Chapter XX: Home Nursing and First Aid in the Nursery34

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=General Principles.= Careful hygiene will reduce illness to a
minimum. Study what to do in emergencies and illness before these
appear, in order to be mentally and technically prepared to act
promptly, with confidence and poise, when need arises. Teach
children as early as possible how to spit, gargle, raise phlegm,
inhale. Habits of obedience, self-control, and regularity will
assist in recovery. Under any circumstances avoid excitement; keep
calm and self-possessed. Use firmness, gentleness, patience, good
cheer, and the spirit of play in care of illness. It is wiser to
call the doctor at first, when symptoms of illness appear, than
to incur severe sickness and greater cost by delay. A severely
sick child needs a trained nurse. Children have less resistance
than adults, and succumb more easily, therefore they need prompt,
intelligent treatment.

Every woman who has the care of a little child should learn the
following from the physician or nurse: use of clinical thermometer,
bedpan, giving of enema, massage, dressing and bathing of bed
patient, bandaging, first aid in serious cuts, fractures, broken
limbs, drowning. There should always be at least one room in the
house with washable walls, sunny exposure, and without carpets,
heavy draperies or upholstered furniture, that can be used for an
isolation sick room in emergency.

=Symptoms of Illness and Their Immediate Care.= When several
symptoms are evident at once, the matter is more urgent. It is
usually advisable to have the doctor call, rather than to expose
the sick child to the change of temperature, dust, excitement of
crowds, or danger of infecting others. In severe injury, secure any
medical assistance in quickest way.

Discharge from nose C (?)[35] 1
Discharge from eyes with inflammation C (?) 1
Swollen lids, inflamed, yellow discharge C[36] 3
Sore throat C 2
Pain in or behind ears 1
Swollen glands in neck 1
Persistent cough C (?) 1
Persistent lassitude C (?) 1
Loss of appetite 1
Loss of weight 1
Severe or frequent earache 2
Headache with delirium 3
Stupor or dullness 2
Chills, with or without fever C (?) 2
Fever with languor, loss of appetite C (?) 2
Nausea with fever C (?) 2
Convulsions 3
Eruptions C (?) 2
Cramps and vomiting C (?) 3
may be poisoning
Persistent pain in feet or legs 1
Swelling of feet and legs 2
Black, or bloody stools 2
Claylike stools 1
Constipation (48 hours, not yielding to home care) 1
Green stools, diarrhea 3
White vaginal discharge 2
Bleeding from mouth or rectum 2
Frequent bleeding from nose 1
Pain at urinating 1
Retention of urine (24 hours) 1
Injuries:
Fall, especially of young child 3
Blow on head, severe 3
Deep cut, needing stitches 3
Deep burn 3
Excessive bleeding 3
Wound of rusty instrument 2
Bite of animal 2

1. Notify doctor.
2. Call doctor.
3. Get doctor immediately; urgent.

When a child shows even slight symptoms of illness, isolate and
keep in bed for a day in a well-ventilated room. This avoids
changes of temperature, requires less work of heart and nerves,
removes pressure upon spinal nerves, and gives the body better
opportunity to combat the lowered vital condition.

Communicable Diseases to which Children are Especially Susceptible

Communicable diseases may be conveyed by discharges, especially
from nose and mouth, and in breath; also in vomitus, discharges
from eyes and ears, feces, urine, and blood. May be contagious
several days before serious symptoms appear in acute cases; and may
be carried in throat and mouth many months and conveyed by persons
showing no symptoms.

=To Prevent Contagion.= (1) Avoid exposing the child to any one who
has a contagious disease. (2) Do not take young children (under
seven, at least) into crowds, busy streets, city dust, or street
cars. (3) Household employees, especially child’s nurse, cook,
kitchen employee, or laundress, should be selected with regard
to their health; a thorough health examination for the child’s
caretaker, unless personally well known or professionally trained,
is the only safeguard. (4) No one with a cold, sore throat or other
symptoms of contagious disease should be with a young child or
prepare its food. (5) Keep special handkerchiefs for each child and
never use any one else’s for it. (6) Teach scrupulous individual
use of cups, spoons, forks, wash cloths, towels, handkerchiefs,
whistles, and not to use wash basin for brushing teeth. (7) Avoid
pacifiers; wipe toys daily. (8) Clean the child’s finger nails
daily, and always wash his hands before eating. (9) Attendant
should always wash hands before preparing food, giving medicine,
caring for eyes, nose, mouth, or wounds; and after care of diapers,
toilet, wounds. (10) Milk and water supply should be carefully
guarded; unless assured pure, milk must be pasteurized, water
boiled. (11) Avoid cats or dogs for young children’s pets.

Disease germs can thrive in the mucus, in some tissues, or in the
blood. They may enter (1) through the nose, (2) the mouth, (3)
a break in the skin. The sick person may convey them (1) from
the mouth, by coughing, by a kiss, or on cups, spoons, forks,
napkins, towels; (2) in mucus from the nose, in sneezing, or on
handkerchiefs; in discharges from eyes or ears; (3) in cases of
intestinal infections, from intestinal discharges; (4) venereal
disease, from break in skin, from open sore, from suppurating
infected eyes; (5) from discharge of boils; (6) scales from skin
probably only in smallpox or chicken-pox; (7) on fingers. (8) Germs
of contagious diseases are sometimes carried in water, ice, milk,
or dust. (9) Cats and dogs easily carry disease germs.

Contagious diseases are always dangerous, causing a large harvest
of deaths and leaving lifelong defects in many survivors. It is not
necessary that children should have any of them. Children should
be carefully protected from exposure to any disease. Good hygiene
raises vitality and increases the white blood corpuscles, which are
the special protectors against disease germs.

If a child has been exposed to dust or crowds, or if contagious
disease is prevalent, give a nasal douche and gargle with normal
salt solution, 4% boric solution, or diluted listerine, before
meals and at night. If exposed to disease, also disinfect face,
neck, hands, clothes, shampoo the hair with tincture green soap,
isolate, notify doctor; repeat after quarantine.

=Care of Illnesses Prevalent in Childhood.= _Anemia._ Pallor,
languor, loss of weight, poor appetite. Give outdoor life,
nutritious diet, cold baths, sun baths. Needs medical examination
for cause.

_Boils._ Indicate low resistance. Applying hot fomentations wet
in boric solution may prevent coming to head. If at head, apply
hot fomentation five minutes; lance with sterilized needle. After
removing contents, apply listerine, witch hazel or 25% alcohol, on
sterile gauze; anoint with zinc ointment, and bandage to prevent
re-infection. Poultices are unsanitary. Pus is infectious; prevent
its touching skin, burn immediately, and sterilize needle.

_Chap._ Prevent by drying face and hands thoroughly after washing.
Apply camphor ice or cold cream before taking outdoors, and at
bedtime. Use corn meal or oatmeal in place of soap.

_Cold._ May be either a congestion or an infection. In any case
isolate and treat first symptoms at once; give persistent care to
cure quickly. Colds pave the way for more serious infections. Give
oil laxative for one or two days. Apply few drops of glycerine,
albolene, or liquid vaseline in nose every two hours and at
bedtime. Use sterilized medicine dropper; warm oil slightly by
heating in dropper over boiling water. For children over one year
use nasal oil spray or nasal douche with physician’s prescription.
Give hot leg bath or hot tub bath, wrapping well to produce slight
perspiration; rub with 25% alcohol solution few hours later, or
before rising, to close pores; keep well covered. Keep in bed while
fever continues. If in head and eyes, apply cold cloth wet in weak
boric or salt solution, over eyes and nose, changing every five
minutes, in half-hour periods. Give all the water patient will
take, at hourly intervals, or lemonade for children over eighteen
months. For dry, parched mouth, rinse with weak salt water, give
weak lemonade, or cracker to chew.

If accompanied by chills, keep in warm room, (68°) well ventilated.
If without chills, and when fever has subsided, keep outdoors,
well protected, but not dressed warm enough to perspire. If in
chest, apply counter-irritant (adapted to age) to chest and back.
If not recovered in a day or two, notify physician. For repeated
colds, discover cause, improve hygiene; increase resistance by cold
morning bath, at least to chest and back, and give cod-liver oil.

_Colic._ Give no food during the attack. Give a teaspoon of water
(96° F.) with weak peppermint or soda mint dissolved in one ounce
water; repeat every five minutes. Upright position, with patting
on back, will relieve gas in stomach. For gas in intestine, massage
gently, beginning at lower left side, and working backward along
length of colon, always pressing and stroking toward end of colon.
If constipated, or attack very severe, give warm enema (110° F.)
with soap or normal salt solution. Apply hot fomentations, or hot
stupe, made by thoroughly mixing twenty drops of turpentine in
one pint water, to abdomen; or hot flannels or hot water bag, to
abdomen, buttocks, and thighs. Keep feet warm. Change fomentation
or stupe every ten minutes. When relieved, follow with cool hand
rub (80°). Constipation in nursing mother will cause colic. Baby
subject to colic should have two or three daily movements. Give
less at feeding, with longer intervals, slower feeding.

_Constipation._ Prevent and treat by diet, exercise, and general
hygiene. If these fail, have medical examination for possible
anatomical defect or obstruction. For acute attack, give mineral
oil, increase water, give abdominal exercises at intervals during
day, gently knead abdomen, working along line of colon from right
to left. The use of enemas and suppositories relaxes the intestinal
wall, and induces a chronic condition. Salts, castor oil, cascara,
and other drugs overstimulate intestinal secretions, irritate
lining, and require continued, increasing use. Calomel may remain
in system and cause serious illness; it should never be given to
children. If necessary to use any special measures, adapt laxative
from list (page 362). For chronic cases in older children, apply
cold compress around abdomen at night until condition is improved.

_Convulsions._ Give leg or tub bath at 98° F. for ten minutes;
mustard may be added. Be very careful that water is not too hot.
Child may be put in with clothing on. Put cold cloth around neck
and on head. Give prompt laxative and an emetic. Keep child in bed
till recovered from shock.

_Cramp in Intestines._ Treat as colic.

_Croup._ Apply hot fomentation to chest for ten minutes, followed
by cold compress. Give salt water emetic to cause vomiting and
remove phlegm, if breathing is still difficult. If necessary, in
severe case, give half teaspoon of syrup of ipecac to produce
vomiting; apply counter-irritant to chest and back. Keep child
well wrapped. If severe, prepare kettle of boiling water so child
can inhale steam. Add two tablespoonfuls of compound tincture of
benzoin, creosote or oil eucalyptus, or teaspoon of vinegar or
ammonia. Use light blanket to cover kettle and head of child. See
that kettle is not near enough to burn face. Be careful that child
does not choke, and that clothing is not dampened. Wrap a piece
of rubber sheeting or woolen blanket about shoulders, and remove
when through steaming. For mild cases, or when child is relieved,
place saucer with tincture of benzoin near child’s head, where
fumes will be inhaled. Treat as for cold, on following day, with
counter-irritants, and use menthol, oil nasal spray, or tincture
of benzoin for inhaling. For children subject to repeated attacks,
provide a special croup kettle.

_Cough._ Ascertain cause from physician and treat by his
prescription. Avoid cough syrups, which are dangerous for children.
Plain honey, figs, fig juice, are soothing. Use menthol inhaler.
Apply salve of menthol and vaseline in nose at night, and a cold
compress or mild counter-irritant on throat.

_Diarrhea._ Stop regular food. Give infants barley water, older
children only special dietary. Give prompt laxative. Keep in bed.
Call doctor promptly and save stools for his inspection.

_Earache._ Symptoms in infant include crying, and turning head
from side to side. Apply counter-irritant behind and below ears.
Place few drops of lukewarm phenol and olive oil mixture in ear, on
sterilized cotton. Apply hot flannel, hot-water bag, or other dry
heat.

_Eczema._ Apply salve or lotion, according to doctor’s direction.
Avoid water or vaseline on affected places, as these are
irritating. Keep clean with olive oil or cold cream. Give dietary
treatment.

_Eyes Inflamed._ Bathe hourly with 2% boric solution or weak salt
water. For cold in eyes, also apply vaseline at night and in
morning to lids, avoiding eyes.

_Headache._ Frequently due to constipation, indigestion, eyestrain,
excitement, fatigue, overheating. Ascertain and treat cause. Apply
cold cloths, changing every five minutes, or hot cloths, changing
every ten minutes, or alternate hot and cold, according to wishes
of patient, to forehead and back of neck. Apply menthol pencil
to forehead and base of brain. Massage back of neck, with strong
pressure downward and toward sides. Inhale menthol, mild camphor,
ammonia, or smelling salts.

_Hiccough._ Due to indigestion or overeating. Hold breath. Sip
water slowly while holding breath. Give small lump of sugar. If
severe and continued, induce sneezing or give emetic to remove
cause.

_Nausea._ Give soda mint tablet in glass of hot water. If not
relieved, give emetic. After vomiting, give glass of hot or cold
water hourly, mildly salted or with soda mint, for several hours.

_Poisoning._ Keep poisons out of children’s reach. Nick cork of
bottles containing poison, and tie red ribbon around neck. Keep
list of common poisons and antidotes posted on door of medicine
cabinet for ready reference.

_Prickly Heat._ Due to overheating from too much clothing or from
weather. Reduce quantity of clothing. Avoid wool next the skin.
Bathe several times a day with water 70°-80° F., adding one
teaspoon baking soda to a quart of water. Powder affected places
lightly with starch or baby powder (page 47).

_Rheumatism._ Found in all its forms in childhood. If chronic, may
permanently injure heart. Give mild laxative. Keep in bed. Apply
dry heat as directed to affected parts. Rub with alcohol (25%
solution), witch hazel, or arnica. Improve diet, reducing purins
and increasing alkali-forming foods. Electric treatments may be
beneficial.

_Sunburn._ Prevent by use of canopy, sunshade, or hat, and by
applying cold cream before taking out in sun or wind. To treat,
apply cloths wet in sweet cream, cold cream, almond lotion. Avoid
use of water on affected parts.

_Fever._ Keep in bed. Fever is not a disease but a symptom of
poison in system. Reduce temperature gradually. Give cool sponge
(75°-80° F.) with plain water, weak salt solution, or 25% alcohol
solution, for ten or fifteen minutes every hour. Keep cool collar
of wet cloth around neck, or on head, changing every five minutes.
In severe cases, also keep icebag at head, hot-water bag at feet.
Give abundance of cold water, cold fruit juice with little or no
sugar, or small quantity of ice cream. Keep room cool (60°-65° F.).
There is no danger of patient taking cold while temperature is
high, but special precautions must be taken, as fever diminishes,
to prevent chilling.

_Sore Throat._ Dissolve chlorate of potash tablet in half pint of
water, and give spoonful every half hour, holding in mouth as long
as possible. Gargle and rinse mouth with normal salt solution,
boric acid, or listerine, without swallowing. For mild cases, apply
cold compress to throat. For severe attack, use counter-irritant.

_Stomach._ Sour stomach or heartburn. Use soda mint tablet or
saltspoon of baking soda in glass of hot water. For stomach-ache
give same treatment, and massage by deep breathing and voluntary
pulling in and pushing out abdominal wall by muscular effort; use
mild trunk-bending and twisting exercises. If constipated, give
prompt laxative.

_Toothache._ Apply listerine or oil of cloves or wintergreen on
cotton to the cavity, and dry heat or counter-irritant outside,
until dentist can be seen.

_Worms._ Indicated by disturbed sleep, grating teeth in sleep,
picking at nose, poor or ravenous appetite, irritation at rectum.
May sometimes be visible as fine white threads in stools. Can be
accurately diagnosed only by microscopic examination. Avoid giving
medicine except on doctor’s prescription. Reduce candy and meat in
diet.

=Injuries.= Practice first aid until prepared to act promptly in
any ordinary emergency. Call physician in all but mildest cases, to
ascertain extent of injury, overcome shock, and prevent poisoning.
Disinfect hands before treating any wounds.

_Bruise, Bump, or Sprain._ Apply very cold or very hot water,
changing at proper intervals. Continue until swelling is reduced.

_Burns._ Never use flour or cotton on burns. Exclude air and
prevent infection from dirt or water. Burns are easily infected or
cause shock. For burns by dry heat, apply vaseline, baking soda,
carron oil, or olive oil, and wrap in sterilized gauze to exclude
air. For scalds, apply wet cloths of cool water (sterilized if
possible), with baking soda or boric acid. Exclude air and be
careful not to break blister. Treat blisters as burns.

If clothing is afire, smother by rolling on floor or wrapping in
heavy coverings. Prevent fumes and smoke from entering lungs. If
clothing is burned to skin, cut around it and soak off with olive
oil. For fire in room, close windows and doors, and attempt to
smother before using water. To go through smoke, put wet cloth over
mouth and nose.

_Cuts and Scratches._ Hold under running cool water to thoroughly
rinse out dirt. Wash with disinfectant. Take special care with
wounds from rusty instruments. Scratches may then be painted with
collodion, cuts covered with court plaster (do not moisten in
mouth) or surgeon’s plaster.

_Fall or Shock._ Lay flat. Apply cold water to head, hot-water bag
at heart and to feet. Cover warmly. Rub arms and legs toward heart,
without uncovering. Apply mild smelling salts, ammonia, or camphor
at nose. Never give alcohol without doctor’s order. Hot milk, tea,
or coffee are safe stimulants.

_Foreign Body in Ear._ Do not attempt to remove by poking. Put in
few drops of sweet oil, lay head down on that side, till doctor
comes.

_Foreign Body in Nose._ Do not attempt to remove by poking. Let
child blow nose, closing opposite nostril. Call doctor.

_Foreign Body in Throat._ If not easily removed with finger, hold
child by ankles, head downward, and slap on back. If swallowed,
give soft bread at once but do not give laxative. Remove fishbone
with fingers.

_Foreign Body in Eye._ Do not rub. Encourage crying. Blow nose. If
visible, remove with corner of clean handkerchief. If not visible,
pull upper lid over lower, and move gently. Wash eyes with boric or
salt solution. For injury, apply cold cloths wet in boric or salt
solution.

_Slivers._ Remove with a sterilized needle, wash with antiseptic
and bandage with zinc ointment or paint with collodion. Never use a
pin. If very difficult to remove, apply hot fomentations.

=Use of Water, Heat, and Light.= Heat, cold, water and light
are effective because of their action upon the distribution of
circulation, rate of metabolism, the local and reflex nerves,
the heart action, the chemical condition of the blood. Their
therapeutic use has only in recent years become a science.
Extensive study and experience is necessary for their efficient
application. A few fundamental principles will guide in their
ordinary use, but only a physician trained in hydrotherapy and
thermotherapy can give directions meeting every factor in an
individual case.

Applications affect not only the local part but also the parts
with which it is reflexly connected. The volume of blood can be
withdrawn from any part or to any part. The first effect of hot
applications is stimulating; continued for more than ten or fifteen
minutes (after the surface is reddened) is depressing. Cold is
first depressing; continued slightly is stimulating, and long
continued becomes depressing. Alternate heat and cold for three to
ten minutes is the most stimulating.

Pain, inflammation or increased secretion in any part usually
indicates local congestion of blood which needs to be withdrawn.
Congestion in the head, indicated by headache or cold; or in the
chest, indicated by chest cold; or in the abdomen or pelvic organs,
can be reduced either by a general distribution of blood to the
surface or by withdrawing the supply to the legs and feet. A hot
bath or pack draws the supply to the surface; a hot leg bath or
pack draws it to these extremities. The cool sponge following the
hot water keeps the blood in these parts, besides reducing the
temperature of the superheated surface and toning up the skin. Hot
fomentations draw the circulation to the surface, away from the
congested internal parts directly beneath or reflexly connected.
Thus, heat applied to the forehead and base of brain reduces head
congestion; or as fever is usually present, cold (50° F.) will have
the same effect and at the same time reduce the temperature, while
a hot-water bag at the feet will maintain the temperature if the
fever is mild or absent. Congestion in the abdomen or pelvic organs
is relieved by local applications of heat to these parts and to
their reflex areas—the buttocks, thighs, feet and hands.

In using heat or cold, the application must be changed whenever its
temperature approaches that of the body. Local hot applications
may be continued until the surface is reddened—from five to twenty
minutes. The surface is then sponged quickly with water, or 25%
alcohol, at 70°-80° F., to prevent superheating of tissues. Cold
general sponging in fever may be continued ten or fifteen minutes,
one part sponged and dried at a time, patient covered with a light
blanket; and repeated every hour. Local cold, as icebags or cold
cloths, may be continued half an hour, and repeated at half hourly
intervals. A cold compress is a mild counter-irritant. Water
reaches tissues below the surface, and for deep-seated disorders is
therefore more effective than dry applications, when practicable.
Care must be taken to protect hair, clothing and bedding from
dampness, by use of rubber cloth or oiled silk. For young children,
temperatures must be less severe and changes more gradual than with
adults. The nurse should test the heat of applications by applying
to her own face.

_Hot Tub Bath._ For chills, convulsions, incipient cold, general
depression without fever. If patient is constipated or had no
movement in preceding twelve hours, precede by enema, as hot water
increases absorption from intestinal tract. Give in warm room
(70° F.), at 100° F., or higher for children over four years.
One tablespoon mustard (in cheesecloth bag) per gallon of water
increases effect. Wrap cold cloth around neck, and protect hair.
Continue five to ten minutes, until skin is red, adding hot water
carefully to slightly raise temperature. Give quick hand rub with
water at 80° F. unless sweating is desired. Dry quickly, wrap and
cover warmly. Giving water to drink will increase perspiration.
After perspiring, rub with 25% alcohol.

_Hot Leg Bath._ For intestinal pain, headache, incipient cold, cold
feet, convulsions. Conditions and temperatures as for tub bath.
Keep patient well covered. Can be given with patient lying in bed,
water in bucket on chair at side of bed. Rinse with lukewarm water,
put on stockings, and keep hot-water bag at feet.

_Hot Fomentations._ To relieve local pain and congestion. Apply
one or two thicknesses of flannel to place; lay on this a double
flannel wrung out of boiling water, and cover with dry flannel
and waterproof. Be careful that it is not too hot at first. In
changing, prevent air striking part. Change every three minutes,
and continue twelve minutes. Sponge quickly with water 70°-80° F.

_Warm Tub Bath_ (90°-93° F.). For nervousness and irritability. May
continue, maintaining temperature, for half an hour.

_Dry Heat._ For chills, neuralgia, rheumatic pain, earache. Use
thermophore, hot-water bottle, hot flannel, salt, bran, hops,
soapstone, flatiron wrapped in flannel, or Japanese handstove. In
using hot-water bag, be careful it is not too hot; wrap in flannel,
and watch for leakage. Water should be below boiling or rubber will
be damaged. Press out air before putting in stopper. Remove when
cool. If electric pad is used, turn off current when hot. Continue
dry heat for half hour periods; sponge quickly with water 80° F.;
repeat at half hour intervals if necessary.

_Light._ Light rays penetrate about two inches below the surface,
and therefore continue the therapeutic effects of heat to the
deeper tissues. Systematic sun baths may be given. Carbon electric
light gives the same effect; it cannot be used to advantage,
however, with children under four or five years. For pain in
chest, sore throat, abdominal pain, may be used instead of hot
water or dry heat. Concentrate the light and protect the skin from
contact with bulb by a cone made of white paper. For earache, use
the smallest size bulb. Apply for fifteen or twenty minutes, until
redness is induced, then give quick cool sponge. May be repeated
several times during day.

_Cold Bath, Tub or Sponge._ For fever. Cool as patient can react
from, beginning at 85° and working lower. Give several times during
day, continuing ten to fifteen minutes. Add 25% alcohol for severe
cases.

_Cold Compress._ Useful as counter-irritant and stimulant in sore
throat, cough, croup, cold in chest, constipation. Wring cloth out
of cold water (50°); wrap on part; cover with flannel and with
oiled silk or rubber sheeting. Leave on overnight. For greater
effect, may be preceded by hot fomentation. For throat, apply from
ear to ear, bring up behind ears and hold in place by tapes over
head.

_Cold Cloths for Local Congestion in Head or Back._ Apply to
temples, throat, base of brain, and to spine. Change every ten
minutes, or sooner if warm. For severe congestion and pain,
alternate hot and cold cloths, changing as soon as warm.

=Feeding in Illness.= The food is a great factor in recovery
from illness, and should be regulated with much care. Do not
urge eating. Sick animals refrain from eating, or seek grass or
special herbs. Less food is needed when patient is in bed, except
in wasting diseases. In any illness give simple, easily digested
food, requiring minimum of chewing, providing much nourishment
with minimum of effort for patient. In disease, provide anti-toxic
diet, highly alkaline, with little or no purins, laxative (except
in intestinal disorders), dainty, small servings, served hot,
with variety from day to day. Note all symptoms and fit dietary
to all conditions present. It is an error to stuff a cold, but
rather it should be starved. Beef tea and meat broths contain very
little nourishment, but harmful extractives; their stimulation
is in part from extractives, in part from the salt and heat. Hot
milk, toast-water with butter, clear vegetable broths, provide the
stimulation, with a higher percentage of nourishment and minerals,
and with none of the disadvantages of meat broths.

_Colds._ Reduce food almost entirely for one or two days. Follow
general diet for illness, or as for constipation.

_Constipation._ (See page 171.) Increase oils, fruits, and fruit
juice, especially on rising and at bedtime. Oatmeal is laxative to
some children, constipating to others. Figs, prunes, and seedless
dates may be cooked together or made into a paste. Pecan nuts,
ground for children under five, may be used for sandwiches or with
fig paste. Use olive oil and lemon juice for salad. Serve eggs raw.
Avoid foods prescribed for diarrhea.

_Diarrhea._ Flour browned in oven lightly, then made into gruel,
cooking twenty minutes; season with salt. Milk boiled, bread
toasted; cornstarch pudding, blackberry juice, gelatine, buttermilk
made with yogurt tablets; especially avoid purins, cellulose, raw
milk, raw eggs, as well as laxative foods.

_Fever._ Moot question whether diet should be limited or increased.
Reduce proteins, omit purins; provide salads, highly alkaline
foods, as celery, spinach, baked potato, cantaloupe; allow
gelatine, fruit juices, strained vegetable purées, pure ice cream,
sherbets, yogurt buttermilk, whey, toast-water.

_Sore Throat._ Infection or from operation. Soft, soothing, healing
food. Gelatine, honey, dipped or milk toast, fig paste, date
butter, jellies, raw beaten egg, egg and milk, blanc mange, pure
ice cream. Avoid hard, strongly acid foods, or those requiring any
chewing.

_Wasting Diseases._ Increase diet to patient’s capacity, especially
milk, eggs, spinach, salads, fruits, butter, olive oil.

=The Sick Room.= Furnishing, care, and cleaning should be as for
nursery. For a contagious disease, disinfect room before and after
patient uses. Attendant should wear cotton dress. Street clothes
should not be allowed in sick room. Discretion should be used
regarding visitors; no one should enter in case of contagion. Use
separate bed linen and clothing for night and day. Turn pillows
frequently and change position of patient. Use ring of cotton cloth
to lift head and prevent bedsores. Reduce room temperature by
hanging up wet sheets. Open dishes of chloride of lime will absorb
dampness. Charcoal, occasionally changed, will absorb odors. Keep
all medicines, glasses, and food covered, room orderly and well
ventilated. In contagious diseases, attendant should disinfect
hands, gargle and rinse mouth with antiseptic before eating; and
before leaving the room, wash face and hands with weak bichloride
solution and remove dress, cap, and shoes; a cap should cover the
hair.

=Bathing and Dressing.= The sick child should usually have a bath
twice a day, temperature and method depending upon his condition.
This removal of waste will add to his comfort and hasten recovery.
A sponge bath is less fatiguing than the tub. A salt bath (one
third cup per gallon of water) is a tonic. It should not be used if
the skin is irritated. Bran, starch, or soda baths relieve chafing,
inflamed skin, prickly heat, irritation in eruptive diseases. To
one gallon water use half a cup of clean bran, tied in cheesecloth
and previously soaked; or a cup of ordinary raw laundry starch,
or a tablespoon of baking soda. Alcohol bath, using one fourth
alcohol, is cooling and hardening. Pure alcohol reduces heat too
rapidly. Oil rub with cocoa butter, or olive oil may be used for
cleansing in cold weather, for emaciation, or after bath in
eruptive diseases.

Rinse mouth and clean teeth after each feeding, using boric
solution, weak soda water, mild listerine or 1% menthol solution.
Disinfect brush in 70% alcohol after using. In contagious diseases,
or great weakness, use a mouth swab, and clean teeth with
antiseptic gauze on toothpick, instead of with brush.

=Maternal Nursing and Hygiene.= _Constipation._ Purgatives are
never to be used, and enemas employed only as a last resort. If
diet and exercise fail, cascara sagrada or compound licorice powder
may be used.

_Heartburn._ (Acidity of the stomach.) Sometimes develops. It may
be prevented by avoiding nervousness, by taking less fat at meals,
and drinking a glass of rich milk half an hour before mealtime;
if it develops after a meal, a soda mint tablet or a quarter of
a teaspoonful of soda bicarbonate will relieve it. The nausea
sometimes present in the first four months is probably due to
auto-intoxication from lack of elimination of toxins. Preventive
measures include careful attention to diet, daily baths, and
exercise. If it occurs, a cup of hot water slightly salted, or a
piece of dry, hard toast taken before rising, will usually overcome
it. Peppermint, acid from grape fruit, salty food, whole cloves
held in the mouth, or a cold cloth laid over the abdomen, are
relief measures. It is rarely present in the last four months.

_Varicose Veins._ May be prevented by avoiding fatigue, long
standing, and by lying down several times a day, especially after
meals, for a quarter hour, with feet elevated higher than hips.
Tight bandaging or elastic stockings must be used, if veins become
varicose; in severe cases, rest in bed is necessary.

_Hemorrhoids._ May be prevented by avoiding constipation, heavy
exercise, overfatigue, and by lying down a few minutes after a
movement. May be corrected by local applications, either of cold
or hot cloths.

_Pruritus._ Local applications of lukewarm bran water several times
a day, followed by dusting powder made by combining one teaspoon
salicylic acid with one cup cornstarch, will relieve itching.

_Hemorrhage._ Patient should be put to bed, hips and legs elevated,
with local applications of cold cloths or styptic cotton. Doctor
should be called immediately.

_Urine._ Decrease in quantity (less than one quart a day), high
color, odor, or sediment, should be reported at once to physician.

_Abdomen._ After fourth month anoint daily with cocoa butter or
vaseline to give elasticity to skin.

_Breasts._ During last two months wash morning and evening with
soap and warm water, drying thoroughly. Anoint at night with cocoa
butter, gently draw out nipple. In the morning apply 25% alcohol.

_Teeth._ Rinse mouth after each meal and at bedtime with milk of
magnesia or weak sodium bicarbonate solution, to neutralize acids.

_Childbirth._ Primitive women have only slight discomfort, because
of natural outdoor living and unrestricting clothing. Minimum of
pain requires well-developed pelvis, normal position of organs,
strong abdominal muscles, previous good hygiene, moderate-sized
baby, with normal presentation. Narrow, ill-shaped pelvis may
be caused by rickets, tight binders or diapers in infancy, or
to indoor life, long sitting, and tight clothing in girlhood,
especially from twelve to sixteen years. Abnormal position of
organs or of infant may be caused by tight clothing, heavy clothing
supported from the waist, incorrect posture, long hours of standing
during girlhood or womanhood. Weak abdominal muscles are due to
corsets and lack of exercise. Hygiene includes regularity and rest
at periods, freedom from excitation of the pelvic organs during
pregnancy and lactation, an interval of two or three years between
births, and a condition of reserve vitality at the beginning of
maternity. An overweight baby is produced by overfeeding and
lack of exercise during pregnancy. Abnormal presentation may be
corrected by skilful medical care during pregnancy. Osteopathic
treatment during pregnancy, by a skilful practitioner, may improve
muscle tone.

The physician should be selected with special care, either a
specialist or a general practitioner with an extensive successful
obstetrical practice; and the nurse likewise. The physician
should be consulted and the urine examined once a month until
the last two months, then fortnightly. This is necessary to
prevent toxemias, correct any abnormal position, and prepare for
any possible complications. Absolute surgical cleanliness by
physician and attendants is of the greatest importance at birth
and during confinement. Silver nitrate solution for the baby’s
eyes should not be neglected. If there are no probabilities of
complications, if the local physician is competent and can be
readily reached, and if the home can provide sterile conditions,
strong artificial light and quiet, the home is preferable for
confinement; otherwise the hospital is better. Midwives, unless
from accredited foreign training schools, with local licenses, and
of scrupulous cleanliness, are a dangerous investment; a competent
physician is preferable. With prenatal medical care, an experienced
physician, _and aseptic care_ during confinement, it is a very safe
experience. Thoroughly satisfactory anesthetics have not yet been
discovered. With attention to hygiene from infancy, natural means
will minimize pain.

Diet should be light during the first few days. Overfeeding may
cause constipation and poor milk. Rest in bed for two weeks, and
quiet life, with only light exercise, and chiefly out-of-doors,
for the succeeding month, is necessary for complete recovery of
the pelvic organs. A few weeks’ care and quiet at this time, even
though the mother feels strong, may prevent months or years of
invalidism. The physician should make examinations of both mother
and baby four weeks and six weeks after birth.

_Nursing._ The baby should be put to the breast six to twelve
hours after birth, when the mother has rested, and every six hours
for two days; thereafter, according to schedule. This should be
persisted in for ten days, at least, the milk sometimes not coming
for a week. This is as important for the recovery of the pelvic
organs of the mother as for the nourishment of the baby. The baby
should be given water between the feedings, but no food, unless on
the doctor’s order.

If the baby is unable to take the breast, through weakness or
some malformation of the mouth, the milk should be drawn out with
disinfected fingers or breast pump into a sterilized glass, and fed
through a sterilized medicine dropper, or after two months, with a
spoon.

If the nipples become sore or cracked, a glass breast shield with
rubber nipple should be used. This is to be boiled for five minutes
after using, and kept in saturated boric solution until needed.
If the breasts are heavy, congested, or tender, a knitted breast
binder should be worn, the breasts massaged from base toward the
center for ten minutes between nursings. If they become caked, hot
fomentations should also be applied for fifteen minutes before
massaging or nursing.

=Administering Medicine.= Use as little medicine as possible. When
prescribed, give exactly according to directions. Wipe mouth of
bottle and examine label carefully, before and after pouring. Use
clean spoon and disinfect after using. Remove cork with fingers,
not with teeth. Avoid getting irritating substances into eyes or
on tender, broken skin. Make a game of administering medicine and
keep the child amiable, if possible. When necessary, hold nose, and
put spoon back on base of tongue, to administer.

=The Nursery Apothecary Chest.= A few essentials should be kept at
hand in a cabinet, protected from dust.

2-ounce bottle each:
liquid vaseline
liquid albolene
glycerine
carron oil
turpentine
camphor
oil eucalyptus
oil Wintergreen
castor oil
tincture green soap
carbolic 5%
listerine

1-ounce bottle each:
peppermint
olive oil with 3% phenol
syrup ipecac
soda mint tablets
chlorate potash tablets
collodion

Tube or box:
zinc ointment
analgesic balm
vaseline
cocoa butter

½-pound each:
mustard
sodium bicarbonate
boracic acid

½-pint bottle each:
grain alcohol
olive oil
compound tincture benzoin
witch hazel

milk of magnesia
mineral oil

_Apparatus_:

medicine dropper, sterilized, kept in sterilized jar
clinical thermometer
menthol inhaler
nasal spray; nasal douche
thermophore or hot-water bag
bulb syringe
court plaster; surgeon’s plaster, small size; antiseptic gauze,
small size antiseptic cotton; styptic cotton
sterilized bandages; 18-inch flannel squares; oiled silk, paper napkins
safety pins, needles, tooth picks, handbrush, scissors

In case of infectious disease, lysol, creolin, or _fresh_ chloride
of lime will be needed.

_Emetics._ _Mild_: lukewarm water with teaspoon salt. _Stronger_:
tablespoon salt or teaspoon mustard in glass lukewarm water.
_Severe_: 10 to 20 drops syrup ipecac (fresh).

_Laxatives._ _Mild_: mineral oil, milk of magnesia, olive oil;
one teaspoon for babies, tablespoon at six years. For emergency,
castor oil, preferably in capsule, or between layers of orange or
grape juice. For immediate action, citrate of magnesia. For older
children or adults, compound licorice powder may be used. Laxative
oils should be given between meals; nutritive oils shortly after
meals.

_Antiseptics._ These hinder development of germs. For internal
use and on eyes, normal salt solution (1 teaspoon salt to 1 pint
water), 2% boric solution (1 teaspoon to quart water), listerine
50%. For external use, saturated boric solution (1 teaspoon to pint
water) listerine, 70% alcohol, witch hazel. Peroxide is uncertain.
Use tincture of green soap in warm water for washing infected
tissues. Use boiled or distilled water in making solutions. Put in
sterilized bottles.

_Disinfecting._ Hands: scrub with hot water and tincture of
green soap or lysol, clean and trim finger nails; for surgical
cleanliness, scrub through several waters, soak one minute in
70% alcohol, and dry on sterilized towel. Linen from infectious
patient: soak in solution of ½ ounce creolin to two gallons water
for twelve hours before removing to laundry; boil at once. Dishes
from infectious patient: burn food; put into covered kettle with
soap powder; immediately boil twenty minutes; or keep in patient’s
room; or use papier-maché and burn. Excreta from infectious patient
(urine, stools, vomitus): put with equal volume of a solution
made of equal parts saturated solution of chloride of lime and 2%
solution acetic acid or vinegar; let stand quarter hour before
disposing. Use tissue napkins, squares of cheesecloth or old linen
for nose and mouth discharges. Put these and soiled dressings into
paper bag and burn at once. Room: formaldehyde gas. Hot water and
soap suds, strong sunlight, and fresh air are disinfectants.

_Sterilizing._ Needle: dip in 70% alcohol, or hold in match flame
until red. Water: boil twenty minutes. Dishes: boil twenty minutes;
keep in water with vessel covered, or in boric solution, until
needed. Gauze, bandages: boil twenty minutes in saturated boric
solution or 2% carbolic. Let cool slightly in water, wring out with
disinfected hands or in sterilized towel. Or suspend in cheesecloth
hammock tied to handles of wash boiler. Cover tightly and steam,
with water boiling, thirty minutes. Press in sterile towel with hot
iron, leave wrapped, and keep in covered receptacle until needed.
Small squares for nursery use: cut and tack in bundles of five
before sterilizing, store in a sterile, covered jar, and remove
only as needed.

_Counter-irritants._ These draw the circulation to the surface,
relieving internal congestion; they have not the chemical or
metabolic effect of water and light. Mild: analgesic balm,
mentholated vaseline, cold compress. Mustard plaster is more
severe. Mix one part mustard and two parts flour, then bind
together with white of egg or _lukewarm_ water. Rub lard or
vaseline into skin before applying. Leave on five to ten minutes.
If necessary, repeat in six hours, using four parts flour.
Kerosene, capsicum vaseline, red pepper, are too severe for
children. Dry mustard may be rubbed behind ears for earache.
Blistering has no value.

Patent medicines are expensive and dangerous. Avoid them,
especially soothing syrups, cough or worm medicines, cold or
headache cures, tonics. Many of these contain forms of opium or
of coal tar products that affect the heart, and high per cent. of
alcohol, and are positively dangerous. Hygienic measures are safe
and more certain.

Choose a physician who favors hygienic treatment, and who knows how
to use physiological measures—diet, hydrotherapy, massage, open-air
treatment—with a minimum of drugs.

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The mothercraft manualChapter XX: Home Nursing and First Aid in the Nursery34

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