Rubber bags are made to contain ice, and these are made in different shapes to be adapted to different parts of the body. They should not be more than half filled, and as soon as the ice melts the supply must be renewed. The ice used should be finely broken; this may be done by wrapping it in a fine cloth and pounding it. If mixed with one-third saw dust the ice will keep longer. A fold of muslin should be interposed between the ice bag and the skin, and they should be kept in their place by a bandage or some other means. An ice bladder for application to the head can be kept from pressing on the head by being folded in a napkin, which may be attached to the pillow by a pin. A cup shaped sponge may answer in the place of the ice cap to contain the ice; this must be wrung out before it is saturated, so that the pillow may not become wet.
Collyria are best applied to the eye at the outer angle; a glass dropper or a camel’s hair pencil may be used—this same one should be used for nothing else. Draw down the lower lid, and tell the patient to look up at the same time that the drop of eyewater is slid in. Do not leave moist cloths bound upon the eye as they become hot and may do harm.
If you rub in liniment with your hand, wash the hand carefully before touching a sensitive spot, as some of the ingredients may cause smarting or other injury.
CHAPTER V.
DUTIES OF THE NURSE IN VARIOUS CIRCUMSTANCES, CONTAGION, DEATH, &C.
The fact that certain diseases are contagious is one that throws some grave responsibilities upon the nurse, and on account of the importance of the subject, I will here discuss it in the light of modern science.
Infectious diseases are supposed to be propagated by the agency of minute living parasites given off from the body of the sick and conveying the specific virus. The germ thereby includes this for the cause of all the zymotic diseases—diseases that are contagious and produced by some morbid principle or germs acting on the system like a ferment. They are claimed to be a vegetable growth of a fungoid nature, and the theory is that during the process or period of each—a period of growth like mildew—the victim is a sufferer from a more or less violent fever; that the period varies; in typhoid it is twenty-one days, in other forms of fever perhaps a shorter time, till the microscopic fungoid growth may be said to effloresce and shed its spores. Some diseases also that are not contagious are believed to be caused by organisms in the air. There are various kinds; monads, bacteria, vibriones, &c., are among the substances found in the atmosphere of a large city, and elsewhere.
A very great variety of these forms called fungoid growth have been seen and distinguished, and it is demonstrated clearly that certain forms cause certain diseases. For example, cholera or choleraic symptoms have been induced in animals by the introduction of the cholera bacillus into their intestines, and almost invariably the dead animals showed a great abundance of the characteristic bacillus in the intestinal tract. The diseases which are now known or believed to be caused by such virus are very numerous, and directions for preventing a disease from spreading are based upon this theory; epidemic and endemic diseases are generally attributed to such a cause. The list of germ diseases is about as extensive as the list of contagious diseases.
Epidemic diseases are those that act upon numbers of people at the same time. Probably there is generally, though not always, disease organisms diffused through the air.
Endemic diseases are confined to particular localities. Sporadic cases of disease are those occurring singly, or scattered considerably.
Disinfectants are such substances as act upon the specific germs or minute living particles to destroy them. Antiseptics are such as prevent decomposition or putrefaction.
Septic germs are generally destroyed when widely diffused in the air. It is believed that oxygen acts as a disinfectant, at least dry air is not favorable to their growth. A dry heat of 300 degrees will destroy them, and they are generally killed by a freezing temperature. Against communicable diseases the chlorine class of antiseptics including iodine, iodoform, bromine, and sulphur are the most effectual, and chlorine and sulphuric acid may without danger be used in the sick room to a sufficient extent to do some good.
The most rapid and powerful of the disinfectants is the solution of the bichloride of mercury (corrosive sublimate). The solution most commonly used is of the strength of fifteen grains to the quart. It can be applied directly to floors, beds, walls, sinks, drains, vessels, &c.
For clothing use a solution of common salt and sulphate of zinc, two ounces of the salt and four ounces of the sulphate to a gallon of hot water; soak the clothes in this and then boil them in water with borax, or soap or soda.
When a disease is known to be very contagious and dangerous, especial care is necessary to avoid contact on the part of patients and nurses with outsiders. All superfluous things must be taken out of the room before the patient is put into it, and care will be necessary continually to make the quarantine effectual. Every article carried out of the sick room must be disinfected; a set of dishes should be kept for the patient’s exclusive use, washed only by the nurse; the bedding, clothing, &c., must be washed by the nurses themselves, after being soaked in a disinfecting solution; dressings and other cloths, such as old cloths used for handkerchiefs, may be burned; all excrementitious and vomited matter must be disinfected; the broom that is used to sweep the room must not be used elsewhere; no current of air must be permitted to pass from the sick room to the rest of the house; and it is well also to hang about the room cloths wet with some disinfectant solution; hang over the doorway a sheet similarly disinfected; and the nurse should cover her head with a close cap.
Lest the confinement and isolation make the nurse sick she must take care of her own health. Two nurses should be employed for every such case, so that neither may be obliged to sleep in the same room with the patient, and each should change her clothes and go out of doors for a time every day and take a brisk walk in the open air.
The ventilation is of especial importance in contagious diseases, as no disinfection can render the air entirely pure. To prevent the infectious particles that are thrown off the skin in cases like small pox and scarlet fever, from polluting the air of the room, the clothes should be frequently changed, and the patient’s body be washed and anointed with some ointment.
Charcoal placed about the room in shallow vessels does some good by means of its property of absorbing gas; and solutions of carbolic acid, chloride of lime, soda, and zinc are germicides, but the chief use of the carbolic acid family is where suppuration is going on, to prevent the spread of septic infection. It is also a means of disinfection perhaps, if the spray is used in malarial disease. Condy’s fluid and sulphate of iron are used as antiseptics, but these stain clothing.
Chlorine should not be used with sulphuric acid, or carbolic acid.
Either copperas or chloride of lime may be thrown dry into water closets. A little disinfectant should be kept standing in all sputa cups, urinals, and bedpans, and in cases of typhoid, and cholera, the stools must be carefully disinfected. These diseases are not only directly infectious, but the germs in the discharges may multiply and spread the disease. Cover the bottom of receiving vessels for stools with copperas or chloride of lime, and after use add crude hydrochloric or sulphuric acids in quantity equal to half the bulk of the discharge. Cover closely and carry from the room, and empty into a trench prepared to receive them, at a distance from the water supply, and all clothing and bedding soiled by the discharges must be disinfected and boiled.
After a case is ended the room must be subjected to a cleaning and fumigation. Everything that can be so treated should be either boiled or subjected to a heat of 220° in a disinfecting oven. Rubber sheets and aprons may be cleaned with bichloride solution, and the floors, woodwork, and perhaps the walls should also be washed with a solution of bichloride of Mercury. While the room is being fumigated, drawers and closets should be open and things not thoroughly disinfected should be hung up in it. A good way to fumigate the room is to burn sulphur in it, but you may evolve chlorine from common salt in the following way: Mix an equal bulk of common salt and black oxide of manganese in a shallow earthen dish, add two pints of sulphuric acid previously diluted with two pints of water, and stir with a stick. It is best in using this to have also steam in the room.
To fumigate a room have the doors, windows, and fireplace closed, and paste paper carefully over the cracks. If sulphur is used put it in iron pans, allowing two pounds to every thousand cubic feet of space; set the pans on brick, so that they will not burn the floor; pour a little alcohol on the sulphur and ignite, then leave the room quickly so that you do not breathe the gas; paste up the door when you go out; keep it closed for twenty-four hours, then open all the windows and let the room air.
Those directing the disinfection should always remember the bleaching and corroding power of chlorine and sulphurous acid gas.
When a patient has died from any infectious disease the body should be washed in some disinfectant solution, or soap should be used containing bichloride of mercury, and a sheet should be wrapped around the body wet with the same. Saturate also a large wad of cotton with it and leave it under the hips. The burial should be soon and private in these cases.
OF THE NURSE’S DUTIES IN CARING FOR THE DYING AND DEAD.
Certain duties devolve upon the nurse in cases of DEATH from any disease, and I prefer to refer to those duties here.
Among the signs that indicate approaching dissolution are a peculiar sharpness of the features; coldness of the toes, fingers and nose; a dusky shade about the finger nails; cold perspiration, restlessness, and muscular twitchings or stupor. When you are sure that the end is near it is best that the friends should be informed. While there is slight grounds for hope do not give up all efforts, but do not disturb the dying by useless ministrations. Note the exact time at which death takes place; this is usually, though not always, obvious.
There may be a rise of temperature, and the body be quite warm a short time after death; this is produced by chemical changes, but after a short time its temperature corresponds with that of the room in which it is lying. Then the peculiar stiffening of the muscles called RIGOR MORTIS sets in which lasts for a time and then disappears. Before rigor mortis comes on prepare the body for burial by washing it (using a weak solution of chlorinated soda or carbolic acid), closing the eyes, arranging the lips naturally, and combing the hair. Bandage the jaws closely, stuff all the orifices of the body with absorbent cotton to prevent discharges, and bind a cloth around the hips. A clean night dress or shroud or any other clothing desired can be over this, then cover the face and all with a sheet.
The arrangements can be put in the hands of an undertaker, but it is quite likely the friends will wish you to superintend them. If the body is to be kept for several days it must be packed in ice, and after twenty-four hours the face has a more natural appearance. The dark discoloration of the skin observable a few hours after death on the neck and sides and more dependent parts, is caused not by mortification, but by the blood settling or gravitating downwards. Slight discolorations about the face can be made less conspicuous by dusting them with toilet powder.
After the body has been taken from the house, the bedding must be sent out to be disinfected, all the appliances of sickness removed, the room put in order, and the windows left wide open for several hours.
SOME GENERAL LESSONS IN NURSING.
Rule 1. Do not get out of temper, but try to make the sick chamber the pleasantest and yet the quietest room in the house. Do not appear anxious however great your anxiety.
2. Do not converse in whispers; invalids generally are suspicious and will imagine all sorts of things if they see their friends conversing in this manner.
3. Do not urge the invalid to eat and drink when she does not feel like it.
4. Do not ask a convalescent if she would like this or that to eat and drink, but prepare the delicacies and present them in a tempting way.
5. Do not allow the nauseating medicine bottles to stand in the sight of the patient.
6. Study all the peculiarities of your patients, and instead of opposing them by arguments or otherwise, humor them whenever they do not interfere with the physician’s orders or instructions.
7. In all cases keep everything that is used by the patient perfectly clean.
8. If the patient is not allowed to drink as much as she desires, give her the limited quantity instead of a full glass. If she is allowed to drain the glass she will probably be satisfied.
9. Do not allow flowers or plants to remain in the room over night, and always remove flowers from the sick chamber as soon as they become stale.
10. In all cases the patient should have baths so often that the skin is kept clean, and the pores are not stopped up.
11. Take care not to chill or fatigue a patient while bathing. A sponge bath can be given in bed, the bed being protected by an extra draw sheet.
12. The mouth should be often washed and the teeth brushed or wiped off with a soft cloth.
13. The hair should be combed at least once daily. The ladies’ hair is braided or twisted on top of the head so that she will not have to lie on a knot.
14. Do not light a sick room at night by means of a jet of gas burning low.
15. Preferably use sperm candles.
16. Do not have the temperature of the sick room much above 60°.
17. Do not allow offensive matters to remain; but in a case of emergency where these cannot be removed at once, you can wring a heavy cloth out of cold water and use as a cover, placing over this ordinary paper.
18. Do not neglect during the day to attend to necessaries for the night, that the rest of the patient and family be not disturbed.
19. To avoid making a noise by throwing coals on the fire, place it in paper bags and lay them on the fire.
20. Do not lean or sit upon the bed, if this is disagreeable to the patient.
21. Always remember that nothing which contributes to the welfare of those who require the nurse’s care, is too trivial to demand her attention.
22. The following may by some be called little matters, but attention to them will add materially to the well being of the sick: Refrain from constant enquiries of patients as to how they feel, for sick people are easily annoyed; anticipate the wants of your patient if possible; never tiptoe about the room; if the patient is very sick have the courage to tell the friends who call that the invalid cannot see friends, if able to see them their stay must not be prolonged; do not allow a patient to sit up in bed without covering the shoulders with some light wrap; support them properly with pillows, or a chair and pillows; when obliged to leave the room take something with you which is no longer needed, and bring back necessary articles, thus saving annoyance to the patient and labor to yourself.
23. To AVOID MISTAKES IN GIVING MEDICINE it is a good rule to always read the label before and after measuring the dose; no medicine should ever be given in the dark; tie a ribbon on bottles that contain remedies for external use; shake a bottle before opening it; do not leave a bottle uncorked; generally keep medicines in a dark closet which is cool as possible; have every medicine that is dangerous taken internally labeled “poison”; keep them under lock and key.
24. The nurse should know the ordinary doses of medicines and the symptoms of overdosing. Every unusual and inordinate action of a drug may be a good reason for omitting a dose or two till the physician is seen and new directions are given, otherwise be always regular and prompt in the administration of medicines.
25. But in general the nurse can best display her knowledge and exercise her skill by faithfully carrying out the instructions she has received from the physician. If the directions are not what she would expect, it may be an exceptional case; the doctor and not the nurse is the judge as to what is exceptional; she must obey his orders. Do not receive orders from the physician in silence, and when he is gone refuse to obey them. The nurse should never hide anything from the doctor, even if she has done wrong; it is a serious thing to think that life should be risked in order to conceal wrong doing. Never be afraid of troubling the doctor; he will always be glad to hear anything that will help in the diagnosis or treatment of the case. The nurse has much to do with an art whose end is the saving of human life; any neglect to act openly and intelligently becomes a crime.
26. Remember that kindness and tenderness as well as faithfulness are needful to successful nursing.
BEDSORES.
Every precaution should be taken by the nurse to avoid bedsores on her patient. These appear most frequently upon the hips, but may develop elsewhere in parts subjected to pressure. To harden the parts they must be frequently washed with soap and water and thoroughly dried. A draw sheet should be placed under the patient that can be changed as often as it becomes wet and damp. Be careful to keep the sheet free from wrinkles and inequalities, and the patient’s clothes must be kept smooth under her. Occasionally rub on the skin oil or vaseline, and then dust on some fine powder such as oxide of zinc, fine starch, or toilet powder.
Plasters that are entirely unirritating may be applied either before or after there is an evident sore, and if change of position is not possible, it may be necessary to obtain air cushions or a water bed.
An air mattrass or air cushions may be put on any bed, but a water bed must be put in a trough or wooden frame made of just the right size. The water in a bed of this kind should be of a temperature of 70° and renewed every two weeks. To prevent a water bed from sticking to the boards some old cloths must be interposed.
Reddening and roughening of the skin, and pain on pressure indicate an approaching bedsore before there is an abrasion of the skin. Those washes that cause smarting must be discontinued, and sulphate of zinc ointment, and unirritating plasters used.
If a part is dead and likely to slough off, apply charcoal or yeast or chlorinated poultices until the gangrenous parts can be removed. After the separation of the slough you can apply lint smeared over with carbolated cosmoline or whatever application the surgeon or doctor may direct. The sore must be washed and applications renewed each day, and at each time it may be covered with a piece of oiled silk or muslin, or rubber tissue confined in place by adhesive straps.
BATHS.
The SPONGE BATH or washing can be done partly under the bed clothes, and but a small part of the body need to be exposed at a time. Do not bathe immediately after a meal.
Always have a bath of the temperature directed by the doctor. The following terms are used to indicate different temperatures:
| BATH. | WATER. | VAPOR. | AIR. |
|---|---|---|---|
| Cold, | 32° to 65° Fahr. | ||
| Cool, | 65 to 75 | ||
| Temperate, | 75 to 85 | ||
| Tepid, | 85 to 92 | 90° to 100° | 96° to 106° |
| Warm, | 92 to 98 | 100 to 115 | 106 to 120 |
| Hot, | 98 to 112 | 115 to 140 | 120 to 180 |
To put a feeble patient in a bath wrap her in a sheet and lower her gently down in it. When she is taken out wrap her in a warm dry sheet and over this fold a blanket. After a few minutes’ rest and a little wiping with a soft dry towel the clothes may be put on.
Do not give a cold bath when the patient feels chilly, when there is perspiration, or there is inflammation or congestion of an internal organ.
The temperature of the body may be lessened by means of the wet pack in cold water, or by means of a sheet wrung out of cold water wrapped around the patient, and changed every ten or fifteen minutes, or by applying towels from the neck downwards, wrung out of cold water.
For the wet pack the sheet may be wrung out of either hot or cold water. Spread a comforter and two blankets on the bed and over these a sheet wrung out of the water. Remove all the patient’s clothing, lay her in the middle of the sheet, then draw over one side after another of the blankets and comforter, wrapping her from the neck to ankles; apply something to the feet to keep them warm, give plenty of drink, and put a wet compress on the forehead. If this is intended to induce perspiration or repose, the patient may remain in the pack two or three hours.
A BLANKET BATH is used as a means of sweating. A blanket is wrung out of hot water and wrapped around the patient. She is to be packed in three or four dry blankets and allowed to rest quietly for thirty minutes. Then the surface of the body must be well rubbed with warm towels, and the patient made comfortable in bed.
Cold or tepid sponging is sometimes directed when there is a fever. Commence at the head and sponge downwards, then wrap in a blanket and leave her undisturbed for an hour or more.
The effect of the HOT BATH if long continued is to induce languor and weakness. Watch by the patient while she is in the water, and take her out if there is any sign of fainting. Do not give a hot bath during a menstrual period.
A hot foot bath is one of the best means of revulsion to relieve the head. Let the water come nearly to the knees, cover both the patient and tub with a blanket, keep the feet in the hot water for about twenty minutes.
If a HOT AIR BATH or a VAPOR BATH is given, some device should be used to keep the blankets from pressing upon the patient. Two half hoops may be tied together so that they answer the purpose. By the same means steam may be diffused around her, if hot bricks wrapped in wet flannel and put on dishes are placed in the bed beside her, or steam can be conducted from a boiling teakettle under the blankets. Or place the patient in a large cane seated chair, and surround both completely with blankets, letting them extend to the floor and be secured about the patient’s neck. Under the chair, place a basin of hot water with an alcohol lamp beneath it; bring the water to boiling, and the patient will soon be in a perspiration which may be carried to any extent.
For a BRAN BATH, boil two pounds of bran in a gallon of water and add to the bath.
For a SALT BATH, add one pound rock salt to every four gallons of water.
For a SULPHUR BATH, add twenty grains sulphuret of potassium to a gallon of water. Used for skin diseases and rheumatism.
In cases where there is a high fever, especially in children, the warm water bath is given to reduce the temperature. If a child that has a temperature of 104° is immersed in water heated only to 98° for fifteen or twenty minutes, it will part with some of its heat.
BATHING OF INFANTS.
The bath for very young infants should be quite warm—about 97°. Some nurses ascertain if it is an agreeable warmth by dipping an elbow in the water. The temperature may from week to week be lowered gradually to 85° or 80°. Two baths a day may be given. The evening bath should be warmer than the morning. A brisk, gentle rubbing after the bath is beneficial. If a child gets blue and shivers the bath is too cold. The warm bath will often serve to put a restless and feverish child to sleep.
To bathe an infant support its head on your hand and arm, dip the baby into the bath; then rub the whole surface of the skin rapidly with a soft sponge or piece of flannel soaped; next again immerse the body in the water, then quickly and thoroughly dry with a fine warm towel.
Before giving a bath have every thing likely to be needed at hand, and the room warm.
CHANGING CLOTHING.
Before raising up a patient to put on a chemise or night dress, pull up the soiled one towards the neck, and as soon as the head and shoulders are raised, the soiled garment can be slipped off over the head and a clean one put on; then pull this down smoothly under the back before laying the patient down.
If two garments are worn one can be slipped inside the other, and they can be slipped on as one.
CHAPTER VI.
SURGICAL NURSING.
Before I dwell particularly upon surgical cases and wounds of all kinds, I will refer to some general duties of the nurse who attends during a surgical operation.
Generally the patient to be operated on should have a bath the previous night, and perhaps an enema on the morning of the operation; if the operation is on the female genital organs a warm douche should be given.
Prepare the room by having it well cleaned and aired and of a temperature of about 85°. Such things as are likely to be needed; for example, vaseline, carbolic acid, basins, sponges, towels, scissors, needles, pins, ice, hot and cold water, should be provided. If you have to make bandages, an old cotton sheet is good material from which to tear the strips. To join the strips lay two ends flat on each other overlapping for an inch, and baste together all four sides. A roller bandage may be from two to twelve yards long; it must be rolled as tightly as possible; the selvage and all loose threads must be trimmed off.
The proper cleaning and preparing of sponges is important. If one has been used it should be well washed and left in a solution of sal soda, and then kept for several days in a five per cent. solution of carbolic acid. New sponges should be prepared with twice as much care.
In a case where there is to be an operation upon the female genitals, a T bandage may be required; this should be put on before the ether is given, at least the part above the hips, the other part may be left free till after the operation, to be then brought between the thighs and attached to the other in front.
Only a little light food should be taken for three or four hours before etherization. Prepare the patient for going to the room by having her hair combed and braided, artificial teeth must be taken out, and all tight bands loosened. Arrange the clothing so that it will be protected, and so that it can be changed afterwards easily. See that she passes the urine the last thing before taking her place for the operation.
Have a bed ready that is properly made and protected, to which she can be moved when the doctors allow it, and where she can be kept quiet. If there is nausea and vomiting, the effects of the ether, you may quiet it by letting her sip a little hot water or by putting a hot, dry cloth on her neck and chest. During the operation you had simply to wait on the surgeon, now the patient will be principally in your care.
You will receive instruction from the surgeon in regard to things needing peculiar watchfulness and every point must be carefully noted.
As the wound may need to be watched during the first twenty-four hours for hemorrhage, it must be so arranged that it can be looked at without waking the patient.
The danger to which surgical cases are liable are, 1. Shock; 2. Hemorrhage; 3. Erysipelas; 4. Pyemia; 5. Tetanus. If there is TRAUMATIC ERYSIPELAS the edges of the wound are red and swollen, the secretion of pus ceases, and by the next day the skin around the wound becomes of a peculiar red color. There will be fever, headache, nausea, and a coated tongue.
Erysipelas can be generated by inattention to sanitary laws. It is infectious and spread by fomites, and the virus of erysipelas may give rise to puerperal fever. It is not proper for a nurse that has had the care of a case of erysipelas, to soon be the nurse of a lying-in woman, even if she is careful about using disinfectants on her hands and changing her clothes.
Certain influences augment the susceptibility of the body to the agency of the poison. Among the influences are intemperance, low spirits, anxiety, insufficient nourishment, and foul air. There should be great care in regard to ventilation, and clearing and cleaning the room where it has been present.
The disease cannot be cut short by active remedies, but may be made to terminate favorably by the use of the perchloride of iron, &c. (F. 177.)
Tetanus (lockjaw) may follow slight wounds. At first the muscles of the jaw are rigid, but the rigidity or spasms may extend all over the body. It may result from exposure of the wound to cold, and some cases of tetanus in infants have been attributed to the funis, in instances where as much as three or four inches were left attached to the umbilicus. In a case of tetanus the patient should lie in a darkened room, and noise should also be excluded.
Incised wounds, made in the flesh by sharp cutting instruments, of course may be trivial cuts, or deep incisions, and may sometimes be treated by the nurse, either because they are slight injuries or because a surgeon cannot immediately be obtained.
If there is not much bleeding there will not be very much to do. It is well to have a little carbolic acid in the water with which it is washed. The bleeding will soon cease if only small vessels are divided. If there is any extraneous matter on the surface of the wound it must be removed. Then put the surface of the lips of the cuts together, and take measures to keep them in this state till they have become firmly healed. If sutures are necessary take one or more stitches. The most common method of keeping the surface of divided parts in contact is by strips of adhesive plaster. Apply them after having put the wounded parts in a position favorable for bringing the edges of the wound together, then while one holds the lips of the wound evenly together secure them in this position by strips of adhesive plaster applied across the line of the wound. Leave a little interspace between each two strips of plaster. It is not best to bind it up so that there is no passage or exit for blood. But slight wounds may become serious if some poison or virus gets into it; you may need to put on lint or a compress over the strips of plaster and then a roller or bandage.
But some incised wounds instead of being immediately dressed and bound up, demand that immediate attention should be paid to the hemorrhage. We may usually know whether the bleeding is arterial, venous or capillary. If the wound is open, blood from an artery will spurt out in jets and is of a bright red color. Unless the artery is very small a surgeon will be needed, but you may be required to act very promptly to suppress for a time a dangerous flow of blood. If a large artery is cut or punctured the hemorrhage may be fatal in a short time. The application of heat or cold, and the elevation of the part injured, may suffice in slight cases, but in these severe cases other means are necessary.
First endeavor to arrest the rapid flow of blood by pressure upon the wounded artery with your thumb. Then if the wound is in a limb let some one tie a handkerchief loosely around the limb, and if you know the course of the artery have the knot directly over it and between the heart and the wound. Then put a stick in under and twist the handkerchief so that it is tight enough to compress the artery. The hemorrhage can thus be checked until the surgeon arrives. If the wound is over a bone in the head or body, the bleeding may probably be checked by binding on a hard compress where the artery is cut, thus making direct pressure upon it. A ligature upon a limb ought not to remain very tight more than an hour.
If the hemorrhage is from a leg below the knee it may be checked by putting a firm roll of cotton in the flexed joint, and pressing the lower part of the leg against the thigh; this will compress the artery.
Contused wounds are not often attended with serious hemorrhage. If there is in the bruised part only slight subcutaneous laceration, nature may soon repair the injury. But if there is considerable contusion indicated by the ecchymosis where small blood vessels have been lacerated and the blood extravasated into celular tissue, causing the dark discolored spots and other evidences of severe injury, there will be subsequent inflammation, perhaps suppuration, demanding treatment. A proper mode of dressing at first is to bind on a compress saturated with a four per cent. solution of carbolic acid, and for the fever and inflammation one drop doses of ext. veratrum may be given.
But in all cases where wounds are severe the services of a physician will be required.
A PUNCTURED WOUND signifies one made with a sharp pointed instrument, the external opening being small compared to its depth. It is a good rule in these cases to leave a free vent for any discharge that may be set up. The danger in these cases is from serious injury to the deep seated parts, and from suppuration which may burrow and extend still deeper if there is not free exit for the pus.
One mode of treating POISONED punctural wounds (serpent bites, &c.), which of course are peculiarly dangerous, is by applying cups over the wound.
Any wound that suppurates much or sloughs causes a cavity to be filled up, and the process by which the wounds and sores heal is called granulation, and cicitrization. The wound is gradually filled up to the surrounding level by new tissue appearing in the form of small red granules bathed in pus. Healthy granulations on an exposed or flat surface rise nearly even with the surrounding skin, and often a little higher, but when they are much higher, and take on a growing action, they are what is called proud flesh. Their growth may be checked by the application of active astringents; nitrate of silver or burnt alum may be used, or adhesive straps may be applied. The skin with which it is covered when healed is formed from the surrounding skin, and the process which is called CICITRIZATION does not go on well except when the granulations are nearly level with the adjacent skin. The centre of a sore has power to form new skin when there is a particle of live skin there, and for this reason skin is sometimes grafted in.
A patient suffering from a suppurating wound becomes enfeebled from the discharge of pus, and should have his strength kept up by nourishing food. A surgeon will always endeavor to prevent the retention and decomposition of discharges, and to protect from external contamination. He will direct the time and means of dressing the wounds, but the nurse must remember that decomposed animal matter acts as a virulent poison introduced into the system as it may be through any abrasion of the skin. All instruments used about a wound must be thoroughly cleansed before being put away. Dressings which have been next the wound should be burned; those which are to be washed should be disinfected. Avoid soiling your own hands with discharges; protect with a bit of plaster every place where there is any cut, or scratch, or sore. If you fear that any virus has got in where there is any sore, or where the skin is broken, touch it with carbolic acid.
FRACTURES AND DISLOCATIONS.
One of the signs of a FRACTURE is crepitus, the sound made by the rubbing of the ends of broken bones together. This sound cannot always be obtained, even when the bone can be moved so that the ends rub each other, and as such motion causes considerable pain the nurse should not seek for it, except as she harkens when the limb is accidentally or necessarily moved. The separation and inequalities of the ends of the fracture (when the bones are superficial), the change in the form of the limb, and the shortening of it, are circumstances communicating information in very many cases, and the diagnosis is made pretty certain if there is unnatural mobility of the limb. In other cases there is loss of motion or immobility, swelling and pain in the injured part, &c., but it will possibly require the services of the skillful surgeon to detect the existence and character of a fracture; and generally the coaptation or setting of the bone, can be deferred until he arrives. The nurse can do something in the meantime—can have the patient and fractured limb put in as easy a position as possible; perhaps have something ready for bandages and splints. A splint may be made of anything that will hold the bone securely in place; it should be longer than the bone that is broken. Sole leather is sometimes used; cut the required size, softened in hot water, moulded to fit the part and left on until dry, when it will be of the desired shape. Plaster of Paris bandages are sometimes used. These are prepared by rubbing into the ordinary muslin rollers dry plaster. They are then rolled. When they are applied, soft flannel bandages are first put on the broken limb, then the one containing plaster is (after being dipped in water, and some of the water squeezed out), applied over the flannel. It takes ten or twelve hours for this to set and become hard, and the broken limb must be kept still during the time. Dust the part over with toilet powder before the bandage is applied. The success of the surgeon depends very much on the good constant care of the nurse. If it is necessary to move the limb keep up some extension on it and do not twist it. Be very careful that the directions of the surgeon are carried out, and it will probably be necessary to keep up extension all the time, otherwise the deformity may return and the limb be shortened.
Dislocations are not so easily reduced as fractures, but after the setting and reduction of a dislocated joint the action of the muscles tends to keep it in place. There is always some laceration of the ligaments and sufficient injury to the soft parts to excite a little inflammation, but the pain is relieved as soon as the bones are replaced.
In general recent dislocations are easily reduced, but when the head of a bone has been out of its place for several days the reduction becomes exceedingly difficult, and as a rule the difficulty of reduction arising from the muscles is proportioned to the length of time that has elapsed from the period of the accident. For this reason a person who has a little general knowledge on the subject of dislocations, should sometimes make an attempt at reduction immediately after the accident.
The signs of dislocations are pain, incapacity of motion in the limb, change in the length of the limb and in the direction of its axis. Sometimes the dislocated limb is nearly incapable of any motion, and sometimes the destruction of the means of union, allows the limb to obey any extraneous influence.
The replacing of the dislocation would require very little effort or force were it not for the resistance of the muscles and tendons attached to them. In reducing a luxated bone the main point is to apply force until the head of the bone dislocated can be slipped into its place, which is generally when it is nearly to a level with its socket. This is easily effected immediately after the accident, because at that time the resistance of the muscles is not great; it may be best to attempt it, but there should be no delay in sending for a surgeon.
I recommend that an attempt be made to set a DISLOCATED THUMB or FINGER by making extension on the lower member and at the same time pressing the head of the bone towards its natural situation. If the reduction is effected, the thumb or finger should be rolled with tape and surrounded and supported with pasteboard; and the hand and forearm put in a sling. A surgeon may be necessary even in a case of dislocated thumb or finger, but bones out of joint are so much more easily set at first, that it is best to attempt to set them then, and the same may be said of some larger bones.
For instance, if there is a DISLOCATION OF THE ELBOW, the patient being settled, let one man take hold of his arm near the shoulder, to make counter extension while another makes extension at the wrist. You yourself being seated grasp the elbow with your two hands by applying your fingers to the anterior part and your thumbs to the posterior, press on the projecting point of bone downwards and forwards. You will generally be successful, but I do not advise five minutes’ delay in sending for a surgeon. I only advise that an effort be made immediately.
After thus reducing a dislocation of the forearm backwards at the elbow, apply a bandage in the form of a figure of eight; apply some lotion or liniment, and keep the arm in a sling. At the end of seven or eight days when the inflammation has subsided, the articulation can be gently moved, and the motion may be increased every day.
The figure of eight bandage is a roller applied alternately above and below a joint, the roll being carried obliquely over a central point.
The art of putting on a roller bandage is an important one for a nurse to acquire, and I may here give a few general principles though no exact directions can be given. In applying a bandage care must be taken that it is put on tight enough to fulfil the object in view, without running any risk of stopping the circulation. A bandage must lie smoothly, without wrinkles, and making an even pressure. For bandaging an arm or leg a roller from two to three inches wide may be used; a few turns may first be given on the hand or foot, and after this every circle is to be applied so as to ascend up the limb in a gradual spiral form and cover about one-third of the turn of the roller immediately below it. To accommodate it to the shape of the limb reverses are made. The bandage is doubled back by placing a finger on the lower edge to hold it firmly, and turning the bandage downward over itself, at such an angle as properly shapes its direction, and these turns can be made as often as is necessary.