Chapter CD: AB. 3 aces 150 (5)

=The Bed.=--The best kind of bed for the sick is a small iron bedstead, about 3½ ft. wide and not too high, with firm, level, spring mattress, and light warm covering, avoiding large heavy linen counterpanes, which, though oppressively weighty, give but little heat. It should be placed in such a position as will be most out of draughts, and at the same time convenient for the nurse in performing personal services for the patient. It must never have either side against a wall, nor be between the door and the fire. It is a point of some importance, especially in cases of long illness, to arrange the position of the bed so that the sick person can see the fire or look out of window. A second bed, or hammock, or stretcher on wheels, is often very useful for shifting the patient on to while airing and making the other bed.

Good bed-making is imperative in sickness, and nothing is a better test of a nurse’s capacity than the way she keeps her patient’s bed. Some nurses are eternally fidgeting till they work the unhappy invalid into a frenzy. Others, again, in their dread of disturbing him, let the patient toss everything to the wildest confusion, trusting to one grand and general clearing up to set matters right. A good nurse keeps things straight almost unconsciously, taking advantage of any chance the patient gives to smooth out the crumpled sheet, or tossed bed-clothes, with a strong even pull, or to replace a heated, crushed pillow with a fresh cool one (though careful that, if cool, it is not chilly). Remember when smoothing a sickbed never to jerk or twitch the clothes, and be always sure your attempts do not endanger anything that may be lying on the bed, and whose downfall would most certainly disturb and flurry the invalid. A wide bed in a measure is a substitute for having 2 beds, as considerable relief may be obtained by using alternate sides of the bed; moreover, you can cool one side when the patient is on the opposite side, by turning back the clothes so as to let the air reach the lower sheet. Bed linen should always, if possible, be exposed to the open air, in the sun and wind, before using, as this freshens it most effectually, whilst a drop or two of good lavender or rose water sprinkled on sheet and pillow-case add greatly to the pleasantness. The best way of making a bed so as to give the least possible disturbance to the sick person, and prevent bed sores, is laid down in these rules:--(1) Keep the sheet below the patient perfectly smooth; (2) wash the parts where the bone is prominent daily with soap and warm water, dry them well, rub them over with a little spirits of wine or whisky to harden the skin; (3) change the patient’s position frequently; (4) never let him lie on a blanket; a freshly-made bed, a good sponge over with vinegar and water, would often, after a restless, sleepless night, have the good effect of making the patient fall into a sound sleep. It is best to make a good lather with the soap, and not to use much water. Zinc-powder and boracic acid powder are often used to powder the back after the washing.

A very common torment of invalids is the weight of the bed clothes. They are heavy, but not warm. For the rich, blankets and eiderdown quilts are easily obtained; but for the poor, paper is far better than many more costly coverlids. It is by no means necessary to spend money on a paper blanket, though these are excellent; a few sheets of brown paper, or even newspapers, pasted together to the size of the bed, add greatly to the warmth and practically nothing to the weight. If it is not the beat possible covering, it is very good, and absolutely costless.

It is often necessary to change the sheets without disturbing the patient. This can be done either from side to side or from head to foot. The former method consists in loosely rolling up the soiled sheet sideways, from the side of the bed where there is most unoccupied space, until the roll can be pressed against the patient’s side. The clean sheet, previously loosely rolled up from side to side, is then unrolled over the uncovered part of the bed, until the clean roll lies by the side of the soiled one. The patient is now lifted over on to the clean sheet, the soiled sheet is taken away, and the spreading of the clean sheet is completed. The second plan is to roll up a clean sheet loosely from end to end. Beginning at the head of the bed, the soiled sheet is rolled down from underneath the bolster, and the clean sheet unrolled after it, and arranged in its place. The shoulders of the patient should then be raised a little, and the soiled sheet rolled down from under them, while the clean sheet is unrolled to follow it. The hips, and lastly the legs and feet, are to be gently raised one after another in a similar manner, the soiled sheet taken away at the foot of the bed, and the unrolling of the clean sheet completed.

With paralysed and other helpless patients, frequent washing or sponging is more necessary, and the draw-sheet becomes useful. This consists of a small sheet folded lengthwise 2 or 3 times, so that when placed beneath the patient it may reach from the middle of the back to the knees. One end of the folded sheet should be the part first used, the rest being loosely rolled up to within a few inches of the patient’s side. As the sheet becomes soiled, the unused portion is unrolled sufficiently for the soiled part to be drawn from under the sick person, and a clean part substituted. The soiled portion is rolled up as it is withdrawn, and secured by a safety-pin. A piece of waterproof sheeting or a strip of thin oil-cloth passed beneath the draw-sheet still further protects the bed.

Bedding and pillows should not be too soft, otherwise the patient is continually sinking into hollows, and becoming hot and restless in consequence. When a patient needs to be propped up, the greatest mistakes are made. Pillows are jammed and wedged in at the patient’s back till he is completely built in. A cheap and simple pillow which doctors strongly recommend as a support in such cases is made of chaff, or chopped straw, and stuffed hard. It is covered with any cheap material, and is shaped like a writing desk--that is to say, it is made to slope. It should be a little longer than an ordinary pillow, and should be 8-12 in. deep behind and 3-4 in. in front. Ordinary pillows (1 or 2) placed upon this as a basement make a capital back-rest for persons suffering, say, from bronchitis. Such a rest has many advantages: it does not give way, hence the patient no longer finds himself from time to time in a deep hole; it allows the arms and shoulders free movement; it is also cooler, and permits more frequent change of posture. In propping a patient up it should always be remembered that the back needs support as well as the head and shoulders.

A very great comfort to sick people, especially to those who have to be left much alone, is to be furnished with some simple arrangement by which they can raise themselves into the sitting posture and so maintain themselves with slight effort. This can be attained by fixing a length of strong webbing to the foot of the bed, and placing knots upon it at intervals, so as to enable it to be more readily and firmly grasped. A netted bed-rest, 3 yd. in length, is a very simple and useful contrivance; its main use is the same as that of the knotted webbing, but by allowing it to pass round the back of the invalid, and spreading it out, it makes an exceedingly pleasant bed-rest, fashioned on the principle of the hammock. A swing bed-rest has several advantages. It is very cool, and allows a free play of air on all sides of the patient, which is a very important advantage. It permits, moreover, considerable movement, and does away with the fatiguing restraint of keeping the body in one position. If the ventilation through the network be too great, or the weather be cold, a pillow can be placed against the patient’s back, within the rest. Instead of the rest being netted, it may be made of strong towelling, which will bear rougher usage. Its strength and serviceability will be increased by stitching here and there bands of webbing; and at each of its narrower ends strong broad tapes must be fastened, by which it can be secured to the foot of the bed. Such netted bed-rests can be had (5_s._ 6_d._ each) at the Depot for Ladies’ Work, 16, King Street, Manchester.

Bedridden patients, and those who are paralysed or otherwise reduced to a condition of great weakness, often complain that they are continually slipping down in the bed. Often a box or footstool is slipped in at the foot of the bed, that the patient’s feet may be pressed firmly against it to prevent slipping. But this cannot be long continued where the legs are weak, for the muscles become exhausted, the knees give way, and then the slipping goes on just as badly as ever. This can be prevented, if a little round pillow, 3-4 in. only in diameter, be fixed so that the patient, though lying down, as it were sits upon it. Such a pillow, to answer its purpose, must be tied in its position very securely, and this may be done by a piece of webbing attached to each end, and tied either to the head or sides of the bedstead.

Following is a way to make pillows with paper stuffing. Use any sort of paper, and tear all into small square or oblong pieces. Then roll each piece between the finger and thumb into a tiny spiral, exactly as if beginning to make round spills. It is very little trouble to do. It is a most suitable occupation for blindman’s holiday, or for people with weak eyesight; and the pillows, as may be supposed, are far more elastic than if made of the same paper, flat. Of course, it is most suitable for an under pillow, if one has a choice; but so long as there are so many unfortunate invalids without any pillows at all, the plan is worthy of remembrance.

A table to stand on the bed is very convenient for trays, &c. It can be bought ready made, and is not at all expensive, or a very little ingenuity is needed to make one. About 2 ft. long, hollowed out on one side, and 1 ft. broad, is a good size. The legs may be 6-7 in. high.

The bed can be refreshed and aired by raising and lowering the clothes so as to produce a fanning motion. To turn a pillow without fatiguing the patient, put the hollowed palm of one hand at the back of his head while with the other you quickly reverse the pillow and replace it. To lay a bed with a waterproof sheet for temporary use, first make the bed with a blanket beneath the under sheet, and then spread the waterproof, a blanket and another sheet, without tucking in. When done with, it is only necessary to draw out the waterproof with its blanket and sheet, leaving the patient on a fresh sheet. No amount of care will keep crumbs out of a sickbed; they catch in every fold and frill and pass up the sleeves, and demand a search after every meal in which bread figures. To avoid rucks in the under sheets, stretch it tight on the mattress and fasten it down with safety pins.

=Sickroom accessories.=--These are of a varied character, and will be described under separate headings.

_Poultices._ Linseed.--The great art of poultice-making consists in applying it to the patient sufficiently hot, and, therefore, it is advisable to warm all the materials before beginning. Put the linseed (crushed or meal) before the fire or in the oven for 20 minutes to heat. Use by preference a tin bowl, and scald it with boiling water; then pour in as much boiling water as will be needed for the poultice, sprinkle in the hot linseed with one hand, and stir vigorously with a knife to the required thickness. To judge of this requires some practice. A poultice should be somewhat moister, if applied to an open wound, than if it is intended to relieve some internal pain; but in no case ought it to be sufficiently moist to stick in patches to the skin of the patient. The next step is to take a square of rag or paper ½ in. larger all round than the poultice is intended to be; spread the linseed on this about ½ in. thick, leaving the edges clear; fold the rag over on each side, and apply at once, covering with a pad of cotton wool and a layer of indiarubber or oil silk to keep the heat in. It is a good plan to oil the face of the poultice with a feather, as this effectually keeps it from sticking to the skin, even if it is not well mixed, and it is better than to put the poultice into a muslin. If, however, the muslin is preferred, on no account should a bag be made, for the poultice cools while it is being put in. A large piece of old linen, folded over at the back, like a parcel, keeps the linseed in, and makes at the same time a pad to cover it. Failing linseed meal, you can use either oatmeal or bran; if oatmeal, then boil it with the water like porridge. A poultice should be larger than appears absolutely necessary. It is intended to allay pain and inflammation, and as the pain probably extends beyond the inflamed part, a large poultice should be made to cover the inflamed part. Dr. Atkinson says that meal deprived of its oil is far better than that from which the oil has not been extracted. The latter does not retain its heat as long, and, unless covered by some fabric, is not so easily removed as the poultice made from the former. The exhausted meal takes up more water, and retains its heat longer. In making a poultice, the meal should be thoroughly stirred with a spoon while boiling water is gradually added, and when of proper (rather soft) consistence, should be spread on linen. The ability to bear the heat on the back of the hand is a good test of the degree to be used. The poultice should be applied directly to the skin, without intervening fabric, and be covered on the outside with good oiled-silk. A teaspoonful of laudanum may be sprinkled on the surface to increase its anodyne effects, or in place of water may be used a boiling infusion of camomile or poppy-heads. When the skin is inflamed, 3 grs. sulphate zinc or alum may be added to each oz. of water. A solution of 1-40 of carbolic acid may be used instead of simple water in the case of sloughing wounds. Once in 4 hours is a good rule to follow in changing poultices on the chest, the front and back being covered by separate poultices, and only one should be removed at a time. A fresh one should be ready when the change is made. Frequent changes are most grateful in cases of abdominal pain.

To relieve spasm, as in colic--intestinal, biliary, or renal; to relieve inflammation of the pleura (lining membrane of the chest), the lungs, the liver, or other organs, it is essential to apply the poultice as hot as possible, while protecting the skin from being scalded. In order to do this, a flannel bag should be prepared, a convenient size being 12 in. by 8; this should be closed at 3 edges and open at the fourth; one side of it should be 1-1½ in. longer than the other, and it is convenient also to have 4 tapes attached at the points which form the corners when the bag is closed, in order to keep the poultice in position. Besides this, another strip of flannel should be prepared of the same breadth as the length of the bag, and long enough to wrap round it once or oftener. Crushed linseed, bowl, and spoon should be got together, and the spoon and bowl thoroughly heated by means of boiling water; the poultice should then be made with perfectly boiling water, and rather soft. As soon as it is ready, it should be poured into the bag, previously warmed by holding it before the fire; the flap which is formed by the longest side of the bag should now be turned down and fastened in its place by a few long stitches with a needle and thread; it should then be quickly wrapped in the strip of flannel (also previously warmed), and fastened _in situ_, if necessary, by means of the tapes. It may be covered outside with a sheet of cotton wool. In this way the poultice may be applied boiling hot to the skin without burning; the 2 layers of flannel which are at first dry allow the heat to pass very gradually indeed to the skin; as the moisture of the poultice soaks through them they become better conductors, and the heat passes more quickly, but the increase is so gradual as not to cause any painful sensations whatever, but only one of soothing and comfort. The poultice also naturally keeps much longer hot, and the necessity for changing it arises much less frequently. The difference between the effect of a poultice made in the ordinary way and in the manner just described is sometimes exceedingly striking. It is, perhaps, less marked in cases of inflammation than in those of spasm.

Bread.--In a small and perfectly clean saucepan have a teacupful of boiling water. Add breadcrumbs, or the crumb of a stale loaf: 1½-2 oz. will be sufficient for this quantity of water, and let it soak over the fire for about 5 minutes. Then turn it into a piece of rag, and spread it of suitable size and evenly. This plan ensures its being hot.

Mustard.--If a mustard poultice is wanted it can be made in the same way as linseed, save by adding a certain proportion of dry mustard to the linseed. Some persons prefer to boil a little mustard in the water that is to be used. Dr. Tyson, of Philadelphia, recommends the addition of molasses to mustard in making plasters. This furnishes a mild persistent counter-irritant which can be worn for hours. Leaves of so-called “mustard paper” may be made as follows: The mustard must be deprived of all fatty matters; the adhesive agent must contain neither alcohol, resin, nor fatty matter; nor must it be of the nature of a plaster. Submit the mustard farina to strong pressure, and wash with sulphide of carbon or petroleum essence. Spread on paper an adhesive liquid formed of a solution of 4-5 parts caoutchouc in 100 parts mixed carbon sulphide and petroleum essence. Sprinkle over the freshly coated paper by means of a sieve, the prepared mustard. Pass between two rollers, and afterwards gently warm to promote volatilisation of the liquid solvents used. Cut to pattern as required.

_Court Plaster._--This is generally bought. To make it, soak isinglass in a little warm water for 74 hours, then evaporate nearly all the water by gentle heat, dissolve the residue in a little proof spirits of wine, and strain the whole through a piece of open linen. The strained mass should be a stiff jelly when cool. Now stretch a piece of silk or sarcenet on a wooden frame, and fix it tight with tacks or pack-thread. Melt the jelly and apply it to the silk thinly and evenly, with a badger-hair brush. A second coating must be applied when the first has dried. When both are dry, apply over the whole surface 2 or 3 coatings of the balsam of Peru. Plaster thus made is very pliable and never breaks.

To make it without silk, mix enough collodion with castor oil to render it elastic when dry, the oil having profusely been rubbed with some zinc oxide. Into this mixture dip glass plates, and, after drying, redip and redry 2 or 3 times, or until a film of suitable thickness is obtained. Upon this paint the usual solution of isinglass to give it adhesiveness, and, after again drying, separate it from the glass.

_Applying cold to the Head._--Take one fold of cotton or linen rag, soak it in cold water, the colder the better, squeeze dry and apply it as rapidly as possible. Do not take a large piece of cloth folded several times, and keep squeezing it in your hand till it is quite hot and then put on. One fold of cloth, the thinner the better, dipped often in the cold water and rapidly applied gives great relief in headaches, for example. If you can procure ice put a piece in the water. Ice is sometimes ordered to be kept constantly on the head; to keep it from melting, wrap it up in flannel, or put it in sawdust, and in a cool place. To break ice, use a large needle. Ice-bags can be bought for 3_s._-4_s._, or it may be put in a bladder and applied to the part, or a bag may be made of guttapercha and chloroform. By putting a little chloroform along the edges and folding them over, you can make a very useful bag for ice; the ice should be broken in small pieces before being put in the bag, and be removed as soon as it melts.

_Fomentations._--A very good, perhaps the best, plan is to put a piece of flannel, folded 4 or 5 times thick to the required size, into a potato-steamer over boiling water. In this way it soon becomes hot, and little or no wringing is necessary. Where a potato-steamer is not to be had, however, the following plan should be adopted. Take a strong towel or cloth, or a piece of ticking, and pin or tack a deep hem in each end. Into these run two short, strong sticks--anything will serve: a couple of iron spoons, and even a small poker, such as is called a “curate,” though this last is rather long for choice. Lay the towel, or “wringer,” as it is technically called, over a large basin, so that the sticks hang outside; place the folded flannel in the middle, and pour boiling water over. The flannel can easily be wrung dry by one pair of hands, and if it is not made by the bed side, it can be carried there without fear of cooling in the wringer. Sometimes opium or turpentine is to be added. The quantity of either to be used will be prescribed by the doctor, and it should be sprinkled on the side of the flannel that is to go next the skin, immediately before applying it to the patient. The flannel should be covered with wool and oil-silk, just as a poultice is covered. Fomentations are, in many cases, as efficacious as poultices, and they possess, besides, the advantage of being easier to make, and of costing practically nothing, since the flannels can be used repeatedly. For the very poor, the cost of linseed for poultices is often a serious item. There is no danger of scalding if the flannel is squeezed so dry that it cannot drip nor wet the palm of the hand.

Another plan is described as follows: Take your flannel folded to a required thickness and size, dampened quite perceptibly with water, but not enough to drip, and place it between the folds of a large newspaper, having the edges of the paper lap well over the cloth, so as to give no vent to the steam. Thus prepared, lay it on the stove or register, and in a moment steam is generated from the under surface, and has permeated the whole cloth, heating it to the required temperature.

_Blisters._--Blisters and leeches should only be used under medical direction. Before the application of either, the part should be well washed with soap and warm water. Then, in the case of the blister, it has only to be slightly warmed before the fire and left on until “it rises,” and a good-sized vesicle has formed (which will usually be in about 8-10 hours), when the water must be let out by snipping the skin with the point of a sharp scissors--a perfectly painless operation--and the blistered surface dressed with spermaceti ointment spread on soft lint.

_Leeches._--Leeches can generally be induced to bite by putting a few drops of milk or blood on the spots they are intended to take. They will usually fall off of themselves when filled, but if they remain on too long they must not be pulled off, but a little salt shaken on them, which will soon make them let go. Another simple and easy way of detaching leeches is to drop a few drops of camphor julep (mist. camph.) on the part, when they will soon relinquish their hold. The bleeding from their bites will also generally stop without interference. If it should continue to an undesirable degree, the nurse may nearly always stop it by making gentle pressure over the bite with her finger, or applying a little powdered alum or the muriated tincture of iron (tinctura ferri perchloridi). Never leave a patient for the night until all bleeding has completely ceased. The bleeding may be increased, when desired, by fomenting with warm water.

_Enemas._--A nurse is often required to administer an enema or injection--which in many conditions of disease is a most valuable method of treatment. Be careful not to disturb or uncover the patient until quite certain that you have arranged ready to hand everything that will be required. Almost any variety of injection apparatus answers the purpose sufficiently well, but in using the rubber ones care must be taken to squeeze out all air from the bulb before commencing, else the air will be forced in by the first compression. The most convenient position for the patient is lying on the left side. Then the nozzle of the instrument, having been well greased and warmed, should be passed slowly and carefully into the bowel, the point being directed slightly backwards. On no account whatever must the least force be used. If there is any difficulty or pain in introducing the tube to the required distance, the nurse must wait for a minute or two, when, in all probability, the opposing muscle having become relaxed, it will pass in easily and without pain. The injection should then be given very slowly and quietly, and without any jerking or irregularity of motion, especially if it be desired that it should be long retained; it must be stopped immediately if the patient calls out that he can bear no more. Enemata are generally either nutrient or purgative; but occasionally other medicines are given in this way. The nutrient are of extreme value, as it sometimes happens that, when nourishment can be taken in no other way, sufficient may be supplied by this means to tide over the period of danger. A good nutritive enema may be made as follows: The yolks of 2 fresh eggs well battered in about ½ pint strong beef tea, or in 2 tablespoonfuls (half a canister) of Brand’s extract of beef, dissolved in warm milk. About ½ wineglassful port wine, or 1 tablespoonful brandy may be added in cases of extreme exhaustion. It should be given at about blood heat--100° F. An active purgative enema may be made with: 4 tablespoonfuls castor oil, 1 teaspoonful oil of turpentine, and about 1 pint well-strained gruel, or soap and water. An enema of plain soap and water often answers very well.

_Clinical Thermometer._--In trifling ailments its use is for reference; in serious attacks it may give immediate warning that the physician is required; and even while the doctor is in attendance he often wishes observations regarding the temperature to be taken several times a day, in his absence, for his guidance and information. Following are a few illustrations of the uses to which the clinical thermometer may be put by any intelligent person. The natural temperature of the human body is 98·4°F. and the little arrow on the thermometer indicates this normal degree of heat, so that when the index rests at the arrow, the natural temperature is proved to be present. It is the variations above or below the arrow that mark the presence of disease.

The agony of colic is well known, but it is generally of little danger in the absence of inflammation. In peritonitis (inflammation of the bowels), the temperature runs quickly up to over 101° F.; in colic it scarcely rises more than a degree, if even thus far, above the natural temperature. A severe pain in the side causes pleurisy to be suspected. If the temperature is normal, there is no pleurisy, and the pain is probably neuralgic. Diarrhœa may continue for a few days, and the patient feels so out of sorts that typhoid fever seems to have set in; but all the specific forms, such as typhoid, typhus, scarlet fever, diphtheria, or measles, are accompanied by such an increase of body heat as will probably send up the record to 101° F., or possibly 3-4° higher. A child with persistent vomiting, sore throat, and high temperature will probably in a day or so show the rash of scarlet fever. In any case, when a temperature remains above 100-101° F. for more than 1-2 days, without obvious cause, the doctor should be consulted. If the child has disordered stomach or sustained a chill, the thermometer will record fever; but, after a purgative in the one case and a tepid or hot bath in the other, the increased heat will be found to be gone, and with it any alarm which may have been felt. In the course of an inflammation or fever, the friends can be informed by the medical man what degree of heat he expects, and should this be exceeded the doctor should be informed of the fact. Indeed the clinical thermometer is invaluable, especially to families at a distance from their medical adviser. It can be obtained from any instrument maker for 7_s._ 6_d._-12_s._ 6_d._, or more. Its application is a very easy matter. The bulb containing the mercury should be placed in the mouth or arm-pit; care should be had in the last case that clothes do not intervene between the instrument and the arm, and that it is so placed in the arm-pit as to be completely surrounded by skin. The patient must then press the arm gently to the side so as to retain the instrument, and in 5 minutes the thermometer will show the body’s temperature.

Dollond, 1 Ludgate Hill, London, E.C., sells an improved Lens Clinical Thermometer. The importance of the “lens” front cannot be over estimated, for with such a thermometer there is no difficulty in reading off the temperature even in the dull light of a sickroom, for the thin thread of mercury is magnified quite twenty times its size. This thermometer is made with a contraction in the tube near the bulb, which prevents the mercury returning, until shaken down. The price of this thermometer is 7_s._ 6_d._

W. H. Harling, 47 Finsbury Pavement, London, E.C., is the maker of an excellent clinical thermometer with lens front, which registers the temperature in the space of a single minute. It is furnished with a metal case having a bayonet fastening, and costs only 8_s._ 6_d._ The same maker supplies also ordinary clinical thermometers, in cases, at prices ranging from 3_s._ 6_d._ upwards. Other sickroom requisites are noticed on p. 1007.

When used to take the temperature of patients suffering from infectious disease, the thermometer should be disinfected by being washed in “Sanitas” or carbolic acid solution after each time of using. In taking the temperature under the tongue, the index should be “set” as directed, and the bulb should be placed as far back under the tongue as convenient and agreeable; the mouth should then be kept shut, and the patient should breathe through the nose: 3 minutes are sufficient for taking the tongue-temperature. In the arm-pit the thermometer should be left for 5 minutes and the fore-arm should be made to lie across the chest, so that the thermometer may thus be made to rest in a sheltered position.

Temperatures should be taken in ordinary cases at 8 A.M. and 8 P.M.; 2 o’clock is a convenient hour for a third observation. Variations in temperature occur in healthy persons, but such change does not usually amount to more than 2° or 3° F. What is to be regarded as deserving of attention under the ordinary circumstances of life is a fall below 97°, or a rise above 99·5°. In fevers, as a rule, the temperature does not rise above 106°; but in fever a heat of 108°, continuing even for a very short time, would be regarded as a most dangerous symptom. A very high or very low temperature must be looked upon as dangerous; should it be excessive either way, the case will probably prove fatal. A very sudden change is suspicious, and very frequently dangerous. In children, however, the presence of indigestible food in the intestinal canal may suffice to cause a rapid rise in the temperature. After the temperature has been stationary for some time, or has commenced to fall, a fresh rise may herald the advent of some complication, or the approach of a new disease. An unexpected fall may denote hæmorrhage, exhausting diarrhœa, or the perforation of the peritoneum or pleura (lining membranes of the abdomen and chest). A considerable rise during the course of a disease which is not generally regarded as febrile--viz., in tetanus, epilepsy, and cholera--usually precedes death.

_Making a Medical Coil._--Procure a well-seasoned walnut board about 21½ in. long, 3 in. wide, and ⅜ in. thick. From this cut one length 12 in. long for the base board _a_, and 3 pieces 3 in. square (like _b_) for the coil heads; when cut, a fillet 8 in. long must be nailed or screwed on the two sides of the base board (as shown in _a_); these fillets should be ¼ in. square section. Corresponding square nicks must be cut of two of the square heads (as shown at _x_ in _c_). All the woodwork when thus squared and finished should be soaked for ¼ hour in melted paraffin wax, and then rubbed dry while still warm.

Obtain a thin brass tube (known in the trade as “triblet tubing”) about ½ in. diameter, 4½ in. long; turn up a short plug and button to fit one end of this tube and serve as a handle (see _d_). This may be fastened to the tube by driving in 3 fine brass brads, and filing off the heads flush with the tube.

Cut up about 100 lengths of straight iron wire (best soft annealed) No. 22 gauge, say, about 4½ in. in length; fill the brass tube with them as tight as you can fit them; cut them all to the same length (they must protrude a little beyond the tube). Now draw out about 2 in. of the iron bundle and wrap it tightly round with twine, leaving about ½ in. free. Draw more out, and continue wrapping until you have wrapped to within ½ in. at each end of the bundle. Tie the string, and withdraw the bundle from the brass tube. Melt a little solder in a ladle, dip the ends of the iron bundle into soldering fluid (zinc dissolved in hydrochloric acid), and then at once into the melted solder. Allow the bundle to cool; file off the superfluous solder, so that the bundle will just enter freely into the tube. It should appear like _e_ when the string has been removed.

The next operation is to make a good stout paper tube, also about 4½ in. in length, into which the brass tube _d_ can slide easily. To make this, put a few turns soaped writing paper round the tube No. 1, then roll and glue seven turns of good stout brown paper, 4½ in. in length, round this writing paper, or else it will be difficult to draw out the tube. This paper tube _f_ must be allowed to dry thoroughly while still on the brass tube _d_. When quite dry, it must be slipped off, the writing paper lining drawn out, and then it must be soaked for a few minutes in melted paraffin wax.

The iron bundle should also be allowed to stand in melted paraffin wax for some time, and then stood up to drain in a warm place. This will prevent rusting. When quite cold, all superfluous paraffin having been removed, a strip of brown paper, ½ in. wide, is rolled round one extremity of the iron bundle, until it is of such a diameter as to fit tightly into the paper tube _f_. This paper strip must be cut off at this point and glued tightly round the end of the iron bundle. The brass tube _d_ is then slipped over the iron bundle until it just reaches the little paper collar just made. The brass tube and bundle together are pushed, button end first, into the paper tube _f_; and when the paper collar round the iron bundle is just about to enter the paper tube, it is to be well served with hot glue and forced into the tube. The whole must now be allowed to dry and set thoroughly.

Taking one of the 3 in. heads (the one which has not any nicks in the sides), bore a centre hole with a brace and centre bit, just large enough for the paper tube _f_, with its iron core, to fit tightly (see _b_). Putting a little thin good hot glue round the free extremity (the end opposite to that at which the brass enters), push it into the hole in the square head, until it projects about ⅛ in. on the other side. This must be allowed to dry thoroughly before proceeding to the next operation.

Now proceed to wind the primary coil. To this end, take about ½ lb. No. 24 silk-covered copper wire, and wind it round the tube, as shown at _g_, from end to end, in continuous layers, taking care to put a sheet of paraffined paper between each layer, and also to baste each layer with melted paraffin wax before winding on another. About 4 layers will thus be got on, and an even number of layers must be aimed at, so as to get the 2 ends of the wire at the same extremity, and able to fasten them under the binding screw _y_. To effect this, before screwing down the said screws, the ends of the copper wire are stripped of their covering and wound once round the screw of the binder. Free ends of wire, at least 6 in. in length, must be left for attachments, &c. This is shown at _h_.

This primary coil, with its iron core, sliding brass tube regulator, &c. may now be fastened to the base board by means of 2 screws from underneath, as shown at _i_, at 4 in. from one end, and therefore 8 in. from the other. One of the free ends of the primary wire is brought to one of the binding screws _v_, while the other connects to the clapper _z_. A short piece of wire connects the platinum screw pillar _w_, to the other binding screw, which is not visible, as it is behind the platinum pillar. At this point it will be well to try the working of the primary coil. For this purpose, couple up the 2 binding screws on the base board with a good bichromate cell. Connect the two binding screws _u_ in _i_, with the 2 brass handles intended for use. Screw up the platinum screw _w_ till the clapper _z_ begins to vibrate. Now hold the handles in your hand. As long as the brass tube _j_ is entirely over the iron core, little or no sensation is perceptible. If an assistant pulls out the tube, little by little, the current will be found to increase in strength until the regulator tube is quite out.

The secondary coil now demands attention. A paper tube, precisely similar to _b_, but of such a size as to slide easily over the primary coil _i_ is prepared, and paraffined. This must be cut exactly the length of the coil _k_, leaving the knob _j_ projecting. The 2 square pieces of board in which the nicks were cut (_c_) must then have central holes cut in them to take this paper tube, and then glued, one at each end of the said tube, as shown. Two small binding screws are then to be inserted in the centre of the upper edge of each square. A bung is now placed in each end of the tube, and a ¼ in. iron rod pushed through both, to serve as an axle. This is then mounted on 2 standards, as shown at _n_; and beginning by attaching one end of the uncovered wire to the binding screw _m_, about ½ lb. No. 36 silk-covered copper wire is now carefully coiled on, being most diligent in avoiding kinks, breaks, or flaws of every description. Each layer must be paraffined and separated from its neighbour by paraffined paper. When the quantum of wire has been laid on, the finishing end is connected to the binding screw in _n_. The last coil should be covered with paraffined paper, and finally covered with a jacket of good silk velvet. The secondary coil is then complete, and may be slid in its place over the primary coil _o_. When it is quite over the primary, the secondary current will be at its strongest, if the metal tube regulator is drawn out; it will be weaker as the metal tube regulator is more and more inserted; or may be even more delicately regulated by sliding the secondary coil itself more or less over the primary. The secondary coil, while the primary is being excited with a freshly made pint bichromate, will give a ½ in. spark when the regulator is out and the secondary coil right over the primary. This will pass easily through a dozen persons. (S. R. Bottone.)

There are various other sickroom appliances demanded in special cases which do not require description here. Most may be had of such well-known firms as Salmon, Ody & Co., 292 Strand, and Savory and Moore, 143 New Bond Street.

=Feeding patients.=--A nurse should bear in mind these two leading facts; that while in sickness there is usually a greatly increased tissue-waste, and consequently an increased necessity for nutriment, there is almost always a decreased appetite, or no appetite at all--often such a repugnance to food that, if left to himself, the patient would prefer taking none at all. Hence, although the medical attendant may decide what is the most suitable form of nourishment, on her devolves the more difficult task of inducing the sick person to take it. With this view, she must exercise all her ingenuity to tempt and encourage him, by bringing everything in the neatest possible form. On no pretext whatever should there be any cooking in the sickroom; nor should she take her own meals there; nor should any food be left standing near the patient. On the contrary, though his nutriment must be brought to him frequently--more frequently, of course, the less he can take each time--and punctually, it should only be in such quantity as he is likely to consume; and immediately that is done, everything in connection with food should be removed from sight and smell until the next time.

The nurse must devote much of her attention to the subject of diet, observing carefully the patient’s appetite, and attending carefully to the quantity of food and the effect of it. The sense of taste of many people is very acute when they are ill, and you must take care that the spoon in the arrowroot, which looks perfectly clean, does not taste to the patient of the soup for which it was used last. Eatables should not be kept in a sickroom: if you are obliged to have anything within reach, put it under a cover; a tumbler turned over does very well for biscuits or jelly, and for larger things a bell glass is useful; tin boxes, the next best thing, generally make a noise when they are opened. The water given to a sick person should not only be boiled and allowed to cool, but ought always to be filtered. It should frequently be changed, as it quickly absorbs the impurities with which the air of a sickroom is charged, and becomes injurious, if not dangerous to drink. In cases of faintness, where stimulants are not ordered, the patient should be made to sip some liquid slowly; the mere effort of sipping accelerates the action of the heart.

When solid foods cannot be taken, the best kinds are those which contain the most nourishing properties in the smallest and most easily digested form. Prominent among these is well-made beef tea: not the greasy watery broth which so often goes by that name, but nearly pure beef juice which has been slowly extracted, with the addition of little or no water, from fresh lean beef. A good substitute may be found in Bovril, which has the great advantage in an emergency of being immediately procurable at a chemist’s or grocer’s. Home made beef tea takes a long time to prepare properly, and even then it is deficient in staminal properties, whereas Bovril contains the entire nutritious constituents of pure beef, of which it takes 40 lb. to make 1 lb. of Bovril extract. Of equal value is milk; which, especially when combined with bread and butter, is very nourishing, and forms a most valuable article of sick diet. If it seems to disagree, or curdle on the stomach, it can generally be prevented doing so by the addition of about ⅓-¼ its bulk of lime-water. These may be varied by mutton broth, chicken or rabbit jelly, eggs in any form--plain, in custard, or in pudding with arrowroot and sago--and real turtle soup; which latter is, however, so terribly expensive as to be outside the reach of most people. Jellies made with gelatine, which contains scarcely any nutriment, are almost useless; and tea should be given only as an indulgence when specially wished for, and then it should be very weak, and with plenty of milk. All food given to the sick should be very fresh, of the best quality, and most carefully cooked.

_Boiled Flour Gruel._--Where the illness has been long and tedious, and the strength reduced, the following will be found very useful: To prepare the flour, put into a basin as much as it will hold, pressed tightly down. Then tie a cloth over it, and allow it to boil hard for 6 hours. Then take off the cloth, and let the flour stand in the basin till next day, when remove the crust which will have formed, and put the remainder away in a covered jar. For use, mix 4 tablespoonfuls flour smoothly into a paste, then pour on it ½ pint boiling milk or water, and boil for 10 minutes, constantly stirring to avoid lumps. Brandy, sherry, lemon juice or cream may be added, according to taste. Gruel may also be made from baked flour, but it is not so easy of digestion.

_Rice Gruel._--1 oz. each rice, sago, and pearl barley boiled in 3 pints water, which, in 2 hours, generally reduces it to 1 qt. Strain and flavour to taste. This forms a good nourishing diet, especially with the addition of a little isinglass.

_Onion Posset or Gruel._--This has been found very efficacious for colds, and is made with Robinson’s groats with the addition only of an onion, which should have been previously boiled for 6 hours. The yolk of an egg well beaten is an improvement.

_Chicken Broth._--The younger and fatter the birds are for this the better. It is made by immersing the legs, neck, and trunk of a fowl into just as much water as will cover them, and boiling gently for an hour. The white meat makes a delicious entrée if cut up finely and treated as a veal mince. Potato flour is useful for thickening in cases where boiled flour is not handy; but home-made things are always the best, as the ingredients are known.

_Oyster Fritters._--Remove the beards, and put each oyster into a tablespoon, and fill with a batter made as follows: 1 oz. rice flour mixed with 2 tablespoonfuls water, 1 teaspoonful vinegar, and 2 salad oil, the yolk of an egg, and a little salt and pepper. Allow the batter to stand, and just before using, beat the white of an egg to a stiff froth, and mix with it. Fry the oysters covered with the batter in boiling fat, turn them, place them on blotting paper to drain; serve on a hot dish, and garnish with slices of lemon, and thin rolls of brown bread and butter alternately.

_Potato Chops._--Mash nicely with a little milk, butter, pepper, and salt, any potatoes left from the day before, spread evenly over a boned loin chop previously sprinkled with finely chopped fried mint. Fry to a golden brown in boiling fat, then place it on blotting paper to remove the superfluous grease. Garnish with fresh mint and watercress.

_Jellies and Creams._--The following recipes were published by Mary Hooper, in the _Queen_:--

When jellies and creams are ordered for sick people in families where there is not a good cook, they are usually obtained from the confectioner; but this is not at all in the interest of the invalid, and efforts should be made to provide his diet from the home kitchen. An idea prevails that it is very troublesome to make jelly. It is not at all necessary to clear the jelly through a bag for invalids, nor indeed for ordinary domestic use. By a little care in the use of citric acid, which is perfectly wholesome, a jelly nearly as bright as that which has been cleared with eggs may be produced. In some cases, jelly without wine is required for invalids, when coffee, cocoa, or Seville orange jelly will probably be useful. It is difficult to make these jellies palatable without making them sweet, and they will only keep a short time. If the doctor does not object, or where it is desirable to give stimulants in a disguised form, a very small quantity of absolute alcohol may be used, and it will obviate the last-named disadvantages.

Milk jellies, or creams, whenever they can be taken, are an excellent form of diet, and are very easily prepared by the following recipes. For those who require a quickly-made cream, “Nelson’s Blanc mange” will be found very useful; it merely requires to be dissolved in milk or water, and in a very short time is ready for use. This blanc mange is made of very rich milk, and tastes equal to that prepared at home with cream. The unflavoured blanc mange should, as a rule, be selected for invalids, as any home-made flavour can be added to it. These flavourings--lemon, Seville orange, almond and vanilla--are very easily prepared by infusing any of the three first-named in gin, the latter in brandy. As these are more digestible than any which can be bought, it is well worth while to take a little trouble in the matter. It is sometimes necessary to tempt the appetite of an invalid by a pretty looking dish, which is also nice and nourishing. Such a dish can be easily made by the recipe for Alexandra Cream.

Simple Jelly.--Soak 1 oz. gelatine in ½ pint cold water for 1 hour or more. It is an advantage to soak gelatine overnight when convenient, because it is then more easily dissolved. Boil 6 oz. lump sugar in 1 pint water, skimming it until clear; then throw in the soaked gelatine, let it boil slowly for 5 minutes, removing all scum as it rises. Dissolve in a basin ¼ oz. citric acid, in lump, in ½ gill boiling water, pour the jelly on to this, when more scum will rise, which should be carefully taken off. Now add 1 gill wine and a little lemon flavouring, and, when nearly cold, put the jelly into a mould. Lemon juice can be used instead of the citric acid, but the jelly will not then be so bright.