 5. Spores, 7. Distribution, 8. Protozoa,
8. Visible parasites, 8. Transmission of pathogenic
organisms, 9. Defenses of the body, 12. Immunity, 13.
Vaccination and inoculation, 15. Carriers, 17.
Non-communicable diseases, 20. Physical examinations, 22.
CHAPTER II
HEALTH AND THE HOME 27
Heredity, 27. Hygiene of environment and person, 28.
Ventilation, 29. Lighting, 32. Cleanliness of houses, 33.
Garbage, 37. Insects, 38. Sewage, 39. Personal
cleanliness, 41. Oral hygiene, 44. Treatment of teeth,
46. Clothing, 47. Food, 48. Elimination, 52. Rest and
fatigue, 53. Sleep, 55. Recreation, 55.
CHAPTER III
BABIES AND THEIR CARE 60
Growth and development, 64. Average size, 64. Muscular
development, 65. Development of special senses, of
speech, of teeth, 66. Normal excretions, 67. Clothing,
68. Sleep, 70. Fresh air, 72. Diet, 72. Intervals of
feeding, 73. Water, 75. Weaning, 75. Nursing bottles and
nipples, 75. Tables of diet, 78. Bathing, 78. Eyes, 80.
Mouth, 81. Nostrils, 81. Genital organs, 81. Development
of habits, 82. Exercise, 83. Play and toys, 85.
CHAPTER IV
INDICATIONS OF SICKNESS 88
Objective symptoms, 92. Temperature, 92. Pulse, 96.
Respiration, 99. General appearance, 100. Special senses,
101. Voice, tongue, throat, gums, 102. Cough, 103.
Appetite, 103. Excretions, 103. Loss of weight, 104.
Sleep, 104. Mental conditions, 104. Subjective symptoms,
105. Pain, 105. Records, 107. Tuberculosis, cancer and
mental illness, 107. Tuberculosis, 109. Cancer, 111.
Mental illness, 112.
CHAPTER V
EQUIPMENT AND CARE OF THE SICK ROOM 117
Choice of a sick room, 118. Furnishing, 120. Ventilation,
123. Heating, 124. Lighting, 124. Cleaning, 126. The
attendant, 127.
CHAPTER VI
BEDS AND BEDMAKING 132
Bedsteads, 133. Mattresses, 135. Care of the mattress,
136. Pillows, 136. Protection of the mattress and
pillows, 137. Rubber sheets and pillow-cases, 138.
Sheets, 139. Draw sheets, 139. Pillow covers, 140.
Blankets, 140. Comforters and quilts, 141. Counterpanes,
141. Bedmaking, 141. To make an unoccupied bed, 143. To
change a patient's pillows, 146. Lifting a patient in
bed, 146. To turn a patient in bed, 147. To change sheets
while patient is in bed, 147. To move patient from one
bed to another, 150.
CHAPTER VII
BATHS AND BATHING 154
Cleansing baths, 154. Bed bath, 156. Care of the mouth
and teeth, 160. Care of the hair, 163. To wash the hair
of a bed patient, 164. Hot foot-baths, 165. Cool sponge
bath, 166.
CHAPTER VIII
APPLIANCES AND METHODS FOR THE SICK-ROOM 169
Devices to give support, 172. Bedpans, 176. Daily routine
in the sick-room, 179. Time for visitors, 182.
CHAPTER IX
FEEDING THE SICK 187
The digestive process, 188. Feeding the sick, 191. Liquid
diet, 192. Semi-solid diet, 192. Light or convalescent
diet, 193. Full diet, 193. Serving food for the sick,
195. To feed a helpless patient, 197.
CHAPTER X
MEDICINES AND OTHER REMEDIES 200
Action of drugs, 200. Amateur dosing, 202. Patent
remedies, 205. Administration of medicine, 206.
Suppositories, 209. Enemata, 210. Sprays and gargles,
213. Inhalation, 213. Inunction, 214. Household medicine
cupboard, 215.
CHAPTER XI
APPLICATION OF HEAT, COLD AND COUNTER-IRRITANTS 220
Inflammation, 220. Hot applications, 225. Dry heat, 225.
Moist heat, 227. Stupes or hot fomentations, 229. Cold
applications, 231. Dry cold, 231. Moist cold, 232. Cold
compresses for the eyes, 232. Counter-irritants, 233.
Mustard paste, 233. Mustard leaves, 234.
CHAPTER XII
CARE OF PATIENTS WITH COMMUNICABLE DISEASES 236
Incubation period, 238. Care of patients with colds or
other slight infections, 238. Care during more serious
infections, 242. Children's diseases, 246. Rules for
isolation and exclusion from school, 247. Disinfection,
248. Care of nose and throat discharges, 249. Care of
discharges from the bowels and bladder, 249. Bath water,
250. Care of the hands, 250. Care of utensils, 251. Care
of linen, 251. Disinfection of the person, 252.
Termination of quarantine, 252. Terminal disinfection,
253. Fumigation, 254.
CHAPTER XIII
COMMON AILMENTS AND EMERGENCIES 257
Conditions in which the nervous system is involved, 257.
Headache, 257. Sleeplessness, 258. Fainting, 259.
Convulsions, 260. Shock, 261. Stimulants, 263. Sunstroke
and heat exhaustion, 264. Conditions in which the
digestive tract is affected, 265. Nausea and vomiting,
265. Hiccough, 265. Diarrhœa, 266. Constipation, 266.
Colic, 266. Conditions in which the eyes or ears are
affected, 267. Styes, 267. Foreign bodies in the eye,
267. Disorders affecting the ears, 268. Conditions in
which the skin is affected, 269. Prickly heat, 269.
Insect bites and stings, 270. Ivy poisoning, 270. Other
emergencies, 270. Chills, 270. Croup, 271. Bleeding, 272.
Treatment of slight wounds, 272. Nose bleed, 274. Profuse
menstruation, 275. Other injuries, 275. Sprains, 275.
Bruises, 276. Burns and scalds, 277. Brush burn, 278.
CHAPTER XIV
SPECIAL POINTS IN THE CARE OF CHILDREN, CONVALESCENTS,
CHRONICS, AND THE AGED 280
Children, 281. Physical defects, 283. Eye-strain, 284.
Enlarged tonsils and adenoids, 284. Defective hearing,
285. Defective teeth, 286. Posture, 286. Predisposition
to nervousness, 292. Convalescent patients, 294. Chronic
patients, 299. Care of the aged, 303.
CHAPTER XV
QUESTIONS FOR REVIEW 312
APPENDIX 319
Circulars of information issued by Division of Child
Hygiene, New York Department of Health.
GLOSSARY 326
INDEX 331
INTRODUCTION
Health and sickness, at all times momentous factors in the welfare of
our nation, now as never before are matters of vital importance. To win
its victories both in peace and in war, the nation needs all its
citizens with all their powers, and it is a matter of more than passing
interest that, as conservative estimates show, at least three persons
out of every hundred living in the United States are constantly
incapacitated by serious sickness. In 1910 these seriously sick persons
numbered more than 3,000,000. Even more significant, perhaps, is the
fact that at least half of our national sickness could be prevented if
knowledge and resources that we now possess were fully utilized.
The problem of sickness is by no means peculiar to our own day and
generation. It has been a medical, a religious, and a social problem in
every age. From the time of Job its meaning has baffled philosophers;
from his day to ours thoughtful men have devoted their lives to
searching for causes and cures. Yet before the middle of the last
century little progress was made, either in scientific treatment or in
prevention of disease.
The invention of the microscope first made possible a real
understanding of sickness. Through the microscope a new world was
revealed,--a world of the infinitely small, swarming with tiny forms of
animal and vegetable life. No one, however, appreciated the significance
of these hitherto invisible plants and animals until the latter part of
the 19th century, when the great French savant, Pasteur, proved that
little vegetable forms, now called bacteria, cause putrefaction and
fermentation, and also certain diseases of animals and man. Pasteur's
discoveries were carried still further by other scientists, with the
result that bacteriology has revolutionized medicine, agriculture, and
many industries, and has made possible the brilliant achievements of
modern sanitary science. For the first time in history the prevention of
epidemics has become possible, and sickness is no longer regarded as a
punishment for sin.
Actual care of the sick, both in homes and in hospitals, has always been
one of the responsibilities of women. The first general public hospital
was built in Rome in the 4th century after Christ by Fabiola, a
patrician lady. There she nursed the sick with her own hands, and from
her day to ours extends an unbroken line of devoted women, handing down
through the centuries their tradition of compassionate nursing service.
It remained for Florence Nightingale, however, to give to the training
its technical and scientific foundation, and thus to found the
profession of nursing. As a result of her work, effectiveness was added
to the spirit of service, that spirit which inspires the modern nurse no
less than in an earlier day it inspired the Sisters of Charity who died
nursing the wounded on the battlefields of Poland.
But different generations have different needs, and to meet them the
spirit of service must manifest itself in widely varying ways. The sick
need care today no less than they did when St. Elizabeth bathed the feet
of the lepers; but such limited service, however beautiful, is no longer
enough. Today we serve best by preventing sickness. Cure of sickness and
alleviation of suffering must never be neglected; not in cure, however,
but in prevention lies the hope of modern sanitary science, of modern
medicine, and of modern nursing.
Nearly every woman at some time in her life is called upon to assist in
caring for the sick. Indeed, approximately 90% of all sick persons in
the United States are cared for at home, even in cities where hospital
facilities are good. Moreover, every woman is largely responsible for
maintaining her own health, and few escape responsibility at some time
for maintaining the health of others. For such responsibility most women
are poorly prepared. Every year in our own country thousands of persons,
many of them babies and children, die merely because someone, in many
cases a woman, is fatally ignorant of the laws governing sickness and
health.
Only prolonged and careful training, such as good hospital
training-schools afford, can furnish the skill and judgment required in
nursing persons who are seriously ill. Upon the trained nurse the modern
practice of medicine makes great and ever-increasing demands: a nurse
must perform complicated duties, meet critical situations, and carry out
a wide variety of measures based on scientific principles which she must
understand. Good will and sympathy are no longer enough; amateur
nursing, even when performed with the best intentions, may involve grave
dangers for those who are seriously ill.
On the other hand, although it is true that a little knowledge is a
dangerous thing, it is no less true that total ignorance may be more
dangerous still. For instance, in cases of incipient, slight, or chronic
illness, and in certain emergencies a little knowledge may be safer far
than no knowledge at all; and no one, surely, should be ignorant of the
principles of hygiene.
The American Red Cross, recognizing the part that women can and should
play in preventing sickness and in building up the health and vigor of
the nation, has added to its larger patriotic services this elementary
course of instruction in hygiene and home care of the sick. The lessons
are not intended to take the place of a nurse's training, and procedures
requiring technical skill are necessarily omitted. The object of the
book is to supply a little knowledge of sickness, which though limited
may yet be safe. The book is also designed to set forth some general
laws of health; to make possible earlier recognition of symptoms; to
teach greater care in guarding against communicable disease; and to
describe some elementary methods of caring for the sick, which, however
simple, are essential to comfort, and sometimes indeed to ultimate
recovery.
FOR FURTHER READING
A History of Nursing--Dock and Nutting, Volume I.
The Life of Florence Nightingale--Cook.
The Life of Pasteur--Vallery-Radot.
The House on Henry Street--Wald.
Public Health Nursing--Gardner, Part I, Chapters I-III.
Origin and Growth of the Healing Art--Berdoe.
Medical History from the Earliest Times--Withington.
Under the Red Cross Flag--Boardman.
Report on National Vitality--Fisher, (Bulletin 30 of the Committee of
One Hundred on National Health. Government Printing Office, Washington).
CHAPTER I
CAUSES AND PREVENTION OF SICKNESS
Diseases of two kinds have long been recognized: first, those
transmitted directly or indirectly from person to person, like smallpox,
measles, and typhoid fever; and second, diseases like heart disease and
apoplexy, which are not so transmitted. These two classes are popularly
called "catching" and "not catching;" the former are the infectious or
communicable diseases, and the latter the non-infectious or
non-communicable. The term contagious, formerly applied to diseases
supposed to be spread only by direct contact, is no longer an accurate
or useful term.
THE COMMUNICABLE DISEASES
The invention of the microscope, as we have seen, revealed the existence
of innumerable little plants and animals, so small that even many
millions crowded together are invisible to the naked eye. These tiny
living creatures are called micro-organisms or germs. The plant forms
are called bacteria (singular, bacterium), and the animal forms
protozoa (singular, protozoön). The common belief that all or even most
bacteria are harmful is quite unfounded. As a matter of fact, while not
less than 1500 different kinds of micro-organisms or germs are known,
only about 75 varieties are known to produce disease.
Most bacteria belong to the class of micro-organisms called saprophytes,
which find their food in dead organic matter, both animal and vegetable,
and cannot flourish in living tissues. These saprophytes act upon the
tissues of dead animals and vegetables, and resolve them into simpler
substances, which are then ready to serve as nourishment for plants
higher in the vegetable kingdom. Thus the processes which we know as
fermentation and putrefaction are due to the action of saprophytes.
Higher plants in turn furnish food for men and animals, and so the food
supply is used over and over in different forms, making what is known as
the _food cycle_. If it were not for bacterial activities vegetation
would be robbed of its supply of nourishment, and plant life would
speedily end; destruction of plant life would deprive the animal kingdom
of food and thus all life would become extinct. The saprophytes are
consequently essential to the existence of both animals and vegetables.
There are, however, other organisms called _parasites_, which can exist
in living tissues of animals or vegetables. The organisms at whose
expense the parasites live are called their _hosts_. Parasites not only
contribute nothing to their hosts, but generally harm them by producing
poisonous substances or depriving them of food. Some parasites are able
to lead a saprophytic existence also, but as a rule they live at the
expense of animal or plant life. Pathogenic, or disease-producing, germs
belong to the group of parasites. The pathogenic germs which find
favorable soil in the body produce poisons called toxins. These poisons
or toxins interfere with the bodily functions, and thus cause what we
know as communicable disease. Communicable diseases are caused by
specific germs only: that is, a certain disease cannot develop unless
its particular germs are present; the germs of typhoid for instance, can
cause typhoid fever only, and not tuberculosis or other disease.
A number of diseases are caused by micro-organisms that are now well
known. Chief among these diseases are colds, septicæmia (blood
poisoning), influenza, pneumonia, diphtheria, typhoid fever,
tuberculosis, whooping cough, Asiatic cholera, bubonic plague,
meningitis, tetanus ("lock jaw"), leprosy, gonorrhœa, syphilis,
relapsing fever, typhus fever, glanders, and anthrax. Micro-organisms
not yet identified probably cause the communicable diseases whose origin
is not known with certainty. These include infantile paralysis,
smallpox, scarlet fever, measles, mumps, chicken-pox, Rocky Mountain
spotted fever, yellow fever, hydrophobia (rabies), foot-and-mouth
disease. We can hardly doubt that the intensive laboratory research now
in progress will reveal in the near future the specific germs of these
diseases also.
STRUCTURE AND DEVELOPMENT OF PARASITES
The group of parasites consists of two general classes, the vegetable,
and the animal. In the former class belong the bacteria, and in the
latter the protozoa. The two classes are not sharply differentiated, but
in general the vegetable parasites are less highly organized than the
animal.
BACTERIA
SHAPE.--Bacteria are composed of single cells and are consequently
called unicellular organisms. Under the microscope individual cells are
seen to differ in size, shape, and structure. In shape bacteria show
three different types; the rod-shaped (bacillus), the spherical
(coccus), and the spiral (spirillum). The organisms causing typhoid
fever for example are a variety of bacilli, those causing pneumonia are
cocci, while those causing Asiatic cholera are spirilla.
[Illustration: FIG. 1.--BACILLI OF VARIOUS FORMS. (_Williams._)]
SIZE.--Bacteria vary greatly in size. Average rod-shaped bacteria are
about 1/25000 of an inch long, but there are undoubtedly organisms so
small that they cannot be seen, even by means of the strongest
microscopes we now possess.
[Illustration: STAPHYLOCOCCI. STREPTOCOCCI. DIPLOCOCCI. TETRADS.
SARCINÆ. FIG. 2.--(_Williams._)]
MOTION.--The power of motion in certain species of bacteria is due to
hair-like appendages called flagella. These flagella by a lashing
movement somewhat resembling the action of oars enable the organisms to
move through fluids.
MULTIPLICATION.--After bacteria have fully developed, each cell divides
into two equal parts; the process of division is called fission. Each
of these two parts rapidly grows into a full-sized organism. Then
fission again takes place, so that four bacteria replace the original
one. In each of the four, fission occurs again, and so the process of
multiplication continues. As bacteria develop they group themselves in
characteristic ways. Some, like the streptococci, arrange themselves in
chains; the diplococci, in pairs; the tetrads, in groups of four; others
in packets called sarcinæ, and still others, the staphylococci, form
masses supposed to resemble bunches of grapes.
[Illustration: FIG. 3.--SPIRILLA OF VARIOUS FORMS. (_Williams._)]
[Illustration: FIG. 4.--BACTERIA SHOWING FLAGELLA. (_Williams._)]
Under favorable conditions fission occurs rapidly; in some types a new
generation may appear as often as every 15 minutes. Enormous
multiplication would result if nothing occurred to check the process.
But in nature such increase never continues unhindered, and bacteria,
acting upon their food substances, produce acids and other materials
injurious to themselves. Furthermore, lack of proper food, moisture, or
favorable temperature, and competition with other organisms tend to
prevent their unrestricted growth and multiplication.
[Illustration: FIG. 5.--BACTERIA WITH SPORES. (_Williams._)]
SPORES.--Most bacteria die if conditions become unfavorable to their
growth, but some enter into a resting stage. This stage is characterized
by the development of round or oval glistening bodies called spores,
which are of dense structure and possess an extraordinary power to
withstand heat, chemicals, and unfavorable surroundings. Except in rare
instances a single cell produces but one spore. As soon as favorable
conditions of temperature, moisture, and food supply are restored, the
spore develops into the active form of the germ; it may, however, remain
dormant for months or years. Spore formation, however, occurs in only a
very few varieties of pathogenic bacteria.
DISTRIBUTION.--Bacteria are very widely distributed in nature; they are
in fact found practically everywhere on the surface of the earth. They
are present in plants and water and food; on fabrics and furniture,
walls and floors; and they are found in great numbers on the skin, hair,
many mucous surfaces, and other tissues of the body.
PROTOZOA
The protozoa are the lowest group of the animal kingdom. Like bacteria
they are composed of single cells so small as to be visible only under
the microscope. They play an important part in causing certain diseases
of man, especially in the tropics. Among the well-known human diseases
of protozoan origin are malaria, amoebic dysentery, and
sleeping-sickness. Protozoa also cause several wide-spread and serious
plagues of domestic animals.
VISIBLE PARASITES
A few diseases are caused by parasites large enough to be seen with the
naked eye. One of the most important is hookworm disease. This disease
is caused by a tiny worm which penetrates the victim's skin and
ultimately finds its way into the intestine. Other diseases also are
caused by parasitic worms, such as tapeworms, pinworms, and trichinæ.
The latter are acquired as a result of eating infected meat,
particularly infected pork that has not been thoroughly cooked.
TRANSMISSION OF PATHOGENIC ORGANISMS
Pathogenic or disease producing organisms need for their development
food, moisture, darkness, and warmth, conditions that exist within the
human body. When one or more of these factors is unfavorable,
development of germs is checked; if unfavorable conditions are extreme
or long continued, the organisms begin to die. It is difficult to say at
exactly what moment they will die if deprived of moisture or exposed to
extremes of temperature or other unfavorable conditions, just as it
would be impossible to state at exactly what moment a collection of
house plants would all be dead if water were withheld, or if the room
temperature were greatly reduced.
Most pathogenic organisms, however, do not flourish long outside the
body, and owe their continued existence to a fairly direct transfer
from person to person. They gain access to the body through mucous
surfaces such as the respiratory and digestive tracts, and through
breaks in the skin, such as cuts, abrasions, and the bites of certain
insects. They leave the body chiefly in the nasal and mouth discharges,
as in coughing, sneezing, and spitting, in the urine and bowel
discharges, and in pus or "matter."
[Illustration: FIG. 6. (_L. H. Wilder._)]
The problem of controlling communicable diseases, consequently, lies in
preventing the bodily discharges of one person from travelling directly
into the body of another. If a person is not expelling pathogenic germs,
it is clear that he cannot pass diseases on to others. But both
pathogenic and harmless germs follow the same routes from person to
person, so that safety as well as decency lies in preventing so far as
possible all exchanges of bodily discharges.
There are five routes by which the bodily discharges most frequently
travel from one person to another. Four of these routes of infection are
called public, because in most cases efforts of individuals alone are
not sufficient to control them. The public routes are water, milk, food,
and insects. The fifth, or private route, includes all means by which
fresh discharges of one person are passed to another, as when nose and
mouth discharges are carried in coughing, sneezing, and kissing, or when
bowel and bladder discharges are carried by the hands. These five routes
in a given case differ greatly in relative importance, but the fifth, or
direct route plays an immense part, although its importance in causing
sickness has only lately been recognized. It cannot be too strongly
emphasized that the chief agent in the spread of human diseases is man
himself, and the human hand is the great carrier of disease germs both
to and from the body. If unclean hands could be kept away from the
orifices of the body, particularly the mouth, many diseases would soon
cease to exist.
Defenses of the Body
In view of all the dangers from disease-producing germs it may seem
surprising that the human race has not long ago succumbed to its
invisible enemies. But the body has various defenses by means of which
it may prevent invasion, or successfully combat its enemies in case they
do gain access.
The unbroken skin is usually impassable to bacteria. Virulent organisms
are often found upon the skin of perfectly healthy persons, where they
appear to be harmless unless an abrasion occurs which affords entrance
into the deeper tissues. Most bacteria breathed in with the air cling to
the moist surfaces of the air-passages and never reach the lungs.
Mucous membranes lining the mouth and other cavities of the body would
prove favorable sites for the growth of bacteria if the mucus secreted
by them were not frequently removed. The mouth of a healthy person may
contain bacteria of many kinds, but the saliva has a slight disinfectant
power and serves as a constant wash to the membranes. The normal gastric
(stomach) juice is decidedly unfavorable to the growth of bacteria,
although it does not always kill them; they often pass through the
stomach and are found in large numbers in the intestines. Other bodily
secretions, such as the tears and perspiration, tend to discourage
bacterial growth.
Tissues of the body vary greatly in their power to resist invading
germs, so that the route by which germs enter influences the severity of
their effects. Typhoid bacilli and the spirilla of Asiatic cholera when
taken with food or water produce far more serious disturbances than when
injected under the skin; infections from pus germs through an abrasion
of the skin may result in a slight local disturbance, while the same
amount introduced into a deeper wound might cause a fatal infection.
Certain germs nourish in certain tissues only; even tuberculosis, which
attacks practically all tissues, has its favorite locations.
IMMUNITY.--In addition to its mechanical defenses against disease, the
body shows a varying degree of _immunity_, or the power possessed by
living organisms to resist infections. Immunity or resistance is the
opposite of susceptibility. It is exceedingly variable, being greater or
less in different people and under different conditions, but the exact
ways in which it is brought about are still in many cases far from
clear.
Immunity may be _natural_ or _acquired_. By natural immunity is meant
an inherited characteristic by which all individuals of a species are
immune to a certain disease. The natural immunity of certain species of
animals to the diseases of other animals is well known. Man is immune to
many diseases of lower animals, and they in turn are immune to many
diseases of man. Cattle, for instance, are immune to typhoid and yellow
fever, while man shows high resistance to rinderpest and Texas fever;
both, however, are susceptible to tuberculosis, to which goats are
immune. There are all gradations of immunity within the same species.
Moreover, certain individuals have a personal immunity against diseases
to which others of the same race or species are susceptible.
Immunity may be _acquired_ in several ways. It is commonly known that
one attack of certain communicable diseases renders the individual
immune for a varying length of time, and sometimes for life. Among these
diseases are smallpox, measles, whooping-cough, scarlet fever, infantile
paralysis, typhoid fever, chicken-pox, and mumps; erysipelas and
pneumonia on the other hand appear to diminish resistance and to leave a
person more susceptible to later attacks.
Again, in some cases immunity may be artificially acquired by
introducing certain substances into the body to increase its
resistance. Examples of this method include the use of antitoxin as a
protection against diphtheria, of sera in pneumonia and other
infections, and vaccination against smallpox and typhoid fever whereby a
slight form of the disease is artificially induced. Laboratory research
goes on constantly, and doubtless many more substances will eventually
be discovered that will reduce human misery as vaccines and antitoxin
have already reduced it.
Vaccination and inoculation have saved thousands of lives. Smallpox,
once more prevalent than measles, was the scourge of Europe until
vaccination was introduced. During the 18th century it was estimated
that 60,000,000 people died of it, and at the beginning of the 19th
century one-fifth of all children born died of smallpox before they were
10 years old. In countries where vaccination is not practised the
disease is as serious as ever; in Russia during the five years from
1893-97, 275,502 persons died of smallpox, while in Germany where
vaccination is compulsory, only 8 people died of it during the year
1897. Death rates from diphtheria and typhoid fever have been greatly
reduced by the use of antitoxin and antityphoid vaccine. Thus in New
York State in 1894, before antitoxin was generally used, 99 out of every
100,000 of the population died of diphtheria, while only 20 out of
100,000 died of it in 1914. In 1911 a United States Army Division of
more than 12,000 men camped at San Antonio, Texas, for four months. All
of these men were vaccinated against typhoid fever and only a single
case occurred during the summer, although conditions of camp life always
tend to spread the disease.
While many and various factors tend to lower resistance rather than to
increase it, the idea that these factors act equally in all kinds of
infection is erroneous.
"The principal causes which diminish resistance to
infection are: wet and cold, fatigue, insufficient or
unsuitable food, vitiated atmosphere, insufficient sleep
and rest, worry, and excesses of all kinds. The mechanism
by which these varying conditions lower our immunity must
receive our attention, for they are of the greatest
importance in preventive medicine. It is a matter of common
observation that exposure to wet and cold or sudden changes
of temperature, overwork, worry, stale air, poor food,
etc., make us more liable to contract certain diseases. The
tuberculosis propaganda that has been spread broadcast with
such energy and good effect has taught the value of fresh
air and sunshine, good food, and rest in increasing our
resistance to this infection.
"There is, however, a wrong impression abroad that because
a lowering of the general vitality favors certain diseases,
such as tuberculosis, common colds, pneumonia, septic and
other infections, it plays a similar rôle in all
communicable diseases. Many infections, such as smallpox,
measles, yellow fever, tetanus, whooping-cough, typhoid
fever, cholera, plague, scarlet fever, and other diseases,
have no particular relation whatever to bodily vigor. These
diseases often strike down the young and vigorous in the
prime of life. The most robust will succumb quickly to
tuberculosis if he receives a sufficient dose of the
virulent micro-organisms. A good physical condition does
not always temper the virulence of the disease; on the
contrary, many infections run a particularly severe course
in strong and healthy subjects, and, contrariwise, may be
mild and benign in the feeble. Physical weakness,
therefore, is not necessarily synonymous with increased
susceptibility to all infections, although true for some of
them. In other words, 'general debility' lowers resistance
in a specific, rather than in a general, sense."--(Rosenau:
Preventive Medicine and Hygiene, pp. 403 and 404.)
CARRIERS
Well persons who carry in their bodies pathogenic germs but who
themselves have no symptoms of disease are called carriers. Thus typhoid
carriers have typhoid bacilli in the intestinal tract, while they
themselves show no symptoms of typhoid fever; diphtheria carriers have
bacilli of diphtheria in the throat or nose, but have themselves no
symptoms of diphtheria, and so on. It has now been proved that many
patients harbor bacteria for weeks, months, or even years following an
infection, and are dangerous distributors of disease; also, some
healthy individuals without a history of illness harbor living bacteria
which may infect susceptible persons in the usual ways. Transmission by
healthy carriers goes far to explain the occurrence of diseases among
persons who have apparently not been exposed. This explanation has
greatly clarified the whole problem of the spread of communicable
diseases. Carriers, unfortunately, exist in large numbers, and render
the ultimate control of disease exceedingly difficult. They can usually
be identified by bacteriological tests. To some extent they can be
supervised; food handlers at least should be legally obliged to submit
to physical examinations, and should be licensed only when proved free
from communicable disease.
Diseases are also spread by persons suffering from them in a form so
mild or so unusual that they pass unrecognized. These persons are known
as "missed" cases. Carriers of disease and "missed" cases go freely
about the community, handling food, using common drinking cups,
travelling in crowded street cars, standing in crowded shops; in various
ways coming into close contact with other people, coughing and sneezing
and kissing their friends no less often than normal individuals. It is
consequently clear that the bodily discharges of supposedly normal
persons may be hardly less a menace than those of persons known to be
infected.
Diseases that depend for transmission upon milk, water, food, and
insects may be controlled by public action, that is, by specific
measures taken by a large group of people in order to protect the
individual. Such action constitutes _public sanitation_. There is,
however, a large group of diseases, chiefly sputum-borne, that cannot be
controlled except by individual action. Such individual action
constitutes a large part of _personal hygiene_.
The whole problem of controlling infections sounds simple, depending as
it does for the most part upon unpolluted water, milk, and food,
extermination of certain insects, and cleanliness in personal behaviour.
In practice the problem is not so easy. Public sanitation has performed
miracles in the past, and will do much in the future; behaviour,
however, will continue to be influenced by many factors, social and
economic as well as personal. Ignorance of the laws of health is an
obstacle to progress, but in modern conditions even the instructed may
be unable to control their ways of living and working. Indeed, such
control is at present limited to the privileged few. On the ignorant and
the poor, those least able to bear it, society loads the heaviest burden
of sickness. Only when ignorance and poverty are abolished, as one day
they will be, can the final stage be reached in the fight for public
health.
THE NON-COMMUNICABLE DISEASES
In this group is included a great variety of maladies. Of some the
causes are known, while in the case of others, origin, prevention, and
remedy are still obscure. Here belong defects in structure of the body,
both hereditary and acquired; insanity and other nervous diseases; new
growths, like tumors and cancer; disturbances of bodily processes, as
malnutrition and gout; and the important class of degenerative diseases,
like arteriosclerosis, in which tissues become hardened and fibrous and
hence less able to perform their normal functions.
The degenerative diseases are playing a menacing part in national
health. The average length of life in the United States has shown a
marked increase it is true, during the last 40 years. But this gain
represents chiefly the saving of life through prevention of communicable
diseases, especially among babies and children; among people who have
passed the 30th year on the other hand, death rates are actually
increasing. This increase is most marked after the age of 45, and is
caused chiefly by the increase of cancer, and of degenerative diseases
of the heart, blood vessels, and kidneys. Degeneration of tissues is
normally a condition typical of old age, and in aged persons it may
occur in any tissue. There is no elixir of youth, and for old age there
is no cure. But the important facts in this connection are that
degenerative changes now occur prematurely, and that among a vast number
of people, in various classes of society and various occupations, the
vital organs show a marked tendency to break down after the age of 45.
This condition is not inevitable. Before the beginning of the present
war, death rates at all ages were decreasing in England, Sweden, and
other European countries. In America also degenerative diseases can be
checked or prevented to a large extent, and it is highly important that
their causes should be generally understood.
The two groups following include some of the probable causes:
1. Conditions of life which result in continued overwork, and mental
overwork in particular; worry, excitement, insufficient recreation and
exercise, and other kinds of nervous strain typical of modern life,
especially in cities.
2. Irritating substances in the body, including poisonous substances
resulting from infectious diseases, and from syphilis in particular;
poisons from chronic infections, alcohol, and industrial poisons such
as lead and other metals; overeating and improper eating, especially of
meat and other proteins, and rich or highly seasoned food; faulty
digestion, constipation, and imperfect elimination through the
kidneys.--(See Dr. A. E. Shipley, in bulletin of the N. Y. City Dept. of
Health, Feb., 1915.)
The importance of early recognition cannot be overemphasized. In many of
these troubles the symptoms are not pronounced, and the victims have no
knowledge of their condition until they happen to be examined for life
insurance, or until the disease is far advanced. And even when they
realize that trouble exists, as for example constipation or overwork,
most people absolutely fail to realize how serious the consequences may
be. The first step toward remedy is periodic complete physical
examination by a competent physician, in order to learn in time how to
prevent these degenerative diseases, if present, from growing worse. The
custom of undergoing an annual physical examination is becoming more
common, and "such a course, conservatively estimated, would add 5 years
to the average life of persons between 45 and 50."--(Winslow.)
"Recently, we have been making examinations of the
employees of whole institutions, large banks and other
industrial concerns in New York City, and we find almost
the same conditions there. Out of 2000 such examinations
among young men and women of an average age of 33, just in
the early prime of life, men and women supposedly picked
because of their especial fitness for work, only 3.14% were
found free of impairment or of habits of living which are
obviously leading to impairment. Of the remaining persons,
96.69% were unaware of impairment; 5.38% of the total
number examined were affected with chronic heart trouble;
13.10% with arteriosclerosis; 25.81% with high or low blood
pressure; 35.65% with sugar, casts or albumen in the urine;
12.77% with combination of both heart and kidney disease;
22.22% with decayed teeth or infected gums; 16.03% with
faulty vision uncorrected.... The fact of greatest import,
however, was that impairment, sufficiently serious to
justify the examiner in referring the examinee to his
family physician for medical treatment, was found in 59% of
the total number of cases, while 37.86% were on the road to
impairment because of the use of "too much alcohol," or
"too much tobacco," constipation, eye-strain, overweight,
diseased mouths, errors of diet, and so forth....
"And what is the cause of this appalling increase, in the
United States, of these and other degenerative diseases? I
believe it can be shown to the satisfaction of any
reasonable person that the increase is largely due to the
neglect of individual hygiene in United States....
"If a man were suddenly afflicted with smallpox or typhoid
fever or any other acute malady, he would lose no time in
getting expert advice and applying every known means to
save his life. But his life may be threatened just as
seriously, though possibly not so imminently, by
arteriosclerosis, heart disease, or Bright's disease, and
he will do nothing to prevent the encroachment of these
diseases until it is too late, but will continue to eat as
he pleases, drink as he pleases, smoke as he pleases, or
overwork, and worry himself into a premature
grave."--("Conservation of Life at Middle Age," Prof.
Irving Fisher, Am. Journal of Public Health, July, 1915.)
Periodic physical examinations are as necessary for children as for
adults, in order to detect physical defects. These defects are known to
have such an immense bearing upon health that routine examinations of
all children have become an integral part of the work of enlightened
public schools.
Prevention of degenerative disease, then, as well as of the enormous
numbers of preventable accidents and injuries, depends in large measure
upon proper living conditions and proper personal habits. The infectious
diseases, according to Dr. Hill, cost us annually at least 10 billion
dollars in addition to the loss of life, and he adds: "The infectious
diseases in general radiate from and are kept going by women."--(Hill--
New Public Health, p. 30.) Women, it is true, can prevent many of the
infections, but they can do still more, for hygienic habits to be
effective must be acquired early, and mothers and teachers, because they
have practically the entire control of children, have the power to
prevent many cases of degenerative as well as of communicable disease.
EXERCISES
1. Distinguish between communicable and non-communicable disease.
2. Describe the part played by micro-organisms in causing disease.
3. Describe the structure of bacteria and their method of
multiplication.
4. In what ways are pathogenic germs transmitted from person to person?
5. Upon what preventive measures does the control of communicable
diseases depend?
6. What is meant by immunity?
7. Against what diseases may immunity be acquired artificially? How has
the practice of immunizing affected death rates from communicable
diseases?
8. What factors tend to lower resistance? Do they act equally in the
case of all diseases?
9. Define a carrier, and explain the importance of carriers in the
spread of disease.
10. Name some of the characteristics and causes of degenerative
diseases.
11. Whom do the degenerative diseases most commonly affect?
12. Describe methods that should be employed to prevent degenerative
diseases.
FOR FURTHER READING
The New Public Health--Hill, Chapters I-IX.
Health and Disease--Roger I. Lee, Chapters XV-XXIV.
Principles of Sanitary Science and the Public Health--Sedgwick, Chapters
I, II, III.
Scientific Features of Modern Medicine--Frederic S. Lee, Chapters II,
IV-VI.
Disease and Its Causes--Councilman, Chapter I.
Preventive Medicine and Hygiene--Rosenau.
Publications of the Life Extension Institute--25 West 45th Street, New
York City.
CHAPTER II
HEALTH AND THE HOME
Of all the considerations that determine health, heredity is the one
unalterable factor. Although certain characteristics are obviously
hereditary,--complexion, height, and mental and physical traits in great
variety,--yet in the past heredity has been little understood. In
consequence it has served too often as a scape goat for faults and
failings not beyond an individual's control. Our first clear
understanding of the principles underlying heredity resulted from
experiments made by Mendel, an Austrian monk, during the last century,
and it is now possible to predict with a high degree of accuracy the
inheritance of certain characteristics.
Many diseases, formerly considered hereditary because their actual
causes were unknown, are now known to be communicable. Thus, it is now
understood that tuberculosis is not hereditary, although little children
may be infected by tuberculous parents. No germ diseases are inherited
in the strict sense of the word; but a baby may be infected with
syphilis before birth if his father or his mother has the disease.
It is true, however, that certain tissue weaknesses of the body seem to
be hereditary, and in consequence one family is more susceptible to
digestive disorders, another to diseases of the lungs, a third to
deafness, and so on. Moreover, general low vitality may be inherited. It
should be emphasized, however, that hereditary weakness does not
inevitably lead to disease. Many persons have succeeded in preventing
the development of active disease by guarding against strain in
directions where they are weak by inheritance.
Of all tissue weaknesses that may be inherited, defects of the nervous
system are the most serious. Nervous disorders of every degree of
severity, from slight nervous instability even to insanity, may result
when these tissues are defective; but it is now a recognized fact that
nervous disorders in many cases can be prevented from developing.
Feeblemindedness, another condition due to defective tissue, is known to
be inherited in the majority of cases, and in all cases it is incurable.
HYGIENE OF ENVIRONMENT AND PERSON
By environment is meant everything outside the body that affects it;
taken in its complete meaning the word might include everything that is
or ever was in the whole universe. It is possible to consider here a few
only of the many environmental and personal factors affecting the health
of individuals.
The home constitutes the important part of environment for most persons,
and for children in particular, since they spend the greater part of
their time in or about it, and get there the foundation on which their
health in later years depends. For persons employed away from home,
industrial and occupational hygiene is hardly less important; but those
subjects are too extensive to be considered here.
Most people live where they must, and few have any part in planning the
construction of their own houses. In choosing a house, however, one
should remember that rooms where sunshine never enters are unfit for
continued occupation. For children in particular fresh air and sunshine
are essential, and it may be economy in the end to pay a comparatively
high rent for an apartment having sunshine during at least a part of the
day. Ignorance and carelessness, unfortunately, can spoil the best
living conditions, and sometimes even in the country fresh air and
sunshine are excluded from sleeping and living rooms.
VENTILATION.--Ventilation has a direct bearing on health, although,
contrary to former belief, the actual amount of oxygen in the air is not
ordinarily the most important factor; even badly ventilated rooms
contain more than enough oxygen to support life. The factors of prime
importance in ventilation are temperature, humidity, air movement, and
the number of persons in a given space since the greater the distance
from one another the less is the probability that diseases will be
spread.
Room temperature should not be above 70° F. and, except for the aged or
sick, it is better to be between 60° and 65°. Some moisture in the air
is desirable; the amount needed is from 50% to 55% of the total moisture
that the air can hold at a given temperature. We have no apparatus to
decrease humidity in the air of houses, and in summer we are obliged to
endure humidity, if excessive, no matter how uncomfortable we may be.
But in winter the air in most houses is too dry, so that the mucous
membranes of the nose and throat often become irritated and susceptible
to infection. Most heating systems, particularly in small buildings,
make no provision for supplying moisture. Keeping water in open dishes
on or near radiators is often recommended, and would greatly improve the
condition of the air, if people remembered to keep the dishes filled.
The following is a simple but effective device to increase humidity:
Roll an ordinary desk blotter into a cone about 8 inches in diameter at
the base, and keep it constantly submerged for about one inch in a dish
of water. The water rises to the top of the blotter and a large surface
for evaporation is thus afforded.
[Illustration: FIG. 7.]
Stagnant air is harmful. Air should be in constant though not
necessarily perceptible motion. Air about the body, if motionless, acts
like a warm moist blanket, preventing the passage of heat from the body.
The three factors, heating, humidity, and air motion, must be considered
together. Every person requires each hour about 3000 cubic feet of air,
and the problem of heating and ventilating is that of providing this
amount in gentle motion, at a temperature of about 65° F., and of
humidity from 50-55%. Higher temperatures and stagnant air cause
disinclination to work, headache, nausea, restlessness, or sleepiness,
and if continued are likely to result in loss of appetite, and anemia.
The tuberculosis movement has clearly shown the benefits both for the
sick and the well of living in the open air, and has caused great and
beneficial changes within a generation. The more time spent in the open
air the better; since however most persons who work must spend the
greater part of the day indoors, ventilation is a matter of great
importance.
Although fresh air enthusiasts are still too few, yet some go to the
extreme and think that because cool air in motion is good, the colder
the air and more violent the motion the better. On the contrary,
chilling the whole body or a part of the body lowers resistance.
Draughts of air have no bad effects upon persons in good health,
particularly those accustomed to changes in temperature. But draughts
are likely to be injurious to aged or sick persons and babies, by
diminishing their resistance to such infections as common colds and
pneumonia. It should be remembered that draughts or cold alone cannot
cause colds; the specific germs must be present.
LIGHTING.--Amount and direction of light are physiologically important.
Defects of the eyes, too prolonged use, and insufficient light are the
commonest causes of eye strain. Most eye defects can be relieved by
glasses. Children's eyes should be examined upon entering school, and as
often afterward as the oculist advises. Prolonged use causes fatigue of
the eyes, especially when the illumination is poor; within limits, the
amount of light needed depends on the nature of the work. Light should
come from the left side of right handed people; never from the front.
Light reflected from snow, sand, glazed white paper of books, or other
bright surfaces is fatiguing from its intensity, and from the unusual
angle at which it enters the eyes. Too much light is harmful, and
probably causes some of the effects, such as nausea and headache,
commonly attributed to poor ventilation.
Almost all blindness is preventable, and blindness due to industrial
accidents and processes is no exception to this rule. Surely no
individual precautions or legal measures are too great in order to guard
against this saddest of all physical defects.
CLEANLINESS OF HOUSES.--A clean, well-cared for house is desirable from
every point of view, but certain kinds of cleanliness affect health more
than others.
The most scrupulous care should be exercised wherever food is stored or
prepared. The kitchen is in reality a laboratory; in it either
intelligently or ignorantly are formed chemical compounds which have a
far-reaching effect upon family health. From the standpoint of health no
other room in the house is so important. It should be bright, airy, and
easy to clean. In cleaning kitchen tables and woodwork water should not
be allowed to soak into cracks and dark corners, carrying with it
particles of food for the nourishment of bacteria and insects. Linoleum,
if used to cover the floor, should be well fitted at the edges to
prevent water from running underneath. There should be neither cracks
nor crevices in wall or floor, and no dark corners or out-of-the-way
cupboards in which dust, food particles, and moisture can accumulate.
Such conditions not only attract mice and roaches, but furnish favorable
soil for the development of moulds and fungi which by their growth
affect food deleteriously. Waging a constant warfare against the
development of bacteria constitutes a large part of good housekeeping.
All cooking utensils should be thoroughly washed, scalded, and dried
before they are put away; the use of carelessly washed dishes is bad.
Enameled or agate ware which has begun to chip should be discarded.
Dish-cloths and towels should be washed and boiled after using, and if
possible dried in the sun.
Every place in which food is kept should have constant care. The
refrigerator is particularly important. Its linings should be
water-tight, and the drain freely open at all times; otherwise the
surrounding wood will become foul and saturated with drainings. At least
once a week it should be entirely emptied and cleaned in the following
way: The racks should be thoroughly washed in hot soapsuds to which a
small amount of washing soda has been added, rinsed in boiling water,
dried and placed in the sun and air. All parts of the refrigerator
should be washed in the same manner, especially grooves and projections
where food or dirt may lodge. The drainpipe should be flushed, the whole
interior rinsed again with plain hot water, thoroughly dried with a
clean cloth, and left to air for at least an hour. The drainage pan
should be washed and scalded frequently. Food showing the slightest
evidence of spoiling should be removed from the refrigerator at once.
Even more attention should be paid to the hands of the cook. They should
be washed always before handling food, and always after visiting the
toilet, using the handkerchief, or otherwise coming in contact with
nose, mouth, or other bodily secretions. Theoretically coughing and
sneezing ought not to occur in the neighborhood of food, especially of
food to be eaten raw; and persons with coughs, colds, or other
communicable disease, however slight, ought not to handle food. If this
rule were observed in practice, more persons would go hungry, but fewer
would be sick.
Thorough cleaning of rooms involves soap, water, sunshine, air, and
elbow grease, just as it did before germs were discovered. Cleaning
means actually removing dirt and dust, not merely stirring it up to
settle again; consequently dry sweeping and dusting are ineffectual.
Vacuum cleaning, and sweeping and dusting with damp or "dustless" mops
and dusters are good. Deodorants and disinfectants do not take the place
of ordinary cleanliness.
Dust does not carry living disease germs to an appreciable extent; the
fact is now well established that diseases formerly thought to be
transmitted by dust or even supposed to travel directly through the air,
are carried on tiny particles of moisture and mucus expelled in coughing
and sneezing. This mode of transmission is called droplet or spray
infection; it is one of the most active agents in spreading certain
kinds of communicable diseases.
Nevertheless dust in motion is harmful; it irritates the lining
membranes of the nose, throat, bronchial tubes, and lungs, even causing
tiny wounds through which disease germs enter. Thus tuberculosis is
especially prevalent among stone cutters, felt workers, and others
engaged in dusty trades. Metallic dust is especially harmful, because it
is harder and sharper than dust from organic substances like wool and
cotton. Furthermore, presence of dust indicates a low standard of
cleanliness. People who tolerate it generally tolerate uncleanliness in
other forms, more serious though less apparent.
Cleaning would not be so great a problem if most houses were not
littered with such dust catchers as carpets, so-called ornaments, carved
and upholstered furniture, banners, draperies, and a vast collection of
articles that can only be classified as Christmas presents. In actual
practice things that are difficult or expensive to clean seldom are
cleaned; carpets for example are considered unhygienic, not because they
cannot be cleaned, but because they are not. William Morris' advice to
exclude from houses all articles not known to be useful or believed to
be beautiful would, if followed, add years to the lives of housekeepers.
GARBAGE, has little bearing on health, except in so far as it affords a
breeding place for flies. If it contains disease germs it may be
dangerous, but statistics show that garbage handlers, although they can
hardly be called especially careful, are not more subject to sickness
than other men of their class. Garbage disposal is chiefly a question of
preventing a public nuisance; it is a matter of cleanliness and public
decency.
INSECTS.--Flies, cockroaches, and other scavenging insects may carry
disease germs on their feet and thus infect food on which they walk.
Typhoid, cholera, dysentery, and other diseases have been carried by
flies. Flies are always a menace, and should not be tolerated; moreover,
the thought of their coming to food directly from manure piles and privy
vaults is disgusting. Houses should be thoroughly screened in the fly
season, but it is better to destroy the nuisance at its source. The
chief breeding places of flies are garbage cans and manure piles. If
the garbage can is water tight, closely covered, frequently emptied, and
thoroughly cleaned, flies will not develop in it; about ten days must
elapse from the time when the egg is laid until the insect is ready to
fly. Fly traps to fit on the garbage can are useful. Manure should be
screened and removed frequently, or it can be treated chemically.
Methods for treating it are given in "Preventive Medicine and
Hygiene."--Rosenau, p. 255, and in Bulletin No. 118, of the U. S. Dept.
of Agriculture, July 14, 1914.
[Illustration: FIG. 8.--A FLY WITH GERMS (GREATLY MAGNIFIED) ON ITS
LEGS. (_U. S. Dept. Agri._)]
Other diseases carried by insects are malaria and yellow fever, each by
a special species of mosquito; typhus fever, by lice; and bubonic
plague, by rat fleas. Various diseases less common in this country are
carried by other insects. Even when mosquitoes are not carrying disease
germs their bites may be harmful since they are often rubbed, especially
by children, until the skin is broken, and various infections may enter
through the wounds. Insects of every kind, rats, mice, and vermin should
be excluded from houses.
SEWAGE.--Discharges from the bowels and bladder contain various germs,
and constitute one of the most important routes by which germs of
typhoid fever, cholera and certain other diseases travel from person to
person. Keeping sewage out of the water supply is consequently of great
importance. Where a system of sewage disposal exists, the responsibility
of making the system adequate and thus safeguarding public health rests
upon the community as a whole. Communities ordinarily get just as much,
or just as little typhoid fever as they are willing to endure.
[Illustration: FIG. 9.--HOW A WELL MAY BE POLLUTED. (_From "The Human
Mechanism."_ Copyright by Theodore Hough and William T. Sedgwick. Ginn
and Company, publishers. Used by permission.)]
In places having no system of drainage privies must be used. They can be
made harmless, as army camps prove, but they require scrupulous care.
Fecal matter must be prevented from draining into wells and other water
supplies, and must be screened from flies. The privy should be located
at a distance from the well. The minimum distance that is safe depends
in each case upon the nature of the soil and the direction of the
natural drainage. Even when the privy is situated below the well on
sloping ground, drainage may still occur from the privy to the well;
however, a well-made, properly located pit privy is safe unless it is
near a limestone formation. The dry earth system is satisfactory in
places having an efficient public scavenger system; in this system pails
or cans are used to receive the discharges, which are then covered with
sand, ashes, earth or, preferably, chloride of lime. The buckets are
frequently emptied and the contents buried at least one foot below the
surface of the ground. The objection to this method for more extended
use is that proper care of the cans is a disagreeable duty of which most
households soon tire.
PERSONAL CLEANLINESS.--The main functions of the skin are three: to
protect underlying tissues, to excrete waste matter, and to regulate
bodily heat by checking or allowing the evaporation of perspiration.
After perspiration has evaporated solid matter is left upon the skin,
and oily matter also is deposited on it by the glands that keep the
skin lubricated. Removing these and other materials at least once a day
is desirable to improve the bodily tone and sense of well-being. Real
cleanliness is impossible without frequent use of warm water and soap.
Cold baths are stimulating, though not very efficacious for cleansing
purposes. They are valuable tonics if properly used, but delicate or
elderly persons should use them only by a physician's advice. Chilly
feelings or depression following should be the signal for any person to
discontinue cold bathing or swimming in cold water.
Warm baths are soothing in their effects, and are appropriate at bed
time, particularly for persons inclined to sleeplessness. Very hot
baths, especially if prolonged, may be harmful, and should not be taken
often.
There is no clear connection between general cleanliness and disease.
Frequent bathing does not protect a person from any particular disease,
except in so far as bathing necessarily includes washing the hands. If
typhoid germs for example have actually been swallowed, a clean bodily
exterior is of no avail in preventing typhoid fever or in diminishing
its severity. The same is true of other diseases.
But it is impossible to emphasize unduly the importance of clean hands.
Hands are prime offenders in distributing fresh bodily secretions, and
germs both innocent and harmful. All health authorities agree on this
point.
"Perhaps 90% of all infections are taken into the body
through the mouth. They reach the mouth in water, food,
fingers, dust, and upon the innumerable objects that are
sometimes placed in the mouth. The fact that the great
majority of infections are taken by way of the mouth gives
scientific direction to personal hygiene. Sanitary habits
demand that the hands should be washed after defecation and
again before eating, and fingers should be kept away from
the mouth and nose, and that no unnecessary objects should
be mouthed. All food and drink should be clean or
thoroughly cooked. These simple precautions alone would
prevent many a case of infection."--(Rosenau: Preventive
Medicine and Hygiene, p. 366.)
As Dr. Chapin says:
"Probably the chief vehicle for the conveyance of nasal and
oral secretion from one to another is the fingers. If one
takes the trouble to watch for a short time his neighbors,
or even himself, unless he has been particularly trained in
such matters, he will be surprised to note the number of
times that the fingers go to the mouth and the nose. Not
only is the saliva made use of for a great variety of
purposes, and numberless articles are for one reason or
another placed in the mouth, but for no reason whatever,
and all unconsciously, the fingers are with great frequency
raised to the lips or the nose. Who can doubt that if the
salivary glands secreted indigo the fingers would
continually be stained a deep blue, and who can doubt that
if the nasal and oral secretions contain the germs of
disease these germs will be almost as constantly found upon
the fingers? All successful commerce is reciprocal, and in
this universal trade in human saliva the fingers not only
bring foreign secretions to the mouth of their owner, but
there exchanging them for his own, distribute the latter to
everything that the hand touches. This happens not once,
but scores and hundreds of times during the day's round of
the individual. The cook spreads his saliva on the muffins
and rolls, the waitress infects the glasses and spoons, the
moistened fingers of the peddler arrange his fruit, the
thumb of the milkman is in his measure, the reader moistens
the pages of his book, the conductor his transfer tickets,
the "lady" the fingers of her glove. Every one is busily
engaged in this distribution of saliva, so that the end of
each day finds this secretion freely distributed on the
doors, window sills, furniture and playthings in the home,
the straps of trolley cars, the rails and counter and desks
of shops and public buildings, and indeed upon everything
that the hands of man touch. What avails it if the
pathogens do die quickly? A fresh supply is furnished each
day."--(Chapin: The Sources and Modes of Infection, p.
188.)
ORAL HYGIENE.--Cleanliness and proper care of the mouth and teeth can
hardly be over emphasized. Their bearing upon health is direct. Long ago
it was recognized that persons with decayed or missing teeth frequently
suffered from dyspepsia, a natural result of inability to masticate
properly, but only within recent years has it been realized that decayed
teeth give rise to many other diseased conditions. Bacteria are
constantly present in the mouth. If the mucus of the mouth is not
removed, it forms a sticky coat upon the surfaces of the teeth and gums.
In this bacteria collect, and pus or matter may also be formed, which,
if carried by the blood to other parts of the body, may cause digestive
troubles, rheumatism, and diseases of heart and kidneys. (See Dr. T. B.
Hartzell, Health News, Oct., 1915, "The Importance of Mouth Hygiene and
How to Practise it.")
To keep the mouth and teeth healthy they must have:
1. Proper use.
2. Proper care.
3. Proper treatment.
1. Teeth, like other parts of the body, need exercise. Foods that
require a considerable amount of chewing should be included in the diet.
Such food is needed by children as soon as their first teeth have come,
but care must be exercised to see that the food is actually chewed
before it is swallowed.
2. A good brush should be provided. The stiffness of the bristles should
be regulated according to the individual. The brush should be
thoroughly rinsed after using, and discarded as soon as it is worn.
Dental floss is generally needed to remove particles that have lodged
between the teeth.
Brushing the teeth by passing the bristles across them is not
efficacious. They should be brushed not across but with the cracks, as a
good housewife sweeps a floor.
"In the light of recent investigation conducted by some of
the leading students of mouth hygiene, the most effective
way to use the toothbrush is to place the bristles of the
brush firmly against the teeth, applying firm pressure, as
though trying to force the bristles between the teeth,
using a slight rotary or scrubbing motion.... After a
little practice the user of this method will be surprised
at the results obtained. Care should be used to go over all
the surfaces of the teeth in this manner."--(See Dr. W. G.
Ebersole. "The Importance of Mouth Hygiene and How to
Practice it," Health News, Oct., 1915.)
After brushing the teeth, the mouth should be rinsed by forcing lukewarm
water about the teeth, using all the force that can be brought to bear
by the cheeks, lips, and tongue.
3. TREATMENT.--The teeth, including the first teeth of children, should
be inspected by a competent dentist at least twice a year. Periodic
cleansing by a dentist, and early attention to small cavities, may
prevent serious ill health and impairment of the body, as well as the
acute suffering generally accompanying treatment of advanced dental
defects.
CLOTHING.--Clothing was originally used for purposes of ornament. Desire
for protection from cold and dampness came later. The amount of clothing
required varies greatly according to individual needs and habits, but it
is increasingly recognized that light clothing is best, provided that
the wearer is really protected from cold. Clothing should be porous in
order to allow ventilation of the body, supported so far as possible
from the shoulders, and clean and well aired. Dampness favors the growth
of germs which may cause irritation of the skin.
Clothing should not constrict the body or hamper its movements. Perhaps
the worst health menace for which clothing is to blame comes from the
high heeled shoes on which many women prefer to limp through life. From
the health standpoint shoes are of great importance. Bad shoes are
responsible for many cases of flat feet, whose muscles have degenerated
through non-use, and for much so-called "rheumatism," which is merely
the protest of abused muscles. Bad shoes also, by distorting the feet,
prevent comfortable walking, which is the only out-of-door exercise
readily available for the vast majority of people; and still worse, the
resulting unnatural position of the body sometimes has serious
consequences by bringing injurious strains on other muscles and organs.
FOOD.--Two distinct problems are encountered here: the problem of
nutrition, and the problem of preventing sickness. Nutrition, or proper
feeding, is a subject beyond the scope of this book; it is nevertheless
one of the most important, if not the most important, factor in
maintaining health. Food preparation and care of children, the two most
important functions of the home, are unfortunately relegated to the
least intelligent and least interested members of most households in
which servants are employed.
Most American families eat too much protein food, such as meat and eggs.
Excess of protein probably leads to degeneration of tissues, and plays a
part in causing the degenerative diseases already mentioned. Habit is
important here as in other ways of living, but cereals and vegetables
should in large measure make up the diet of sedentary persons and indeed
of everyone in warm weather.
The amount of food required in 24 hours depends on many factors: age,
height, weight, occupation, season, and habit. Underweight and
overweight are both abnormal conditions; probably the latter is the more
easily remedied. Both require the advice of a physician. Rapid reduction
of weight involves certain dangers, especially for persons with weak
hearts.
Food may cause sickness either because it is in itself harmful, or
because it carries disease germs. Meat from diseased animals should be
destroyed before it reaches the market, but bacterial activities in food
originally wholesome may form in it poisonous substances.
The chief diseases known to be carried by food, water, or milk are
typhoid fever, paratyphoid, dysentery and other diarrhœal diseases,
scarlet fever, diphtheria, septic sore throat, and tuberculosis. The
sole problem here is to keep human and animal excretions out of food,
water, and milk. Since thorough cooking kills disease germs, danger
arises chiefly from raw foods. All fruits and vegetables eaten raw
should first be thoroughly washed.
Water is essential to health. At least three pints should be taken
daily, the amount varying somewhat according to diet, exercise,
temperature, and so forth. Most persons drink too little water.
Cities and towns should of course have public supplies of pure water.
Contamination of water, when it occurs, is caused chiefly by sewage
from cesspools, privies, and drains. All well or spring water must be
constantly watched and Boards of Health are always ready to examine
samples of water and to report whether it is safe to drink. At the
present time a porcelain filter is the only satisfactory kind for a
household, but many domestic filters are so badly cared for that in
actual practice they are worse than none. Danger from a filter
containing an accumulation of impurities is greater than the danger from
most ordinary water supplies. Boiling water for ten minutes kills all
pathogenic germs, but this method is inconvenient on a large scale and
is not practical for continued family use.
Every effort should be made to insure a regular supply of pure water in
every house. It is not satisfactory to have two kinds, one for drinking
and one for other purposes, since mistakes are sure to be made,
especially by children. Some families who use only bottled or filtered
water for drinking purposes habitually run the risk involved in using
impure water from the tap for cleaning the teeth.
Freezing destroys most germs, but ice is not necessarily free from
bacterial life, and should be used in drinking water only when known to
be free from impurities. Neither does freezing milk or cream
necessarily kill germs that may be contained in it.
Raw milk plays so important a part in the spread of disease that its
fitness for human consumption is open to serious question. Certified
milk, where obtainable, is safe but expensive. Boiled milk is safe, but
changed in taste and to some extent in quality. If milk is heated to
142°-145° F. and kept at that temperature for 30 minutes all disease
germs in it are killed. This process, called pasteurization, renders
milk safe. The objection is sometimes made that continued use of
pasteurized milk for infants causes scurvy, but in New York City where
over 90 per cent. of the milk is pasteurized no increase in scurvy has
been noticed, while a large diminution in deaths of infants from
diarrhœal diseases has resulted, as in all cities where pasteurization
is required.
The following is a simple method for pasteurizing a quart bottle of
milk. If the directions are exactly followed the milk will be
pasteurized at the end of the process; no thermometer need be used. To
prevent the bottle from breaking, it is first warmed by placing it for a
few minutes in a pail of warm water.
"From the results of the experiments it was concluded that
any housewife can pasteurize a one quart bottle of milk by:
1. Boiling 2½ quarts of water in a large agate saucepan; or
better
2. Boiling 2 quarts of water in a 10 pound tin lard pail,
placing the slightly warmed bottle from the ice chest in
it, covering with a cloth and setting in a warm place. At
the end of one hour the bottle of milk should be removed
and chilled promptly. The water must be boiled in the
container in which the pasteurization is to be
done."--(Ruth Vories, in "Health News," Sept., 1916.)
ELIMINATION.--Careful attention should be paid to elimination through
the bowels and kidneys. Constipation is responsible for many common
ailments; among them are headache, disinclination to work, irritable
temper, and lowered resistance. If long continued, constipation becomes
serious both from congestion and displacement of pelvic organs, and from
absorption over a considerable time of even small amounts of the
poisonous substances resulting from decomposition of food in the large
intestine. The bowels can best be regulated by diet, water, exercise,
and habit. The habitual use of cathartic and laxative drugs is most
unwise, because they tend to aggravate the trouble. Moreover the
habitual and continued use of injections and "internal baths" is
harmful, and would not be considered necessary if bran and coarse flour
and vegetables were substituted for concentrated foods. Greed, laziness,
and lack of intelligence lead most persons suffering with constipation
to prefer pills to the restraints demanded by hygienic living. The habit
of evacuating the bowels at a regular time, if established in early
childhood and rigidly adhered to, will prevent constipation among most
healthy people. Any person who thinks drugs necessary should consult a
physician, and be prepared to follow the régime he advises over a
considerable period of time and at the cost of some self-denial.
For healthy people, voiding urine presents no difficulty if a sufficient
amount of water is taken; but some persons reduce the amount of liquid
taken in order to escape the inconvenience of urination. This practice
is harmful, and may involve insufficient cleansing of the entire system.
If frequent urination disturbs sleep, liquids may be withheld during the
evening; but the total amount of water taken in 24 hours should not be
diminished.
REST AND FATIGUE.--A fatigued person is a poisoned person. Muscular
exertion burns the fuel constituents of the body, as we recognize by the
greater heat generated within us during muscular exertion. Waste
products, resulting from this burning process, accumulate if not
removed, and clog the body in somewhat the same way that ashes and
cinders clog a furnace. The fatigued person remains fatigued,
consequently, until the accumulations of waste matter are removed by the
normal action of the lungs, skin, and kidneys.
Fatigue is caused by both mental and physical work, and when excessive,
affects the nervous system most disastrously. The body can and should
respond to occasional extra drafts on strength and endurance; its
flexibility and power of adjusting to varying conditions may even be
stimulated thereby. But even slight fatigue, if continued and especially
if associated with anxiety or worry, has caused many nervous and mental
breakdowns.
Work carried beyond the point of normal fatigue requires a
proportionately longer time for recovery. For example, if the point of
fatigue has been reached by a certain finger muscle after 15
contractions, and if half an hour is required to rest it completely, one
might suppose that one hour would rest it after 30 contractions. This is
not so, however; after 30 contractions 2 hours are required, or 4 times
as much rest for twice the amount of work, if continued beyond the point
of fatigue. Laboratory experiments and experience alike show that this
principle holds true in other forms of fatigue. Thus the output of
factories has been shown in many instances to be greater, other things
being equal, when operatives work 8 hours a day than when they work
longer. Excessive hours in any kind of work are the poorest economy.
Fatigue is increased in direct proportion not only to muscular exertion
but also to the amount of speed, complexity, responsibility, monotony,
noise, and confusion involved in an occupation. Ability to bear fatigue
differs greatly with different people, as ability varies to bear other
kinds of strain. Rest at night and on Sunday, and the annual vacation
should be enough to keep a person in good condition. If not, there is
probably something wrong with the worker's health, the nature of his
work, or his adaptation to his particular kind of work. This statement
is not only true of persons regularly employed, but of those living at
home, including children in school, women in "society," and especially
mothers of families.
SLEEP.--A sufficient amount of sleep is essential to health, but
individual requirements vary widely. Each person should know and regard
his own need, and children and young people should be obliged to go to
bed early. Ability to sleep is largely habit; good habits should be
formed and continued. Sleep-producing drugs should never be taken,
except by a doctor's prescription.
RECREATION.--Owing to the speed, complexity, and worry of modern life
among all classes, and to the monotony of work in industry, recreation
has become a matter of vital importance for everyone. Some muscular
activity, preferably in the open air, is needed by every healthy person.
Recreation should be as unlike the regular occupation as possible: going
to the theatre, for example, is not the best exercise for sedentary
workers employed all day in artificially lighted offices. The element of
pleasure is essential. Hoisting dumb-bells purely from conscientious
motives is seldom beneficial, and is generally soon abandoned.
The part played by habit in matters of health is often overlooked.
Although the body adjusts itself to widely varying conditions and even
to unfavorable ones, the importance of forming desirable habits cannot
be overemphasized. Sudden or radical changes in living, however,
particularly among people no longer young, may play havoc. New and
violent systems of exercise, weight reduction, and food fads forced on
families by enthusiastic discoverers involve considerable risk.
Many elements enter into health; in no single one is found hygienic
salvation. Temptation always exists to emphasize one element at the
expense of others. For instance, people who insist upon overventilating
rooms regardless of others' comfort may themselves be utterly careless
in regard to necessary sleep, and more than one fastidiously clean
person has disregarded the highly unclean condition of constipation. To
maintain sound health only a rational program will suffice: properly
balanced work and play, sleep and food and all other elements must be
included in due proportion. And over-anxious health seekers might well
remember that health is not so much an end in itself, as a means to a
happy and productive life; even in concern over health, it is possible
for him that saveth his life to lose it.
EXERCISES
1. Explain the difference between an hereditary disease and hereditary
susceptibility to a disease. How may hereditary susceptibility to a
disease be combatted?
2. What are the essentials of good ventilation?
3. What is the proper temperature for a living room? What are the
effects of higher temperatures? Of lower temperatures?
4. Describe methods for maintaining household cleanliness.
5. Discuss the importance from the point of view of health, of dust; of
insects; of garbage; of sewage.
6. What principles should guide one in deciding whether a certain water
supply is safe to use for drinking purposes? What are the dangers of
impure water? How can impure water be rendered safe?
7. What diseases may be carried by milk? How can milk be rendered safe?
8. Explain the health aspects of personal cleanliness.
9. What care should be given the teeth and mouth? Why?
10. What bad results frequently follow constipation? How should
constipation be remedied?
11. Name seven factors that are important in causing fatigue. Why is it
uneconomical to continue work, either physical or mental, beyond the
point of fatigue?
12. What facilities for recreation, especially in the open air, does
your community provide for little children? For school children? For
working boys and girls? For grown people?
FOR FURTHER READING
Health and Disease--Roger I. Lee, Introduction and Chapters I, III-V,
VII-IX.
How to Live--Fisher and Fisk, Chapters I, III-V.
The Human Mechanism--Hough and Sedgwick, Chapters V, XXII-XXIX.
Disease and Its Causes--Councilman, Chapters X, XII.
Fatigue and Efficiency--Goldmark, Chapters II, III.
Preventive Medicine and Hygiene--Rosenau.
A Manual of Personal Hygiene--6th Edition, Edited by Walter L. Pyle.
Four Epochs of a Woman's Life--Galbraith.
Hygiene and Physical Culture for Women--Galbraith.
The Home and Its Management--Kittredge.
Exercise and Health--F. C. Smith, Supplement 24 to the Public Health
Reports, Government Printing Office, Washington.
The Sanitary Privy--Farmers' Bulletin 463, United States Department of
Agriculture, Government Printing Office, Washington.
Safe Disposal of Human Excreta at Unsewered Homes--Lumsden, Stiles and
Freeman, Bulletin 68, Public Health Reports, Government Printing Office,
Washington.
The Disposal of Human Excreta and Sewage of the Country Home--New York
State Department of Health, Albany.
Milk and Its Relation to Public Health--Bulletin 56, Hygienic
Laboratory, Government Printing Office, Washington.
Milk and Its Relation to Health--New York State Department of Health,
Albany.
Other Publications of the United States Public Health Service and of the
Departments of Health of the different states and cities.
CHAPTER III
BABIES AND THEIR CARE
The principles of hygiene are fundamentally the same for young and old.
The applications, however, differ at different ages. From the time when
physical growth and development are complete until changes due to old
age appear, an individual commonly has greater resistance than at other
ages, and is able in consequence to endure unfavorable conditions of
life with more success.
Babies, on the other hand, are exceedingly sensitive to their
environment. Surroundings that are even slightly unfavorable are likely
to make babies sick. In order to remain healthy, they must have exactly
the right kind of food, in the right quantities and at the right times;
their sleep, exercise, and clothing must be carefully regulated; they
must be protected from careless handling, from nervous strain, and above
all, from the many kinds of infection to which they are peculiarly
susceptible. The life of a baby fortunately can be controlled almost
completely; when properly regulated it offers, therefore, an unequalled
opportunity to see how hygienic principles work out in actual practice.
The primitive mother's instinct to nourish and protect and succor her
helpless child was the original form of nursing. Instinct alone,
unfortunately, has never accomplished much in preserving health. The
human race has now had an experience in the care of infants that extends
over thousands of years. Yet today we are still, on the whole, less
successful in keeping babies alive than we are in raising domestic
animals; we still allow society to continue, like a modern Herod, in its
ruthless career of slaughtering the innocents.
About 14 babies out of every 100 born in the registration area[1] of the
United States die before reaching the age of one year, while in some of
our industrial cities as many as 25 out of every 100 born die before
they are a year old. Most of these deaths are preventable. Thus, in a
few American cities, the death rates have been so reduced that fewer
than 10 babies out of every 100 die before completing the first year;
while in Dunedin, New Zealand, as a result of the work of the Society
for the Health of Women and Children, the infant death rate has been so
reduced that in 1912 only about 4 out of every 100 babies died before
they were a year old.
While ignorant mothers, who may or may not be uneducated women, and
contaminated milk, are as a matter of fact, chiefly responsible for our
high infant death rates, yet as we have already seen, every factor in
the environment has its effect upon a baby. This fact has led Sir Arthur
Newsholme, an eminent English authority, to say:
"Infant Mortality is the most sensitive index we possess of
social welfare. If babies were well born and well cared
for, their mortality would be negligible. The infant death
rate measures the intelligence, health, and right living of
fathers and mothers, the standards of morals and sanitation
of communities and governments, the efficiency of
physicians, nurses, health officers, and educators."
Care of the child should begin at the earliest possible moment: that is,
nearly nine months before he is born. Care before birth, for want of a
better name, is called prenatal care of the mother. Every woman who
thinks that she is pregnant should put herself at once under the care of
a competent physician, so that he can make the necessary examinations as
early as possible. If she follows his advice in regard to hygiene and
proper regulation of her life, she may be free from anxiety, and may
justly expect that her delivery will be a safe and normal process.
A demonstration of the value of prenatal care was recently made by the
Boston District Nursing Association. During the year 1915 prenatal care
was given to 751 expectant mothers in 5 wards of the city; each woman
attended a pregnancy clinic, where she was under the care of an
experienced obstetrician, and was visited at intervals by a nurse who
kept careful watch of her general condition and gave necessary advice
and encouragement. In consequence the death rate among the babies whose
mothers had prenatal care was only half as great, through the whole
first year of life, as the death rate of babies in the same wards whose
mothers had not had prenatal care. Moreover, the rate of still-births
was only half as great as the rate among the general population of
Boston. If prenatal care can save so many lives, surely it ought to be
available for every pregnant woman in the land, including even that
generally neglected class of people who are neither very rich nor very
poor.
Each baby's birth should be recorded by the registrar of births, and
parents should make sure that registration has been attended to in the
city or town where they live. In some states birth registration is
already obligatory, but in any case it is required by the child's own
interest. For instance, in later life it may be necessary for him to
prove the date and place of birth in order to establish, among other
things, his right to vote and to inherit property, and to settle the
question of his liability to military service. Moreover, complete and
accurate birth registration is needed by every community because it is
essential to such reforms as reducing infant mortality and abolishing
child labor.
GROWTH AND DEVELOPMENT
Statements in regard to growth and development are based on observations
of many children. It should be remembered that the following figures
represent averages only, and that healthy children may vary from them
considerably without giving cause for alarm.
AVERAGE SIZE.--The average weight of a baby at birth is from 7 to 7½
lbs. and the average length is about 20 inches, but it is not unusual
for a child to weigh anywhere from 5 to 10 pounds at birth and to
measure from 16 to 22 inches in length. During the first week of life a
baby loses slightly in weight. After the first week a healthy baby
should gain from 4 to 8 ounces a week until he is six months old; after
that time the weekly gain is less. The weight at birth will usually
double during the first five months, and treble during the first year.
Consequently, a baby weighing 7 pounds at birth may be expected to weigh
14 pounds when five months old, and 21 pounds when a year old. Weight is
one of the most important indications of a baby's condition. He should
be weighed every week during the first 6 months, once in two weeks
during the second 6 months, and once a month throughout the 2nd year.
MUSCULAR DEVELOPMENT.--A baby at birth is helpless, and during the first
few months he has little muscular control. During the third month he
ordinarily begins to lift his head, and he can usually hold it up
without support by the time he is 3 months old; when 7 to 8 months old
he sits erect and begins to play with toys. From this time a baby makes
rapid progress; he attempts to stand on his feet, begins to creep, and
by the time he is 14 months old he is usually able to stand alone, or
even to walk a few steps. He is usually running about without difficulty
when fifteen or sixteen months old.
Babies should never be urged to walk or to bear their weight on their
feet. If healthy they are generally eager to go about unaided, and like
to investigate their surroundings without assistance. If walking is
unusually delayed, a physician should be consulted.
DEVELOPMENT OF SPECIAL SENSES.--A new-born baby is unable to
distinguish objects, but the eyes are sensitive to light and need
careful protection. Hearing, although undeveloped at birth, soon becomes
acute; consequently the child should stay in a quiet room. When six or
eight weeks old he notices objects, and at three months old he welcomes
his mother when he is hungry. A month or two later he begins to
distinguish between familiar and unfamiliar faces, and to show approval
or disapproval.
DEVELOPMENT OF SPEECH.--A baby six or seven months old begins
consciously to utter sounds, and usually can say a few unconnected words
by the time he is a year old. The average child, however, does not begin
to form sentences of more than two or three words until he is about two
years old.
DEVELOPMENT OF TEETH.--The so-called milk teeth are twenty in number;
they are followed by thirty-two permanent teeth. The two lower front
teeth (central incisors) generally appear when a child is from five to
nine months old, and in from one to three months later the four upper
front teeth (upper incisors) appear. All the first or milk teeth should
have come through by the time a child is two and a half years old, but
wide variations occur both in the time and order of appearance and
should occasion no uneasiness if the child seems well. Unusual
conditions of any sort should be referred to the physician; it is a
great mistake to attribute all illness at this time to teething.
The first of the permanent teeth appear when a child is about six years
old. Mothers sometimes mistake the first permanent molars for temporary
teeth, a mistake that frequently leads to neglect and even extraction of
highly important teeth. All but the last four molars, sometimes called
wisdom teeth, should be through by the time a child is fifteen. The
wisdom teeth may not appear before the 20th or even the 25th year.
NORMAL EXCRETIONS.--A new-born baby should have one or two bowel
movements during the first twenty-four hours; the first bowel movements
are sticky and almost black in color. After the baby begins to nurse,
three to four movements a day are not unusual, and throughout infancy
and childhood as well as adult life there should be one or two
evacuations of the bowels daily. The character of the stools is more
important than the number. While the baby is taking milk only, the
movements should be soft, yellow in color, and nearly odorless. Change
in frequency of the movements, or appearance of undigested food or curds
of milk in the stool, should be carefully noted and if continued,
reported to a physician; they may be the first signs of serious
digestive trouble.
The urine of an infant should be odorless and colorless. It should be
voided at least once during the first twenty-four hours, and much more
frequently after the baby begins to nurse. Marked diminution in the
amount of urine should be reported to a doctor.
Efforts should be made early to develop habits of regularity in the
evacuation of the bladder and bowels. If taken up regularly most
children learn to use a chamber for bowel movements by the time they are
three months old. Normal children, if properly trained, usually have no
bladder discharge during the night after they are 18 months old, and
they learn even earlier to indicate a desire to urinate during the day
time.
CLOTHING.--The amount and weight of a baby's clothing should depend upon
the season; but garments worn next to the skin, except the diaper,
should be wholly or partly of wool, the lightest weight in summer and
heavier weight in winter. During the first few weeks a baby's abdomen
should be supported by a flannel binder about six inches wide, applied
snugly but not tightly enough to restrict either the abdomen or chest
walls. It may be replaced later by a loosely fitting knitted band worn
for warmth only. Such a band is especially necessary if there is
tendency to diarrhœa, but in no case should it be discarded before
the 18th month. All garments except the diaper and first flannel binder
should hang from the shoulders, and should fit loosely but well.
Clothing for babies should be of soft materials and should be simply
made. Even the first clothes should not be very long. The weight of very
long clothing is an unnecessary burden, and prevents free movements of
the legs. At night an entire change of clothing should be made, and a
nightgown of warmer material substituted for the petticoat and slip.
Most children are dressed too warmly indoors, but in low temperatures
they need to be well protected.
Diapers should be soft and absorbent. It may be necessary to wash new
diapers several times before using in order to make them soft enough.
Care should be taken not to apply them too tightly, or in such a way as
to cause pressure on the genitals. They should be changed during the day
whenever wet or soiled, and at night when the baby is taken up to be
fed. Proper care of diapers is highly important, however laborious. They
should be well washed, boiled, and thoroughly dried before they are used
a second time. Diapers that have been wet but not soiled should not be
dried and used again before being washed. Much work can be saved if
pads of loosely woven absorbent material are used inside the diaper to
receive discharges. The pads can be burned, but even if washed the labor
is less than washing full sized diapers. Like all other infant's
garments, diapers should be washed with pure white soap and without
starch. Waterproof material used to cover the diaper is almost sure to
irritate the baby's skin, and is consequently harmful.
SLEEP.--During his first few weeks a normal baby sleeps about
nine-tenths of the time, and should be left undisturbed except for
necessary care. He should sleep in a crib, bassinet or basket protected
from light and drafts; in no circumstances should a baby sleep in the
bed with his mother or any other person. Pillows are unnecessary for
babies, and indeed for older children, but if used they should be thin
and firm.
The amount of sleep necessary gradually diminishes, but during all the
years of growth a child needs more sleep than an adult. The amount of
sleep required daily is approximately as follows:
First month 18 to 20 hours
Second to sixth month 16 to 18 hours
Sixth month to one year 14 to 15 hours
One to two years 13 to 14 hours
Two to four years 11 to 12 hours
After this time a child should sleep at least ten hours out of the
twenty-four. During the first year a nap in the middle of the forenoon
and another in the afternoon are desirable. A child who is inclined to
sleep so long that his nap interferes with his night's sleep, should be
waked from his nap, but at the same hour every day. When a child is a
year old, one nap during the day is often sufficient, if he is doing
well, but the habit of taking a nap at some time during the day should
be continued through the fifth year if possible, or even later.
Babies should not be rocked or otherwise coaxed to go to sleep; they
should be made comfortable and then left alone. They learn to go to
sleep by themselves as soon as they are convinced that sleep is expected
of them, and that no unfounded objections on their part will be
regarded. Continued inability to sleep normally usually indicates
discomfort or poor general condition, and should be taken up with the
doctor. Pacifiers and thumb-sucking should not be allowed, since they
lead to changes in the shape of the jaw with resulting imperfect
adjustment of the teeth. Soothing syrup and like medicines should never
be given to a baby; death or permanent injury has resulted from their
use. It is impossible to emphasize too strongly the danger of giving
them even a single time.
FRESH AIR.--All that has been said about the importance of fresh air
for adults applies with even greater force to infants and children.
During his first month especially a baby is susceptible to draughts;
nevertheless, the room should be well ventilated and its temperature
kept between 68° and 70° F. during the day, and at about 65° F. at
night. Even in cold weather the room should be well aired two or three
times a day; the baby should be removed to another room while the
windows are open. After the baby is three or four months old the windows
may be left open at night provided the outside temperature does not fall
below freezing. A healthy baby two or three weeks old may be taken
out-of-doors for a short time in mild weather; when he is three months
old he may be taken out-of-doors even in winter on bright sunny days.
The time spent out-of-doors should be gradually increased until the baby
stays out the greater part of the day; but he should not be exposed to
storms, wind, flying dust, dampness, extremes of temperature, or
insects. The eyes should not be covered by veils, but they should be
shielded from the direct rays of the sun at all times.
DIET.--A baby, in order to thrive, must have suitable food, given at
regular intervals. During the first few months of life no other food
can take the place of mother's milk. Breast-fed babies are more robust
than bottle-fed babies; more than this, they are less likely to contract
infectious diseases or to suffer from digestive disorders. The number of
bottle-fed babies who die every year is three times as great as the
number of breast-fed babies who die. Many mothers do not understand the
risk involved in weaning small babies; and so every year many little
lives are lost, and lost needlessly. When poverty forces nursing mothers
to wean their babies and seek work outside their homes, one can only say
that a society which tolerates such a waste of infant life is indeed
regardless of its own welfare.
Special conditions, of course, may make it undesirable for a mother to
nurse her baby. No one but the physician is competent to decide this;
not even neighbors, grandmothers, other members of the family, or the
mother herself. Where artificial feeding must be used, it should be
carefully adapted to the individual child, and in consequence it must be
prescribed by the doctor. Patent foods, notwithstanding the claims on
their printed labels, should be used only under his advice.
INTERVALS OF FEEDING.--Little milk is secreted during the first two days
after the birth of a child. The baby should, nevertheless, be put to
the breast as soon as he has had his first bath, if the mother is
sufficiently rested. Always before and after nursing the mother's
nipples should be washed in water that has been boiled. Nursing should
be repeated at intervals of six hours during the first two days.
The following schedule for the feeding of healthy babies is given by
Holt in "Care and Feeding of Infants." (1917.)
SCHEDULE FOR HEALTHY INFANTS FOR THE FIRST YEAR
------------------+--------+----------+----------+-----------+--------
| | | | |
|Interval| Night | No. of | Quantity |Quantity
Age |between | feedings,| feedings,| for one | for 24
|meals by| 6 p.m. | in 24 | feeding | hours
| day | to | hours | |
| | 6 a.m. | | |
------------------+--------+----------+----------+-----------+--------
| Hours | | | Ounces | Ounces
2d to 7th day | 3 | 2 | 7 | 1-2 | 1-14
2d and 3d weeks | 3 | 2 | 7 | 2-3½ | 14-24
4th to 6th week | 3 | 2 | 7 | 3-4 | 21-28
7th week to 3 mos.| 3 | 2 | 7 | 3½-5 | 25-35
3 to 5 months | 3 | 1 | 6 | 4½-6 | 27-36
5 to 7 months | 3 | 1 | 6 | 5½-6½ | 33-39
7 to 12 months | 4 | 1 | 5 | 7-8½ | 35-43
------------------+--------+----------+----------+-----------+--------
During the period when seven feedings are given in 24 hours the
following hours will be found convenient: 6 a.m., 9 a.m., 12 m., 3 p.m.,
6 p.m., 10 p.m. and 2 a.m. The 2 a.m. feeding is the one omitted when
the number of feedings is reduced from seven to six. Food should be
given on exact schedule time; the baby if asleep should be waked for
any meal except the one due at 2 a.m.
WATER.--Pure boiled water should be given regularly even to a young
baby. He is often satisfied with a little warm water if he is fretful
between the hours of nursing. Water may be given from a cup, a spoon, or
a bottle; it is desirable, however, for the baby to learn to drink from
a cup before the period of weaning begins.
WEANING.--Ordinarily, a baby should be fed from the breast until he is
seven months old, either exclusively or with the exception after the
second month of one bottle-feeding in twenty-four hours. This exception
will do the baby no harm and may be a great relief to his mother.
Partial breast-feeding should continue if possible through the ninth
month, but every baby should be entirely weaned by the time he is one
year old. It may be necessary, if either the baby or the mother is not
thriving, to change the food before the ninth month; but it is desirable
not to make the change in hot weather. Healthy babies, it should be
remembered, increase in weight constantly, and steady gain in weight is
the best indication that a baby's food is suitable.
NURSING BOTTLES AND NIPPLES.--Nursing bottles should be of heavy glass,
cylindrical in shape, without angles or corners to make cleaning
difficult. The number of bottles provided should be two or three more
than the number of feedings given in 24 hours.
Short black rubber nipples which slip over the neck of the bottles
should be selected. They should be of such a shape that they can easily
be turned inside out; a nipple turner costs little, and is well worth
the price. Nipples should be discarded when they become soft or when the
opening grows so large that the milk runs in a stream rather than drop
by drop.
As soon as the baby has finished his meal, the bottle should be removed
from his mouth, rinsed in clear hot water, and left standing filled with
cold water until a convenient time for boiling all the bottles to be
used during the next 24 hours. Sufficient time must be allowed for the
bottles to cool thoroughly between the time when they are boiled and the
time when they are refilled. When it is time to boil the bottles they
should be placed in an agate or other suitable kettle, covered with
water, and boiled vigorously for three minutes. A cloth placed in the
bottom of the kettle will help to prevent the bottles from breaking.
After the bottles have been removed from the boiling water, they should
be stoppered at once, either with rubber stoppers or plugs of sterile
cotton. The stoppers, if used, should be boiled with the bottles;
sterile cotton may be purchased by the package.
An easy and satisfactory method to care for rubber nipples is the
following: Provide as many nipples as the number of feedings given in 24
hours, and another, if desired, to be used in case of accident; provide
also two cups of ordinary white enamel, each one large enough to hold
all the nipples at once. One cup should have a cover; the other should
not. To avoid mistakes it is well to have the cups different in shape.
As soon as each feeding is finished the nipple should be thoroughly
cleansed under running water by scrubbing it inside and out with a
nipple brush. The nipple thus cleansed is placed in the cup without a
cover. When all the nipples have been used, cleansed, and collected in
the uncovered cup, they are transferred into the other cup; water is
added, the cup is covered and its contents are boiled for three minutes.
The nipples remain covered in the boiled water until needed; they are
removed one by one for the successive feedings. Care must be used in
removing a nipple to take it by the rim, not to touch other nipples
during the process and not to dip the fingers into the water. The best
way is to remove them by means of a glass rod, which is boiled with the
nipples and kept with them in the cup when not in use. There are
several advantages of this method of caring for nipples: it is easy; it
reduces to a minimum the necessary handling of the nipples after
boiling; and it reduces the probability of using the wrong nipple, since
boiled nipples are always in one kind of receptacle and used nipples in
another. It also prevents the too common practice of continuing to keep
nipples in a supposedly antiseptic solution long after the solution has
become badly soiled.
TABLES of diet for children over one year of age may be found in the
Appendix, page 322.
BATHING.--Usually the cord has separated and the navel has entirely
healed by the time a baby is 10 days old. After this time a daily tub
bath should be given; it should be given not less than one hour after
feeding. The temperature of the room should be from 70-72°, measured by
a thermometer placed in the part of the room where the bath is to take
place. In order to avoid chilling or tiring the baby the bath should be
given quickly, without confusion or interruption; success can be
achieved by using even a moderate amount of foresight. Before undressing
the baby everything to be used should be collected and placed within
easy reach,--clean clothing, soft towels, 2 wash cloths, pure white
soap, powder, absorbent cotton, etc. The bath tub should last of all be
filled with water, and its temperature tested by means of a bath
thermometer. The temperature of the water should be from 98° to 100°.
After the baby is three months old slightly cooler water should be
splashed over his chest, back, neck, and arms just after he is removed
from the tub, and as he grows older the temperature of his cool splash
can be reduced. Children who become accustomed to cool water in this way
take kindly to their cold showers later.
The baby's face should be washed first and dried carefully, while his
body is still covered. Next the head should be washed; a little soap
should be used, but it must on no account enter the eyes. Next the
entire body should be soaped with the hand; and then the baby should be
placed gently in the bath, his head and shoulders supported by the
attendant's left hand and forearm. Care should be taken to rinse off all
the soap. The baby should not stay in the tub more than 2 or 3 minutes;
after he has been removed from the tub he should be wrapped at once in a
soft bath towel. He should be dried gently but thoroughly by patting
with soft, warm towels rather than by rubbing. Folds of the skin should
be dried with special care. A little powder may be applied, but a baby
who is kept both clean and dry will not need much powder, if any. The
baby should next be quickly dressed, with as little turning and moving
as possible. Clothing should be drawn on over the feet instead of over
the head, and the petticoat should be placed inside the slip so that the
two garments may go on simultaneously.
EYES.--Secretion accumulating in the corners of a baby's eyes should be
removed by means of a bit of absorbent cotton moistened in boiled water.
The secretion should be wiped away gently; a different piece of cotton
should be used for each eye, and a piece that has been used should not
be put back into the water. Further than this, eyes in a normal
condition do not need cleansing.
Every person who handles a baby should be very sure that her hands are
clean; she should be doubly sure before she touches his eyes, since a
baby's eyes are peculiarly susceptible to infection from any source.
More than a quarter of all totally blind persons in the United States
became blind by infection of the eyes at birth. Blindness of the new
born can be prevented in practically all cases if the doctor uses a
preparation of silver in the baby's eyes immediately after birth. This
treatment is effective and entirely safe.
If at any time the eyelids look red or swollen, or if a drop of matter
appears between the lids, the physician should be summoned at once.
Total blindness may result if treatment is delayed even a few hours.
MOUTH.--The mouth should be rinsed after feeding by giving the baby a
teaspoonful of boiled water. Until the teeth come it does not require
other cleansing, and attempts to clean it may injure the delicate
membranes that line it. Indeed, except in an emergency, fingers should
not be inserted into a baby's mouth. The teeth when they appear should
be cleaned by means of a soft tooth-brush.
NOSTRILS.--The nostrils need no cleaning other than removal of mucus
that can easily be reached by means of a piece of cotton. If a little
vaseline is placed in the nostrils on a small piece of absorbent cotton
in the early morning, collections of mucus will usually be softened so
that they can be removed easily at bath time.
GENITAL ORGANS.--The genital organs of girl babies should be gently
washed twice a day, using absorbent cotton, and tepid water. Treatment
other than cleanliness is ordinarily unnecessary. Vaseline may be
applied if the genitals are slightly reddened; any discharge or abnormal
appearance should be reported to the doctor. In the case of boy babies
the foreskin should be gently drawn back twice a week after immersion in
the tub; after the parts have been gently washed with absorbent cotton,
it should be drawn forward again. No force should be employed in
retracting the foreskin; the physician should be consulted if it cannot
be retracted easily.
THE DEVELOPMENT OF HABITS.--During his first few months crying is a
child's only means of expression, and he quickly learns to make
effective use of his limited opportunities. It is important for the
mother to distinguish between crying caused by pain, illness, or hunger,
and crying caused by temper. These cries are more or less distinctive,
but no one can be sure in every case just what a crying baby is
attempting to express.
A cry caused by hunger is fretful and often interrupted by sucking the
thumb; it ceases when the child is fed. A cry caused by indigestion is
similar; the child is relieved for a short time by feeding, but soon
begins to cry again. If he has acute pain, such as earache, the cry is
sharp, repeated at frequent intervals and accompanied by other symptoms
of distress, such as restlessness, contraction of the features, and
drawing up the legs. In serious illness the cry is usually feeble,
fairly constant except when the child is asleep, and exaggerated by
slight causes.
A limited amount of crying is useful exercise for a baby, and should not
distress his mother unduly. Moreover, crying may be merely the
expression of a wish to be taken up, to be played with, carried about or
otherwise amused, to be given a pacifier, or to be indulged in other bad
habits. If not indulged in these ways he may cry from temper. The cry of
temper is loud and violent, accompanied by vigorous kicking or by
holding the body rigid. Proper treatment of the baby may prevent many
months of discomfort, and spare him the formation of his first bad
habit. All other possible causes for crying should be eliminated. If the
child continues to cry when he is warm and dry and comfortable, "It
should simply be allowed to cry it out. This often requires an hour and
in extreme cases two or three hours. A second struggle will seldom last
more than ten or fifteen minutes and a third will rarely be necessary"
(Holt). Gas may form in the child's stomach during prolonged crying. It
is consequently permissible to take him up after 15 minutes, and hold
him erect; he generally expels gas at once, and immediately experiences
relief. As soon as he is relieved, he should go back to his crib.
EXERCISE.--Exercise is essential to the development of the body, but
during the first few weeks warmth and quiet are so important that a baby
should not be disturbed except for necessary care. His position,
however, should be changed occasionally; if he lies on the same side
constantly the soft bones of the head may become misshapen from
pressure. As the baby grows older he needs more exercise, and he may be
given an opportunity for it by removing his outer clothing and placing
him on a bed in a warm room for a short time each day. Unnecessary
handling is not good for a baby at any age.
After he becomes more active, he may play on a mattress or thick blanket
placed on the floor. The blanket should be covered with a washable pad
or rubber cloth and clean sheet, and the whole should be surrounded by a
fence at least two feet high. In such an enclosure a baby may safely be
left to play if protected from draughts and cold. Elevated pens that can
be folded when not in use are more convenient but more expensive than
the home-made arrangement. As soon as a child begins to run about he
takes ample exercise, and he may even need to be guarded from too great
fatigue, especially toward bedtime. Games and play should be adapted to
the age of the child and sufficiently varied to exercise all portions of
the body; but they should not be too violent nor too prolonged. Some
supervision of children's play is necessary, but they should be given as
much freedom as possible and allowed to develop their own initiative.
PLAY AND TOYS.--The desire for play does not develop until a child is
about six months old. At this age toys that can be washed, such as those
of hard or soft rubber, should be selected. A baby instinctively carries
everything to his mouth,--first his thumb, then playthings, and later
whatever he may find, no matter how unsuitable. For his safety and
protection this habit should be overcome as soon as possible, and he
must learn to put nothing in his mouth except food and drink. Relatives
are nearly always tempted to give too many and too fragile toys; they
merely teach a child to be destructive and constantly to expect
something new. Toys are the first possessions of which a child is
conscious, and through them many desirable qualities may be developed:
neatness and order, gentleness and a feeling of protection toward the
helpless doll or Teddy bear, and unselfishness in sharing special
treasures with playmates. Later the child may be given pets and made
responsible for their care; but animals should not be subjected to
unintentional cruelties from small children.
EXERCISES
1. What two factors are chiefly responsible for the deaths of babies
under a year old? What other factors contribute? In your city or town
what is the number of deaths per 1000 births of babies under one year
old?
2. Why is birth registration important to an individual? to a
community? Is it required by law in your city?
3. What is the average weight of babies at birth? Describe the rate at
which they should gain.
4. At what age may a normal child be expected to sit erect? to stand? to
walk? to speak? When should his first teeth appear? his permanent teeth?
5. Describe normal bowel movements of a baby.
6. How should a young baby be dressed?
7. Describe a baby's bath and toilet.
8. Describe the surroundings that are suitable for a baby.
9. What is the best food for a healthy baby? Why?
10. Describe in detail a good daily program for a healthy baby four
months old.
11. What habits are desirable for a baby to form, and how may he be
trained so that he will form them?
12. Name all the indications that would tell you when a baby was not
thriving, and in each case tell what you would do about it.
FOR FURTHER READING
The Care and Feeding of Children--Holt.
The Care and Feeding of the Baby--Truby King.
The Baby's First Two Years--R. M. Smith.
The Care and Feeding of Children--J. L. Morse.
Preventive Medicine and Hygiene--Rosenau, Section III, Chapter II.
Pamphlets:
Prenatal Care, Mrs. Max West.
Infant Care, Mrs. Max West.
Child Care, Mrs. Max West. Published by the Children's Bureau,
United States Department of Labor, Washington, D. C. (Free on
request.)
The Care of the Baby--Supplement No. 10 to the Public Health Reports,
1913, Government Printing Office, Washington, D. C.
Your Baby: How to Keep It Well--New York State Department of Health,
Albany.
Publications of the American Association for the Study and Prevention of
Infant Mortality--1211 Cathedral Street, Baltimore, Md. (Free on
request.)
Publications of the National Committee for the Prevention of
Blindness--130 East 22d Street, New York City. (Free on request.)
FOOTNOTES:
[1] An area including about two-thirds of the population of the United
States.
CHAPTER IV
INDICATIONS OF SICKNESS
By indications of sickness we mean all evidences of deviation from a
normal physical condition. They may be apparent only to the person in
whom they occur, or to a second person only, or to both. These
deviations, commonly called the symptoms of sickness, are always
important to notice, whether the conditions they indicate are serious or
not.
Early symptoms of sickness are often slight; hence they easily pass
unnoticed. Yet a slight trouble, easily checked in its early stages,
may, if neglected, grow into a serious or even fatal disorder: just as a
burning match, which anyone could extinguish instantly, may kindle a
fire beyond the power of an entire city to control.
It is important, then, to notice even slight symptoms of sickness,
first, in order to determine the nature of the trouble, and second, in
order to institute treatment as early as possible. It is, however,
hardly less important to observe symptoms accurately during the entire
course of an illness. A patient's progress can be determined only by
careful comparison between present and past conditions.
Many symptoms can be detected only by methods requiring scientific
apparatus as well as the knowledge and skill of a physician, but very
pronounced symptoms are generally evident to anyone. The neighbors do
not need to be told when a person has advanced tuberculosis; neither is
an expert required to see that something ails a man with a broken leg.
Furthermore less pronounced symptoms may often be clearly seen by any
observant person, even by those not specially trained. Accordingly it is
important for every woman who has charge of others, sick or well, to
form the habit of noticing unusual appearances of any kind. This habit
is one that most people must take pains to acquire, because people
generally see only the things that their own experience in life has
taught them to see. An added difficulty is the fact that when illness
begins it is not a trained observer, but the untrained sufferer or
untrained member of his family who decides whether to send for the
doctor and thus to set in motion the machinery for treatment and cure.
All the training and experience of a physician are required in order to
decide what symptoms indicate, and to prescribe proper remedies.
Diagnosis, or the process of determining the nature of illness from the
symptoms observed, is often exceedingly difficult; it must take into
consideration not one symptom only but the presence or absence of a
number of symptoms. Untrained persons who attempt to make diagnoses are
frequently led astray by the fact that actual causes of trouble may be
situated far from the places where symptoms are felt or observed. For
instance, the real cause of headache may lie in a region far removed
from the head; and so-called heart-burn, which is caused by disordered
digestion, has nothing to do with the heart. Again, an early symptom of
tuberculosis of the hip joint is pain under the knee; a mother is
clearly not doing the best thing when she assumes that any pain in a
joint means rheumatism, and therefore doses her suffering child with the
medicine that "helped" his rheumatic grandfather. No untrained person is
equipped to make a diagnosis, and still less to prescribe medicine or
treatment.
Symptoms, like all other forms of discomfort, tend to trouble a patient
in proportion to the amount of attention that he gives them. Hence, in
order to avoid calling his attention to them unnecessarily they should
be observed so far as possible without his knowledge; when it is
unavoidable for him to realize what is going on, observation should be
made a matter of routine, so that his interest may not be especially
excited. For instance, everyone who has seen the routine medical
inspection of school children realizes how little attention the children
themselves give to the process, apparently regarding it merely as one of
the many inexplicable proceedings of grown people. On the other hand,
children who know their symptoms are over-anxiously watched soon learn
to watch themselves and to exaggerate every little ache and pain.
Symptoms may be divided into two classes: first, objective symptoms, or
those that can be noted by an observer, like cough, pulse rate, or color
of the skin; and second, the subjective symptoms, which are apparent
only to the person affected, like pain and fatigue. The success of any
woman who cares for the sick depends to a large extent upon her
quickness and accuracy in noticing and reporting these symptoms and
their variations. It should be remembered that pronounced symptoms are
not the only ones of importance: even slight symptoms that continue over
an appreciable length of time may be of very great importance. A brief
description of some important symptoms follows, in order to help persons
without technical training to describe the symptoms as well as to
observe them.
OBJECTIVE SYMPTOMS
TEMPERATURE.--Bodily heat is produced by slow burning of food materials,
which goes on for the most part in actively working muscles and glands.
Heat thus generated is distributed by the blood to all parts of the
body, but the surface of the body is generally cooler than the interior.
In health the body temperature varies only a few degrees, no matter how
much the temperature of its surroundings varies; consequently a
temperature is abnormal if it is higher or lower than the usual
temperature of a healthy person.
The temperature is taken by means of a clinical thermometer placed
either in the mouth, the rectum, or the armpit (axilla).
[Illustration: FIG. 10.--CLINICAL THERMOMETER.]
To take the mouth temperature, first wash the thermometer, using cold
water and absorbent cotton or clean soft cloth. Next shake it until the
mercury thread registers 96° or below. It is well before purchasing a
thermometer to see whether it can be shaken down easily. Next place the
thermometer in the patient's mouth, with its bulb under his tongue; he
must then keep his lips closed until it is removed. Leave the
thermometer in his mouth for two minutes. Then remove the thermometer,
read the temperature and record the result. Clean the thermometer at
once, using first cold water and soap, and then alcohol, 70%.
The mouth temperature of a healthy person is about 98.6° F. This
statement holds true if the person has been sitting with his mouth shut
for a little while before his temperature is taken; but a hot bath,
breathing through the mouth, eating or drinking, and so forth may cause
marked temporary changes.
The temperature in the rectum generally varies less than the temperature
in the mouth unless it is taken when the rectum contains fecal matter.
The temperature should be taken by rectum in babies and young children,
restless, drowsy, or delirious patients, patients who cannot be trusted
to keep the thermometer under the tongue, mouth breathers, and in any
patients who have difficulty in keeping the mouth shut. The temperature
is normally about half a degree higher in the rectum than in the mouth.
In order to take a temperature by rectum, adults generally find it more
convenient to lie on the side and prefer, if they are able, to insert
and hold the thermometer themselves; but the attendant should be
certain that they can do so without breaking the thermometer. Rectal
thermometers should be lubricated with oil or vaseline before using;
they should be inserted about two inches, left in three minutes, and
cleansed in the same way as the mouth thermometer. A thermometer used to
take rectal temperatures should never be used in the mouth.
In taking the temperature of a baby place him on his back, hold him
firmly with his legs elevated, and carefully insert the bulb of the
thermometer, well oiled, for about one inch. Keep the child quiet, and
hold the thermometer in place three minutes. Great importance should not
be attached to a slight fever of short duration. The temperature of a
child is much more easily affected by slight causes than that of an
adult, and rectal temperatures between 97.5° and 100.5° should not cause
anxiety unless continued.
Temperatures taken in the axilla are less accurate than those taken by
mouth or rectum. Consequently the method is less often used. The axilla
should first be wiped; then the thermometer should be inserted and held
for 5 minutes by pressing the arm tightly against the chest wall. The
temperature in the axilla is normally about half a degree lower than in
the mouth.
The temperature varies somewhat according to the time of day. It is not
unusual for the mouth temperature of persons who are entirely healthy to
be as low as 97° in the early morning, or as high as 99° in the late
afternoon, and probably most people's temperatures vary as much as a
degree during the twenty-four hours. Even greater variations that are
not long continued have little if any significance in people who feel
well.
Decided variations either above or below normal are highly important
symptoms. A temperature below 98° is called subnormal, and one above
99.5° is called fever. The number of degrees of fever does not
necessarily bear a direct relation to the severity of an illness. Thus,
it does not follow that one person is twice as sick as another, because
his temperature is twice as many degrees above normal. All symptoms,
including variations in temperature, must be considered in connection
with one another, and it is generally impossible to state the
significance of any one symptom taken by itself.
The temperature should be taken once or twice a day as a matter of
routine in almost every form of illness, and oftener when the patient's
condition requires it. Also it should be taken as a matter of routine
whenever there is indication of beginning sickness; especially when
there is headache, pain, sore throat, coated tongue, cough or cold,
chill, vomiting, diarrhœa, or rash. It is not a good plan to take
one's own temperature oftener than necessary, or indeed anyone's;
certainly not a baby's, since frequent use of the thermometer may
irritate the rectum.
PULSE.--Each time the heart beats, blood is forced out from the heart
into the arteries, thus causing an expansion of the arterial walls. This
expansion, called the pulse, can be felt in some places where arteries
lie close to the surface of the body. The character of the pulse beat
and its rate, or the number of times the beat occurs each minute, give
information about the heart and blood vessels; taken together they are
perhaps more important than any other one symptom.
[Illustration: FIG. 11.--TAKING THE PULSE AT THE WRIST. NOTE THE
POSITION OF ARM. (_From "Elementary Nursing Procedures," California
State Board of Health._)]
The pulse rate varies much more than the temperature. It differs in
different individuals and at different ages, and it often shows great
temporary changes, especially during exercise or eating, or as a result
of excitement, fear, or other emotion. Definite statements in regard to
normal pulse rates are hard to make, because different individuals
though in perfect health show marked variations; we generally say,
however, that the pulse rate of a normal man at rest is about 72 a
minute, and that of a normal woman is about 80 a minute. At birth the
pulse is quickest; it may then be from 124 to 144. From the 6th to the
12th month it may be from 105 to 115 a minute, and from 90 to 105
between the 2d and 6th years. About the time of puberty it reaches the
adult rate, and during old age it may be decidedly slower than the adult
rate.
What we chiefly want to know about the pulse is
1. Its rate, or number of beats per minute,
2. Its force,--whether weak or strong,
3. Its rhythm,--whether regular or irregular.
Much practice is necessary before the pulse rate can be counted with any
degree of accuracy, and wide experience with both normal and abnormal
pulses is required in order to judge its strength, rhythm, or other
characteristics.
The pulse may be felt most conveniently on the thumb side of the front
of the wrist. The pulse should be counted while the patient is lying
down, and the watch used must have a second hand. To count the pulse,
one should place two or three fingers (not the thumb) on the patient's
wrist, and after the pulse has been felt distinctly for a few beats, the
exact time by the second hand of the watch should be noticed and the
counting begun immediately. It is generally best to count for half a
minute, multiply the result by two to get the rate for a whole minute,
and then to repeat for another half minute. The two results should agree
within two beats, if the patient is quiet. A greater variation than two
beats may mean that the pulse rate is varying, but when it is counted
by inexperienced persons the apparent difference is generally the result
of inaccurate counting, and it may be necessary to count two or three
times more. The force of the pulse varies also in different individuals;
it is, however, important to notice when it grows stronger or weaker in
the same person. Normally the pulse-beat is regular like the ticking of
a clock; it is called irregular if a few rapid or slow beats are
followed by others of a different rate. During sickness the pulse should
be counted whenever the temperature is taken, or oftener; and the result
should be written down at once. The pulse of a sick person often shows
changes both in rate and character; these changes are generally
important and should be noticed.
RESPIRATION.--Variations in the rate and character of respiration or
breathing should be noticed. The normal rate of respiration for an adult
at rest is 16 to 20 each minute, but it may be much faster, especially
during muscular exercise. In babies the rate is about 30 to 35 a minute,
and 20 to 25 in little children. The respirations, especially of babies,
can best be counted during sleep by placing the hand lightly on the
chest or abdomen. Since the respiration rate is partly under a person's
control, it is almost sure to alter if the patient knows it is being
counted; hence when the patient is awake it is better to keep one's
fingers on his wrist, to place his hand upon his chest, and then to
count the rise and fall of the chest while apparently counting the
pulse. Sometimes it is possible to count the respirations merely by
watching the rise and fall of the nightgown or bed clothes. The
respiration is usually counted for a full minute. A watch with a second
hand must be used, and the result should be recorded immediately.
In certain forms of sickness breathing may become rapid, especially if
the lungs or air passages are affected. In addition to the rate anything
unusual about the breathing should be noticed whether it seems difficult
or painful; if noisy, whether the sound is like snoring, or wheezing, or
sighing, and so on.
GENERAL APPEARANCE.--Any unusual expression of the face should be noted;
whether it is drawn, pinched, anxious, excited, or dull and stupid; and
also, whether the face is thin, swollen, or puffy under the eyes. The
condition and appearance of the skin are significant: the skin may be
dry, moist and clammy, hot or cold; its color, and the color of the face
especially, may be flushed or pale or slightly yellow or blue. A bluish
tinge about the nose, tips of the fingers, or the feet should be
specially noticed. Reddened or discolored areas on any part of the body
may be important, and also eruptions, rashes, swellings, or sores. It
should be noticed whether the abdomen is normal or whether it is
distended and hard.
Strength or weakness is indicated to some extent by the way the patient
moves, and by his ability to walk, stand, sit, hold up his head, feed
himself, or turn in bed without assistance. The position he habitually
takes is sometimes significant; in heart affections, for instance, he
may be unable to lie down, in pleurisy he ordinarily lies on the
affected side, and during abdominal pain he generally draws the knees
up.
SPECIAL SENSES.--The special senses are frequently disturbed in
sickness. The eyes may be blood-shot; the patient may be over-sensitive
to light, or see spots floating before the eyes, or he may be unable to
see at all. The pupils of the eyes may be unusually large or small, or
one may be large while the other is small. Swelling, redness, or
discharge from the eyes should be noticed. Hearing and touch and smell
may be impaired; or they may be abnormally acute, and cause real
suffering. Taste may be impaired, especially when the nose is affected
or when the mouth is not clean. Discharge from the nose or ears should
be reported. Not only discharge, but also trouble of any kind, such as
pain, tenderness, or swelling, is important if situated in or near the
ears.
THE VOICE is often much altered in sickness. It may be weak, hoarse, or
whispered. Speech may be clear or thick, or the ability to speak may be
entirely lost; in extreme weakness speaking is generally difficult, and
may be impossible. Moaning, groaning, and other unusual sounds should be
noted. A loud, sharp cry at night with or without waking, if a repeated
occurrence, may be an early symptom of some diseases of children.
THE TONGUE in health is red and moist; when extended it is somewhat
pointed and can be held steadily. In sickness it may be cracked, dry and
parched, or if the patient is not properly cared for, it may be covered
with white, yellow, or brown coating; in many exhausting illnesses it is
flabby and trembling. In scarlet fever the tongue is often a vivid red
color, and is then called strawberry tongue. The odor of the breath may
be foul from decay or neglect of the teeth, from indigestion,
constipation, nasal catarrh, or special diseases.
THE THROAT and tonsils are sometimes red and swollen as in simple sore
throat; or they may be covered by white patches.
THE GUMS may be swollen, tender, or bleeding. A collection of sticky
brownish material may appear on the teeth and gums of neglected
patients.
COUGH when present may be: dry, or accompanied by expectoration;
painful, frequent, loud, or whooping; and worse by day or by night. The
sputum may be yellow, white, gray, rusty, blood-streaked, dark, or
frothy. The amount of sputum should be noticed as well as its
appearance.
APPETITE or absence of appetite should be noted, and also the amount of
food actually eaten by a patient; the amount eaten is frequently not the
same as the amount carried to him on a tray.
If VOMITING occurs, the color, consistency, amount, and general
appearance of the vomitus should be noted; if its appearance is unusual
the vomitus should be saved for the doctor's inspection.
EXCRETIONS.--The number of bowel movements is important, and also their
character. The consistency of the feces may be hard, soft or fluid;
their color may be any shade of brown, yellow or green, from black to
clay color. They should be saved for the doctor to see if appearance or
odor is unusual.
THE URINE in health is clear, amber colored, and slightly acid. From 30
to 50 ounces should be excreted in 24 hours; the amount varies, however,
especially according to the amount of fluid taken. It is important to
notice whether the urine is scanty or greatly increased in amount, dark
or pale, clear or cloudy, and whether sediment is deposited after
standing. It is essential that urine should be voided in sufficient
amount; the necessity for watching its quantity is frequently overlooked
in the home care of the sick. Frequency of urination should also be
noted. Inability to urinate, particularly where the urine has previously
been scanty, is serious if continued; it should be reported to the
doctor without delay. Inability to control the bladder and bowels are
also symptoms to be reported.
LOSS OF WEIGHT is significant in both adults and children, and failure
of babies and children to gain in weight is a danger signal.
SLEEP.--The number of hours a patient sleeps should be noticed and
recorded as accurately as possible. The word of the patient on this
subject is not sufficient evidence. Character of sleep should also be
noted, whether it is quiet or restless, and whether the patient sleeps
lightly or is difficult to arouse.
MENTAL CONDITIONS.--It is important to watch carefully the mental
condition of a patient; whether, for example, he is normal, or
depressed, irritable, restless, apathetic, dull, excited, wandering,
delirious, or unconscious. Hasty judgment of mental conditions should
be avoided, but close attention to them is necessary.
SUBJECTIVE SYMPTOMS
PAIN is the most important subjective symptom and should never be
disregarded. Bodily pain does not occur in persons who are in all
regards physically and mentally well; hence pain is a sign that
something, small or great, is out of order.
"Of all symptoms pain is the one which interests patients
the most. We here emphasize the truth, too little
understood, that pain is an unpleasant sensation, nothing
more, and is _never_ imagined. Imagination may be its
cause, but the pain thus produced hurts just as truly as
pain produced by a real disease. Pain is only a phenomenon
of consciousness; it is always real, even that felt in a
dream. If the patient is too unconscious to feel it, there
simply is no pain, no matter how badly the person's body is
injured." (Emerson: Essentials of Medicine, p. 356.)
One should remember that no possible method exists to measure the
intensity of pain exactly, or to describe its quality accurately.
Therefore in describing pain, it is best to use the patient's own
language. Four points should especially be observed, (1) its location;
(2) its character, which may be dull or sharp, stabbing, throbbing or
continuous, slight or severe; (3) the time at which it is worst; certain
diseases, for instance, are characterized by more severe pain at night;
(4) it should be noticed whether the pain is relieved or increased by
change of position, eating or drinking, heat or cold, or the like. Pain
may be felt in a part far from the place where the trouble really lies;
thus a dislocated shoulder causes pain in the elbow.
Pain is always a danger signal, although the significance is not always
so great as the sufferer thinks. The more attention a patient gives to
his pain, the more severe it always becomes, therefore his attention
should not be called to it unnecessarily. A good observer, however, can
get much information by noticing the patient's expression, position,
motions, etc., without constantly asking him how he feels. Although many
persons overestimate pain, others persistently disregard it, either
because they are unwilling to take the necessary measures to remedy it,
or because they wish to appear heroic. Both courses of action are
mistaken; everyone should realize the folly and danger of bearing pain
if it is possible to remove the cause.
Nausea, fatigue and malaise are other subjective symptoms; malaise is
the name given to a general feeling of physical discomfort not
restricted to any one part of the body. All three are abnormal when
there is not apparent or sufficient cause.
RECORDS.--An accurate record should be kept of the patient's symptoms,
medicine, diet, treatment, etc., so that the doctor may have a
continuous record, and so that another person taking charge temporarily
may know just what has been done for the patient. The record must be
written; otherwise details cannot be remembered exactly. It should be as
simple and concise as possible; it is the place for facts, not for
opinions, and if inaccurate it is worse than none. It is better not to
keep the record in the patient's room, for the patient should not see
his own record, nor hear its contents discussed. The doctor usually
writes his orders on the record sheet itself, or on a separate sheet to
be attached to the record for reference. Blank record forms can be
purchased, but a form that is made at home is entirely satisfactory. An
example of a daily record sheet follows.
RECORD
------+----------+----+-----+-----+----------------+----+-----+-------
Date | Hour |Tem.|Pulse|Resp.| Diet and |B.M.|Urine|Remarks
| | | | | medicine | | |
------+----------+----+-----+-----+----------------+----+-----+-------
1916 | | | | | | | |
Jan. 1|4 p.m. |100°| 76 | 24 |Medicine | | |
|5 p.m. | | | | | 1 |℥ vii|
|6 p.m. | | | |Supper: | | |
| | | | | Baked potato, | | |
| | | | | toast, fruit, | | |
| | | | | tea. | | |
|8 p.m. | | | |Medicine | | |Sponge
| | | | | | | |bath.
|9:30 p.m. | | | | | | |Asleep.
Jan. 2|3 a.m. | | | | | |℥ ix |
|8 a.m. |99° | 74 | 22 |Medicine | | |Patient
| | | | | | | |slept
| | | | | | | |most
| | | | | | | |of the
| | | | | | | |night.
|8:30 a.m. | | | |Breakfast: | | |
| | | | | Cereal, orange,| | |
| | | | | toast, coffee. | | |
|9:30 a.m. | | | |Bath. | | |
|11:30 a.m.| | | | | | |Sat up
| | | | | | | |1 hour.
------+----------+----+-----+-----+----------------+----+-----+-------
TUBERCULOSIS, CANCER, AND MENTAL ILLNESS.--As we have seen, early
symptoms of sickness are always important; yet it seems worth while to
mention particularly the early symptoms of tuberculosis, cancer, and
mental disorders, because each of these diseases, though curable in
many cases when taken in the early stages, is serious and often fatal
if neglected. Certain facts relating to their cause and prevention
should be known to everyone. Tuberculosis, long our greatest cause of
death, is gradually growing less; but cancer and mental disease are now
on the increase.
TUBERCULOSIS.--Every year tuberculosis causes the death of about 150,000
people in the United States. It is caused by the bacillus tuberculosis,
a germ which may attack any tissue of the body, although it most
frequently affects the lungs of grown people, and the bones and glands
of children. The disease is not inherited, but susceptibility to it
appears to be; it is readily communicated from person to person. The
germ of tuberculosis is so widely distributed that probably few persons
over 30 years of age have not been infected with it at some time,
although the infection may have been too slight to be noticed. Indeed,
most people have probably been infected many times, though without
serious results.
Tuberculosis is spread chiefly in two ways: (1) through any bodily
discharges from infected persons, especially through the nose and mouth
discharges; (2) through milk from infected cows. The ways by which the
disease is spread indicate methods of prevention. Milk, especially for
children, should either be pasteurized or should come from cows that
have been tested and proved to be free from the disease. Other methods
of prevention include avoiding any and all bodily discharges of infected
persons, and increasing bodily resistance as far as possible. Good food,
sufficient rest and fresh air are not only important preventives, but
also the most efficacious means of cure. Persons who suffer from
insufficient food, exposure, bad housing, long hours, and bad conditions
of work are especially susceptible to tuberculosis, and thus it is
rightly called a disease of poverty.
Early symptoms of tuberculosis include cough, hoarseness, loss of
appetite, pain in the side, loss of weight, getting tired easily,
feeling run down, rise in temperature in the afternoon, night sweats,
expectoration, and spitting blood. No one, nor even several, of these
symptoms necessarily indicates the presence of tuberculosis; on the
other hand, even the cough is not necessarily present when tuberculosis
actually exists. When one or more of these symptoms appears and
continues, a thorough examination should be made by a doctor;
examination can do no harm, certainly, if tuberculosis is not found, and
if it is, immediate treatment is of the greatest importance. No known
drug or medicine is a cure for tuberculosis. Successful treatment
depends on taking the disease in time and in following the doctor's
advice unremittingly.
CANCER.--The cause of cancer is not known. All the evidence, however,
goes to show that it is neither communicable nor hereditary. Cancer may
occur on the skin, stomach, or other organs; in women it most commonly
occurs in the breast or uterus (womb). In both sexes it occurs most
frequently after 40 years of age. No known medicine will cure cancer;
salves and ointments have no effect. Radium and _x_-ray should not be
relied upon if the cancer can be removed by operation. Safety consists
in removing the growth entirely, and complete removal is possible only
in the early stages.
Early diagnosis is consequently of the greatest possible importance, and
an examination can do no harm in any case. Warts and moles on the skin
may develop into cancer, and should be removed if they show signs of
irritation. Loss of appetite and weight, any disturbance of the stomach
or intestines, and sores that refuse to heal should lead a person to
consult a physician; the same is true of any lump in the breast, and of
irregular or persistent bleeding from the uterus in women over forty.
The fact that pain is not present in cancer until the late stages leads
many persons to neglect the trouble until it is too far advanced for
operation. Time is all-important; hope depends on operation in the early
stages when there is a very great probability of permanent cure.
MENTAL ILLNESS.--Insanity, like cancer, is increasing. Like both cancer
and tuberculosis, hope lies in prevention and early treatment; and like
them both, in its early symptoms it is too often unrecognized or
neglected.
Many people are surprised to learn that known, avoidable causes are
responsible for the condition of about 50% of the insane patients now
under treatment. Chief among these known causes is a communicable germ
disease called syphilis, to which is due the disease called paresis, or
"softening of the brain." About 25% of patients admitted to hospitals
for the insane are there from the effects of habitual use of alcohol,
even in "moderate" quantities. Other cases of insanity result from
diseases of the heart, arteries, and kidneys, and still others have been
traced to the poisons of tuberculosis, typhoid, diphtheria, and other
communicable diseases. Prevention of insanity caused by these diseases
depends upon prevention or complete cure of the diseases themselves.
Still other causes of insanity are known. Hereditary nervous weakness
may predispose to insanity, and for such persons, those whose nervous
resistance is naturally not very great, the stress of living may prove
too much. Mental breakdowns are rarely caused by overwork unless
accompanied by worry or bad hygienic conditions, but they result not
infrequently from bad mental habits.
"The average person, little realizes the danger of brooding
over slights, injuries, disappointments, or misfortunes, or
of an unnatural attitude towards his fellowmen, shown by
unusual sensitiveness or marked suspicion. Yet all these
unwholesome and painful trains of thought, may if persisted
in and unrelieved by healthy interests and activities, tend
towards insanity. Wholesome work relieved by periods of
rest and simple pleasures and an interest in the affairs of
others, are important preventives of unwholesome ways of
thinking. We should train ourselves not to brood, but to
honestly face personal difficulties."--(Why Should Anyone
Go Insane?, by Folks and Ellwood.)
Prevention of insanity consequently depends chiefly upon avoiding
alcohol and communicable diseases, especially syphilis; upon good
hygiene, self-control, and avoidance of bad mental habits; and upon
adopting a program of living and working that will not overtax one's
nervous strength. Sleeplessness, unusual nervous fatigue following
slight exertion, and diminished power to control the emotions, are among
the danger signals. And when a person becomes unusually depressed or
morose, excited or irritable, suspicious, unreasonable, or "queer," it
is probable that expert medical advice should be obtained as quickly as
possible.
EXERCISES
1. What is a symptom? Why are early symptoms especially important?
2. Distinguish between objective and subjective symptoms.
3. Tell all you can about normal and abnormal variations in the body
temperature. What symptoms would lead you to take a person's
temperature?
4. Describe the method of taking temperatures.
5. How should you cleanse a clinical thermometer? What are the dangers
of neglecting to cleanse it properly?
6. Describe both normal and abnormal pulse and respiration.
7. Discuss the significance and importance of pain.
8. Describe early symptoms of tuberculosis, cancer, and mental illness.
What is the first step to be taken when any one of these symptoms
appears?
9. What symptoms of all those mentioned in this chapter did you notice
in the last sick person with whom you had anything to do?
10. What are the essentials of a good daily record? The following is an
account that a mother gave of the first twenty-four hours of a child's
illness. Make a chart for the patient, and include in it all the
information the mother gave. Which do you consider more useful, your
chart or the narrative?
"Yesterday, October 10th, Johnny came home from school about half past
three, and said he was too cold to play outdoors. He lay down and slept
till about five, when he vomited a large amount of undigested food. I
took his temperature and found that it was 103.8°, pulse 126, and
respiration 28. At 10 that night his temperature was 102.5°, pulse 116,
and respiration the same as before. The next morning at 8 he had a
temperature of 100.6°, pulse 114, respiration 24. At noon his
temperature was 101°, pulse 118, respiration 24; and at 4 o'clock his
temperature was 100.6°, pulse 122, respiration 22. The doctor came at 6
o'clock yesterday afternoon; according to his orders I put Johnny to
bed, gave him half a tablespoonful of castor oil at 6.30, and a special
gargle. His throat was red and sore and he seemed to feel very
miserable. The doctor took a culture from the child's throat. At 8.15
and again at 8.50 he had fluid bowel movements. At 9.30 he had a glass
of milk, after which he slept until 6 a.m. when his bowels moved again
and urine was passed. He passed eight ounces of urine at noon and four
ounces at 3.30. He drank a glass of water at 6 this morning, and at 6.30
I gave him a cup of hot broth. At 8 he had a glass of milk, but at 10 he
refused everything but a glass of water. At 1.30 he had a large dish of
ice cream. He had a cool sponge bath last night at 9, and a cleansing
bath this morning at 8.45. This morning his throat was still sore but
not so red, and I saw that he gargled every half hour when he was awake.
This afternoon he seems brighter and asked for his harmonica, so his
throat is probably more comfortable."
FOR FURTHER READING
Essentials of Medicine--Emerson, Chapters XVI, XVII.
The Human Mechanism--Hough and Sedgwick, Chapter XII.
Notes on Nursing--Florence Nightingale, Pages 105-136.
Why Worry?--Walton.
Those Nerves--Walton.
Tuberculosis: Its Cause, Cure, and Prevention--Otis.
Publications of the National Association for the Study and Prevention of
Tuberculosis--105 East 22d Street, New York City. (Pamphlets free on
request.)
Publications of the National Committee for Mental Hygiene--50 Union
Square, New York City. (Pamphlets free on request.)
Publications of the Mental Hygiene Committee of the State Charities Aid
Association--105 East 22d Street, New York City. (Pamphlets free on
request.)
Publications of The American Society for the Control of Cancer--25 West
45th Street, New York City. (Pamphlets free on request.)
CHAPTER V
EQUIPMENT AND CARE OF THE SICK ROOM
Adequate care of the sick consists to a large extent in rendering their
physical and mental surroundings as favorable as possible. Obviously, a
sick person, since his strength is already depleted, needs not only to
have his resistance increased in all possible ways, but also to have all
his remaining strength conserved by eliminating every unnecessary tax
upon it. In sickness even slight fatigue, chill, or nervous strain,
insufficient ventilation, or improper feeding, may become factors of
immense importance. Nothing is trivial if it affects the welfare and
comfort of a patient.
Even when perfect provision for the care of the sick is out of the
question, every effort should be made to insure as satisfactory
arrangements as possible. Ideal conditions are seldom found except in
buildings originally planned for the sick; yet in many houses a few
simple changes will produce excellent results. Of course, it is not
necessary in every case to adopt all the following suggestions. Common
sense must be the guide. For instance, in illness that is slight and
likely to be of short duration, a patient may be more distressed than
benefited by radical changes in his surroundings. Except when certain
essentials are concerned, great consideration should be given to a
patient's preferences; yet on the other hand it is not reasonable to
make an entire family miserable in order to gratify some slight whim.
CHOICE OF A SICK ROOM.--A south or east exposure is generally best for a
sick room. A south room may be undesirable in very hot weather, but
sunshine during a part of the day is essential. The room should be
quiet, near the bath room, and well removed from odors from the kitchen.
It should be situated so that good ventilation is possible. It is
desirable though not necessary for it to have more than one window; in
summer the windows must be thoroughly screened. It should be possible to
open the window without exposing the patient to a direct current of air,
and to open the door without placing him in full view of all who pass
through the hall.
It is essential for the patient to have a room to himself. Unless he
needs care or help or watching at night, not even the person caring for
him should sleep in the room. Neither should the rest of the family
keep their possessions in the sick room. Closets opening into the room,
bureaus, and chiffoniers should be emptied of the belongings of other
members of the family, to prevent people from tiptoeing into the sick
room at all hours to remove garments. The sick room should for the time
belong exclusively to the patient, and resulting inconvenience should be
borne by well members of the family.
Every possible precaution should be taken to exclude from a sick room
unnecessary noises of all kinds; flapping curtains, squeaky doors and
rocking chairs, heels without rubber, creaking corsets, noisy
petticoats, ticking clocks, refractory bureau drawers, and rustling
newspapers are among the everyday sounds that irritate the nerves of
sick and well alike. Ordinary out-of-door noises do not usually disturb
the sick, except when the country patient is brought to the city, or the
reverse; but nearby and generally avoidable noise is the kind that
distracts and harasses nervous patients.
Whispering is an annoying sound and should not be allowed, either in the
patient's room or just outside the door. Whatever the subject of
conversation may be, the patient thinks that he is under discussion.
Anything undesirable for him to hear should be settled well out of his
hearing, and in speaking to him there is no possible objection to an
ordinary well modulated voice.
Usually a person's own room is more restful and less disturbing than a
strange place, but if it serves as a work room as well as a bed room, it
may easily be the worst place during sickness. The sight of a desk piled
high with papers or a basket overflowing with accumulations of family
mending may actually delay recovery; even the room itself may constantly
suggest work, and work necessarily left undone. The essential thing to
remember is that mental rest is no less important than physical, and
every effort should be made to secure them both.
FURNISHING.--Superfluous articles add to the care of a sick room, and in
consequence they should be removed at the outset. All the furnishings
that remain should be easy to clean, but it is not necessary for a sick
room to look bare and desolate.
The woodwork as in any other room should have a hard finish, and angles
and corners that harbor dust should be as few as possible. Hard wood
floors without cracks are best from the point of view of cleanliness and
convenience. A few light, washable rugs make the best floor covering,
but very small rugs on highly polished floors slide easily and are
decidedly dangerous. Carpets diminish noise, but are objectionable from
every other point of view.
In furnishing houses people ought to realize more frequently than they
do how greatly nervous fatigue may be increased by ill chosen wall
coverings. Plain papers or tinted walls are best for bed rooms and the
color should not be harsh or striking; soft gray, green, or buff is
good. The design is no less important than the color; a design that on
casual inspection appears quite harmless may become an instrument of
torture to a person unable to escape from it for a single hour. Weak or
nervous patients sometimes become quite exhausted from attempting to
follow an intricate pattern, or from counting over and over a design
that is frequently repeated on the wall. If the patient sees grotesque
faces and figures in the design the paper is more objectionable still.
Necessary furniture includes the bed, which will be discussed in detail
later, a small table to stand by the head of the bed, a dresser, two
chairs, and a wall thermometer. If the patient is able to sit up three
chairs are needed, of which one should be an armchair with a high back.
No rocking chair should be allowed in the room unless the patient
himself prefers to sit in one; no one else should be allowed to rock in
the room, since the motion is almost always annoying to patients.
Elaborate, carved, or upholstered furniture is unsuitable in a sick
room, but if it must be used it should have washable covers.
Other desirable articles of furniture are a couch, screen, foot-stool
and a second, larger table. In few cases, if any, is anything further
really necessary, although patients frequently desire special articles
to which there can be no objection.
Most ornaments add much work and little beauty, and have no place in a
sick-room. No heavy unwashable curtains or hangings should be allowed,
but simple washable curtains and clean white covers for the tables and
dresser are desirable. Pictures, if suitable, give much pleasure, but
must be used with discretion. It goes without saying that the subjects
should be pleasant, but not everyone realizes that complicated subjects
are undesirable and that pictures of people or things in motion should
be avoided; patients are sometimes worried to see motion that is forever
incomplete.
Flowers give great pleasure to the sick by adding color and variety and
interest to their surroundings. They should be carefully tended and
given fresh water daily. Fading flowers and forlorn plants should be
removed from the sick room, and those having strong, heavy odors should
not even be admitted. They do not need to be very many or very
expensive; indeed, a potted plant or a few cut flowers are often more
acceptable than the great masses of costly flowers that are daily
brought to the private wards of hospitals.
VENTILATION.--A patient needs fresh air certainly as much as a well
person, and probably even more. His room should be thoroughly ventilated
night and day. A fireplace makes the problem easier, but in most cases
an open window is the main dependence. It should be possible to open
windows at the top as well as at the bottom, and the patient may be
protected from a direct draught by a screen, or by a sheet stretched
along the side of the bed and fastened at the head and foot by tying it
around the posts.
Ventilating a room without subjecting the patient to draughts is not
always easy. One method is to insert a board three or four inches high
under the lower sash so that air is admitted between the two sashes.
Another way to ventilate without causing a draught is to remove one or
two panes of glass and tack cheese cloth over the opening; or to tack
cheese cloth to the lower edge of the upper window casing and to the
upper edge of the upper sash, after the sash has been lowered about a
foot. Once or twice a day the room should be thoroughly aired by opening
windows and doors until the air has been completely changed. The
patient, including his head, must be well-covered during the process.
An electric fan is useful in summer, but it should not be close enough
to the bed for the patient to feel air blowing upon him.
HEATING.--Great care should be taken to maintain a suitable temperature
in the sick-room, and for this purpose a thermometer in the room is a
necessity. Between 65° and 68° is generally the best temperature, and
hot water bags and extra covers may be given if the patient is chilly.
During a bath or other treatment in which the patient is more or less
exposed the temperature should be 70°. The temperature at night may be
lower; how low will depend largely on the patient's condition and on
what must be done for him during the night. Hot water, steam heat, or
electricity is best for the sick room. Gas or oil stoves should never be
used except in emergencies, and then for a short time only.
LIGHTING.--Sunlight is one of the most powerful disinfectants, and for
this reason if for no other it is needed in every sick room. Sunless
rooms, moreover, even if they were wholesome, are too depressing to a
patient's spirits for use except perhaps in hot summer days. Ordinary
well-regulated light is best in a sick room, and except in a few
diseases, especially those in which the eyes are affected, it is
undesirable to darken the room or to encourage in any way an appearance
of gloom. The patient's eyes, however, should be protected from bright
lights shining directly upon them; in this connection it is well to
remember that lights and their reflections strike differently upon the
eyes of a person lying down from the way in which they strike the eyes
of persons sitting or standing, and a light that seems agreeable to the
attendant may therefore be painful to the patient.
Almost all persons sleep best in dark rooms, and in most cases it is
undesirable for a sick room to be lighted at night. The attendant,
however, must be able to see what she is doing and generally needs a
shaded candle, small night light, or electric flash. It should be
possible to see the patient clearly in case of need, otherwise serious
changes in his condition occurring in the night may pass unnoticed.
A reading lamp on the bedside table is desirable for patients allowed to
read, but reading in bed even with a well-regulated light is fatiguing,
and should not be continued for long uninterrupted periods. A pocket
flash light is safer than matches and a candle for patients who wish to
consult their watches in the night; indeed, matches in the hands of
patients always involve risk. Some patients find twilight a time of
great depression. In such a case it had best be shortened by drawing
the shades early, turning on the lights, and remembering not to leave
him alone.
CLEANING.--The sick-room should be kept thoroughly clean at all times,
and the less dust stirred up in doing so the better. Dry sweeping or
dusting should not be allowed. Ordinary brooms should be dampened or
covered with damp cloths, and dust cloths should be dampened also; but
dustless mops and dusters are still better. Vacuum cleaning is very
desirable; the noise, which is its only disadvantage, is not a serious
objection in most cases. The cleaning of rooms after a communicable
disease will be considered later.
A sick room must be kept tidy as well as clean. The effect of order is
quieting, but it should be maintained whether the effect upon the
patient is apparent or not. Food and medicine should not be kept in the
sick-room, and all used dishes, tumblers, soiled linen, etc., should be
removed at once. Unnecessary articles should not be found in the room at
any time; every necessary article should be kept in its place, and its
place should be a good one.
Maintaining order in the room does not mean that patients should be made
uncomfortable. All patients, especially old people, want certain
possessions within reach, and their wishes should be considered in spite
of the fact that the æsthetic effect is generally far from good. For
instance, a perfectly smooth bed is undesirable if in order to make it
smooth the patient must be tucked in so tightly that he is
uncomfortable. And it would be a mistake to remove an old man's
newspapers before he has read them, even if he persists in strewing them
all over the floor.
THE ATTENDANT.--One person and one person only should carry the entire
responsibility for the patient. She should plan for him as well as care
for him, should see the doctor and take the doctor's orders. Confusion
and innumerable mistakes result when several members of the family
attempt to do the talking and directing.
The attendant should wear washable dresses with sleeves that can be
rolled up, washable aprons, and shoes with rubber heels. All her
clothing should be comfortable. She should be neat in appearance,
scrupulously clean in person, and should keep her finger nails short and
smooth. Jewelry, especially rings and chains that rattle, and finery of
any sort are all out of place in a sick-room.
The attendant must learn that her own sleep, her diet, and her
out-of-door exercise are essential to the patient's well-being hardly
less than to her own. An amateur nurse often considers that going
without food and sleep is a proof of her devotion. In a passion of
self-sacrifice she neglects herself utterly for the first few days, and
as a consequence is quite useless at a later period when her services
may be most needed. An exhausted, sleepy nurse, trained or untrained, is
wholly unfit to be trusted with medicines and doctor's orders, to note
changes in the patient's condition, or to give him kindly attention.
Efficiency and fatigue have never pulled together since the world began,
and no one can do good work when suffering from lack of sleep and rest.
The person, then, who genuinely wishes to give her patient the best
possible care should not make a martyr of herself. She should go out of
doors daily; both fresh air and occasional absence from the patient are
essential to her physical and mental well-being. Moreover, she will be
showing her patient the greatest kindness in the long run if during her
recreation time she thinks of him as little as possible. Indeed, she
need not consider herself inhuman if she has a thoroughly good time.
On the other hand, a person who is responsible for the care of a patient
must be made to realize that she and she only is ultimately responsible
during the entire 24 hours of every day. Being responsible for a patient
does not mean that she should be with him every minute, or do everything
herself: it does mean that she should plan so effectively that
everything necessary is done, either by herself or by another competent
person. When she goes away for even half an hour, she should appoint
someone else to be responsible in her place and to her when she comes
back. She must consequently make very clear just what she wants done. If
there is medicine, nourishment, or treatment to be given, she can easily
make a list, with the time for each, and ask that each item be crossed
off the list as soon as the work has been done. She should not forget to
ask for the list when she returns.
What is really needed is a little executive ability. As Florence
Nightingale said:
"It is impossible in a book to teach a person in charge of
the sick how to _manage_, as it is to teach her how to
nurse. Circumstances must vary with each different case.
But it is possible to press upon her to think for herself.
Now what does happen during my absence? I am obliged to be
away on Tuesday. But fresh air, or punctuality is not less
important to my patient on Tuesday than it was on Monday.
Or: At 10 p.m. I am never with my patient; but quiet is of
no less consequence to him at 10 than it was at 5 minutes
to 10. Curious as it may seem, this very obvious
consideration occurs comparatively to few, or, if it does
occur, it is only to cause the devoted friend or nurse to
be absent fewer hours, or even fewer minutes from her
patient--not to arrange so as that no minute and no hour
shall be for her patient without the essentials of her
nursing."--(Notes on Nursing.)
It is exceedingly difficult to care for members of one's own family or
to be cared for by them. Too much or too little is almost invariably
expected by one person or the other, and where great affection is
involved not only is the strain increased on both sides, but often harm
results from too great unselfishness on either side or both. But
sometimes the reverse is true, and then one should remember that normal
behavior may be impossible for the sick. During weakness and pain,
irritability and unreasonableness are as characteristic as other
symptoms, and it is as foolish to demand a normal mental state from a
sick person as it would be to demand a normal temperature. For a
cheerful, reasonable, and unselfish patient--and there are surprisingly
many--one should be devoutly thankful, but patience and pity should be
given no less to those whose tortured nerves cause suffering to others
as well as to themselves.
Every woman who cares for the sick should remember that she is the
patient's chief if not his only link with the normal world, and that his
plight is pitiful indeed if she is complaining or irritable or
unwilling. Anyone who cares for the sick should remember also that she
is necessarily in a most intimate relation with the patient, and that
such enforced intimacy calls for extra consideration on her part, and
for the most scrupulous respect for confidential matters. It is
inexcusable even for members of the patient's family to discuss with one
another the patient's private concerns, or his queer or unreasonable or
annoying ways. During sickness the skeletons in most people's mental
closets walk forth, and anyone who misuses special opportunities to know
intimate affairs can only be classed with eavesdroppers and village
gossips.
EXERCISES
1. What are the essentials of a good sick room as to:
(_a_) Situation and exposure.
(_b_) Lighting and heating.
(_c_) Furnishing.
(_d_) Ventilation.
2. How may a sick room be ventilated without exposing the patient to
draughts?
3. How should the bed be placed in relation to doors, windows, and
walls?
4. How should a sick room be cleaned?
5. What in general are the duties of the attendant?
6. Make a plan of your own bedroom, and show what changes, if any, would
be desirable if it were to be used as a sick room.
FOR FURTHER READING
Notes on Nursing--Florence Nightingale, Pages 1-63, 84-105.
CHAPTER VI
BEDS AND BEDMAKING
The common saying that the best bed for an invalid is his own bed
contains an element of truth. Taking from a patient his own accustomed
bed, even when a better is substituted, sometimes disturbs him greatly
and makes him feel that he is indeed very ill. Nevertheless, a suitable
bed is essential to the proper care of a helpless person, and no patient
should continue to use an unsuitable one, unless his illness is slight
and also likely to be of very short duration.
Besides being comfortable, a bed suitable for the sick must be clean and
easy to keep in a sanitary condition. The springs should be firm, and
the mattress should be elastic and should give an even support without
lumps and hollows. The bed covers should be clean, light, and warm; the
pillows should be sufficient in number not only to make the head and
shoulders comfortable, but also any other part of the body in need of
support. Moreover, the bed should be so placed and of such a kind that
the work of caring for the patient may be rendered as easy for the
attendant as possible. In every household at least one bed suitable for
a sick person should be available in case of need.
BEDSTEADS.--Beds of white enameled iron, brass, or brass and iron
combined are most easily kept clean, and are the best in every way. The
frame should be strong enough to stand firmly, yet not so heavy that it
is hard to move. It should have as few angles as possible, and all its
joints should be smooth and well finished. The springs should be made of
wire stretched tightly on a metal frame that fits smoothly into the head
and foot pieces. Large castors should be used; they may be removed from
the foot if the bed moves too easily.
A bed to be used in sickness should have the following
dimensions--length, 6 ft. 6 in., height 24 to 26 inches, width, 36
inches. If a bed is either too high or too low the labor of lifting and
moving the patient is greatly increased. If the bed is too narrow the
patient is insecure. If the bed is too wide, its center is difficult or
impossible to reach without leaning or kneeling upon it; and if too
short, it will prove uncomfortable for a tall person. A bed that is too
low may be raised on four heavy boxes of the same height; or still
better, upon heavy wooden blocks which any carpenter can easily make,
and which are well worth a little trouble to obtain. In the top of each
block a hollow should be made into which the leg of the bed will fit
after the castor has been removed. A broad firm stool or a low chair may
be provided for a patient who has difficulty in getting in and out of a
high bed.
Beds with complicated attachments for moving patients are not
recommended for family use. They are expensive, likely to get out of
order, seldom needed, and generally unsatisfactory. In some surgical
cases a bed with a firm, flat surface is necessary. Such a surface may
be secured by placing between the mattress and springs two boards
slightly separated, or one wide board with holes bored in it to afford
ventilation.
Wooden beds are undesirable: they are difficult to keep clean, they
readily absorb moisture and odors, they cannot well be disinfected, and
their solid frames prevent a free circulation of air. Moreover, it is
almost impossible to render fit for use again a wooden bed into which
vermin have once made their way. Folding beds and lounges even of the
best type are unhygienic, usually too low for the patient's comfort, and
often insecure.
A bedstead should be wiped frequently with a damp cloth; if it is of
enameled iron it may be washed with soap and water. The springs may be
cleansed with a stiff brush dipped in kerosene oil. Excessive use of
water upon the springs is likely to make them rust.
MATTRESSES.--Various substances are used in the manufacture of
mattresses, but nothing has yet been found that is as satisfactory as
curled hair. It is light and clean and elastic, it does not readily
absorb odors, and it is easily renovated. Although hair is more costly
than other materials, a hair mattress may be used almost indefinitely if
it is occasionally made over.
Felt or cotton mattresses are firm, but heavy, difficult to keep clean,
and likely to absorb odors. A useful mattress made from straw is
sometimes found in country districts. Such a bed is thoroughly hygienic,
for the worn straw may be burned and the tick washed and refilled with
clean straw; but straw beds are generally hard and lumpy. The least
desirable of all mattresses is the old fashioned feather bed, and it
should never be used if a better can by any possibility be obtained; but
a feather bed should not be arbitrarily taken away from an old person
accustomed to its use, unless his welfare is really at stake.
A mattress made in two sections is unnecessary for a single bed; indeed,
a mattress made in one piece is more easily kept in place if the
patient is restless. A good quality of blue and white ticking makes a
serviceable cover for both mattress and pillows since its color is not
likely to run.
CARE OF THE MATTRESS.--A mattress should be brushed frequently with a
whisk broom, especially around the tufts and edges. If a patient is long
confined to bed, a fresh one should occasionally be substituted so that
the regular mattress may be removed, well brushed, beaten with a carpet
beater, and left exposed to the sun and air for a day or two. A mattress
that is badly soiled should be sent to a cleaner and made over; it
cannot be cleaned properly at home. It is generally possible to remove
blood stains, if they have not soaked through the ticking, by applying a
thick cream made from raw starch and cold water. When the starch becomes
dry it should be brushed away, and the application should be repeated
until the stain has disappeared. For the best results the starch should
be applied before the stain is dry.
PILLOWS.--One patient can use an almost unlimited number of feather
pillows. Some should be soft and others firm, some large and some small;
but pillows that are very large and thick are less useful than a greater
number of smaller ones. It is well to have several small pillows of
varying size and thickness to support different parts of the body.
Hair pillows are often acceptable in warm weather, and they are also
desirable for patients with high fever or excessive perspiration. Rubber
air pillows are a convenience in traveling and add much to the comfort
of a patient when he first goes out in a carriage or motor car, but air
pillows are not sufficiently durable for general use.
If a pillow tick becomes soiled, the feathers may be transferred to a
clean tick by making an opening about six inches long in the end of each
pillow, sewing the ticks together, and then shaking the feathers from
one tick to the other. The soiled tick can then be washed. If the
feathers themselves have become soiled they should be renovated by a
cleaner. Pillows, like mattresses, should be frequently brushed, sunned,
and aired. They should not be held in the mouth while a clean
pillow-case is adjusted.
PROTECTION OF THE MATTRESS AND PILLOWS.--In all cases of sickness the
mattress must be adequately protected. Neglect is inexcusable and may
cause expense and trouble as well as discomfort to the patient.
The following may be used to protect the mattress or pillows: large
quilted pads, small pads of cotton batting covered with old muslin or
cheese cloth, slip covers for the mattress, rubber sheets and
pillow-cases, old blankets and quilts that may be washed easily. Heavy
wrapping paper, builders' paper, and newspapers serve well in
emergencies, or for a short time.
RUBBER SHEETS AND PILLOW-CASES.--Soft rubber cloth, single or double
faced, is most frequently used when it is necessary to protect the bed
from discharges. It may be purchased by the yard. Rubber sheets should
not be used unless they are really necessary. They are hot and
uncomfortable, and increase the tendency to perspire. When used, a
rubber sheet should be 1 yard wide or wide enough to reach from the
lower edge of the pillows down to the patient's knees, and long enough
so that it can be tucked in securely on both sides of the bed. Rubber
sheets may be cleaned by laying them on a flat surface and washing on
both sides with soap and water, using a small brush if necessary. After
rinsing they should be wiped, and when thoroughly dry they should be
rolled rather than folded, to prevent the rubber from breaking.
Rubber pillow-cases are used for a patient who perspires profusely, or
who has a discharge of any kind from the head or neck, and also when
substances which may wet or stain the pillow are applied to the head.
They should be put on next to the pillow, securely fastened with tapes,
snap hooks, or buttons, and covered with the regular pillow slip.
Rubber sheets and pillow-cases are not durable. They should be used
carefully, and frequently examined for holes or worn places by holding
them up to the light. Even a pin hole near the center may render a
rubber sheet or pillow-case as useless as a sieve.
SHEETS.--Sheets of ample proportions are necessary for comfort, and
important for sanitary reasons as well. For a bed of the dimensions
mentioned in this lesson sheets should be three yards long, and two
yards wide. A safe rule for any bed is to have the sheets one yard
longer and one yard wider than the mattress. A sheet of these dimensions
is large enough to be tucked under the sides and foot of the mattress,
while at least twelve inches are left to fold over the blankets at the
top. Cotton sheets are as good as linen for general use, or even better,
and are far less expensive.
DRAW SHEETS are used to cover rubber sheets, and to protect beds when
the rubbers are not used. In hospitals special draw sheets are usually
provided, but an ordinary sheet folded answers every purpose. New and
expensive sheets should not be used for draw sheets, since they are
more likely than other sheets to become stained. Draw sheets should be
wide enough to extend about four inches beyond the rubber sheet at the
top and bottom.
PILLOW COVERS.--Pillow covers are generally made of cotton, but persons
who can afford the cost frequently prefer linen, especially in hot
weather. Unless fastened with buttons or tapes, a pillow case should be
several inches longer than its pillow. It should be wide enough to slip
on easily, but not so wide that it wrinkles or allows the pillow to
turn. If it is too small the pillow will become hard and uncomfortable.
These small things, unimportant as they are to the well, may cause much
discomfort to a restless or nervous patient.
BLANKETS.--All wool blankets are both light and warm, and are
consequently the most comfortable bed covering. But unless they can be
dry cleaned frequently, it is better to select blankets made from one
part wool and two parts cotton. Blankets containing equal parts of wool
and cotton are warmer, but are more injured by washing. Very light
blankets of wool or outing flannel are useful in summer. Double blankets
should always be cut in two and bound at the ends, since single blankets
are easier than double blankets to handle and wash. Patients are
frequently too warmly covered by day. Too much warmth is enervating, it
causes the patient to perspire, and makes him restless and more
susceptible to draughts and to changes of temperature. Two light
blankets are warmer and more comfortable than one heavy blanket.
COMFORTERS AND QUILTS.--Heavy cotton comforters are burdensome without
being correspondingly warm. Eiderdown quilts or those padded with wool
are good for a patient who sleeps out of doors, or whose room is kept at
a low temperature. Bed covers that cannot be laundered readily should be
protected by basting on both sides of the top a wide piece of muslin or
linen, which can be removed and washed.
COUNTERPANES.--White dimity counterpanes are desirable, since they are
light in weight, easily laundered, and inexpensive. A heavy counterpane
is uncomfortable at any time, and still more uncomfortable in sickness.
If a light spread is not available, a sheet makes a good substitute. A
counterpane should be wide enough to cover the sheets and blankets at
the sides when the bed is open, and long enough to protect the bedding
at the top and bottom.
BED MAKING
All methods of making beds for the sick are based upon a few underlying
principles. The aim in every case is to obtain the following results
with the least expenditure of time and labor: first, to secure comfort
for the patient, and to eliminate all causes of friction, irritation, or
pressure upon his skin; next to keep the covers firmly in place, so
that the bed will not easily become disarranged; then to protect the
mattress, and last, to secure as good an appearance as possible.
[Illustration: FIG. 12.--THE DRAW SHEET IN PLACE. (_From "Elementary
Nursing Procedures," California State Board of Health._)]
TO MAKE AN UNOCCUPIED BED, proceed as follows: remove the pillows and
covers one at a time, and place them on chairs, near an open window if
possible. Brush the mattress and then set it up on its ends to air, or
turn it back over the foot board. Wipe the bedstead with a damp cloth.
Replace the mattress after it has aired, turning it from side to side
and from end to end on alternate days. Cover the mattress, unless it is
enclosed in a slip cover, with a white quilted pad or an old blanket,
and then spread the lower sheet over the mattress, so that the middle
fold of the sheet lies upon the center of the mattress in a straight
line from the head of the bed to the foot. Tuck the sheet under, first
at the top and then at the bottom, drawing it so that it is firm and
tight. If the sheet is of proper length tuck fourteen or sixteen inches
under at the top, but take care to cover the mattress at the foot also.
Next tuck the sheet under at the side, folding its corners to make a
neat finish like an envelope. Place the rubber sheet, if it must be
used, across the bed, with its upper edge where the lower edge of the
pillows will come. A draw sheet somewhat wider than the rubber sheet is
needed next; an ordinary sheet, folded once the long way of the sheet,
may be used, with the fold toward the head of the bed. Tuck both rubber
and draw sheet securely under the mattress at the side. In some cases
the rubber sheet may be placed next to the mattress, and covered by the
mattress pad and lower sheet. Place the draw sheet as directed, whether
the rubber is used or not. After the lower, rubber, and draw sheets have
been adjusted on one side of the bed, go to the opposite side, draw them
over smoothly, and tuck them under the mattress as tightly as possible.
Next spread the upper sheet over the bed so that its upper edge reaches
to the upper edge of the mattress, and its middle crease lies over the
middle line of the mattress, and place it right side down, so that the
smooth side of the hem will be uppermost when the sheet is turned over
the blankets. Place the blankets so that their upper edges lie a little
higher than the place where the lower edge of the pillow will come, and
tuck them in firmly at the bottom and sides. If the blankets are not
long enough to tuck in at the foot, place the lower blanket as directed
and the upper blanket five or six inches lower than the first. When
tucked in, the upper blanket holds the lower one in place fairly well.
Place the counterpane evenly and smoothly, tuck it under at the foot,
turn its corners neatly, turn its upper edge under the upper edge of the
blankets and fold the upper sheet down over the whole. Last of all,
shake the pillows and place them neatly on the bed.
[Illustration: FIG. 13.--THE CLOSED BED. (_From "Elementary Nursing
Procedures," California State Board of Health._)]
Practice is necessary before it is possible to make a bed quickly and
well, and a certain amount of proficiency in making an unoccupied bed
should be acquired before undertaking to make a bed with a patient in
it. One should learn to work in an orderly way, without confusion,
unnecessary motion, or jarring of the bed.
TO CHANGE A PATIENT'S PILLOWS.--Stand preferably on the right side of
the bed and slip the left arm under the patient's shoulders, supporting
his head in the hollow of the arm. Raise him slightly and remove the
pillows one at a time with the right hand, drawing them outward on the
left side of the bed. Place a small pillow under his head. Shake the
pillows, change the cases if necessary, and replace them on the left
side of the bed, ready to be drawn back into position. Raise the patient
as before, remove the small pillow and draw the others into place. It is
sometimes better to hold the patient on the upper pillow while removing
and replacing the under one.
LIFTING A PATIENT IN BED.--Patients tend to slip down toward the foot of
the bed, and they should be raised if unable to help themselves. To
raise the patient, instruct him to flex his knees and to press his feet
firmly upon the bed; place one arm under his shoulders, as when
changing pillows, the other arm under the thighs, and lift him upward
without jerking. The lifting can be done more easily by two people, and
with less discomfort to the patient: if he is entirely helpless two
people are necessary. Two people should proceed as follows: Let _A_
place her left arm under the patient's head and shoulders as before, her
right arm under the
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