Part 26

Note the exact amount and character of nourishment taken, and the time it was given; also the amount, time of administration, and effect of medicines and stimulants.

Cleanse the mouth and teeth frequently with some antiseptic wash, such as listerine, 1 part; water, 3 parts.

Bed-sores can nearly always be prevented by keeping the patient and bedding perfectly clean, the skin absolutely dry, and the bed-linen smooth. Changes of position are also important. Parts subjected to pressure and soiling should be washed at least twice daily with soap and water, thoroughly dried, gently rubbed with alcohol, and then dusted with a powder like the following:

Boric acid, 1 part; Starch, 1 “ Zinc oxid, 1 “

If the skin be reddened and tender it may be painted with collodion and then dusted. When the part cannot be kept dry, it should be smeared with zinc ointment and powdered. In very prolonged cases it usually becomes necessary to use water- or air-pillows or water- or air-beds.

To disinfect the feces and urine, use a solution of chlorinated soda (Labarraque’s solution). Cover the urine and feces with the solution and leave the contents stand for an hour. Cleanse pan thoroughly and pour into it the Labarraque solution.

PNEUMONIA.

Pneumonia is a general infection, excited by a special organism—the pneumococcus—and manifested by a local inflammatory process in the lung and severe systemic disturbances.

Exposure to cold and lowered vitality from overwork, alcoholism, or some previous disease render persons liable to infection.

=Symptoms.=—These consist in a decided chill, pain in the side, fever rising rapidly to 104°-105° F., and lasting for five, seven, nine, or eleven days, and then rapidly falling; cough; tenacious bloody expectoration, shortness of breath, delirium and stupor, and physical signs indicating a solid condition of the affected lung.

In fatal cases death usually results from exhaustion, the result of the systemic poisoning, but occasionally it is due to a failure of the heart to propel the blood through the solid lung, to suffocation, or a complication, such as inflammation of the covering of the heart (pericarditis) or lining of the heart (endocarditis).

=Management.=—The room should be well ventilated, but free from drafts. The temperature should be maintained between 65° and 70° F. Cool water should be given freely. The points mentioned in connection with temperature, respiration, and pulse in dealing with typhoid fever are applicable here. Note the frequency of cough, the amount and character of expectoration, and whether the latter is raised readily or with difficulty. Note the occurrence of pain and its location; also amount of sleep, amount of nourishment, amount of urine, number of stools, etc., and the effect of sponging, of medicines, and of local applications. Clean the mouth and teeth at intervals, being extremely careful, however, in all manipulations not to tire or exhaust the patient.

SCARLET FEVER.

Scarlet fever is an acute, highly contagious disease characterized by a sudden onset with chill, vomiting, or convulsions; a high fever of from a week to ten days’ duration; a very rapid pulse; severe sore throat; a bright red rash, appearing on the second day, lasting about a week, and followed by desquamation and a marked tendency to nephritis.

The most serious complications are nephritis, suppurative inflammation of the middle ear (otitis media), inflammation of the endocardium or pericardium, and pneumonia.

Scarlet fever, while contagious at all periods, is probably most so during the period of desquamation. The organism may cling to furniture, clothing, etc., and reproduce the disease after very long periods. The contagion may be carried by persons coming in contact with the sick, or the disease may be transmitted through the air of the sick-room or through clothing, utensils, etc., which have been used by the sick.

=Prevention of contagion= consists in isolating the patient; in disinfecting everything that has been in contact with him; in anointing the patient’s body with an antiseptic oil until desquamation is complete; and in thoroughly disinfecting the room after the patient’s removal.

=Management.=—Have the patient, if possible, in a large, airy room, preferably at the top of the house. Keep the temperature uniform and the room well ventilated. Wear a loose wrapper and cap, and leave these inside the room when obliged to leave it.

With cloths moistened with a 3 per cent. solution of carbolic acid wipe the floor, furniture, sills, door-knobs, mantelpiece, etc., once a day, but never dust or sweep. Thoroughly disinfect the secretions of the patient and all articles used by him before they leave the room.

Allow the patient no food except what has been ordered, which will usually be milk, koumiss, junket, fruit-juices, and gruels. Encourage the patient to drink water freely. Apply to the body, at least once a day, a bland ointment. Note temperature, respiration, pulse, stools, quantity of nourishment, sleep, and effect of baths and medicine as in typhoid fever. Note especially the quantity and appearance of the urine, and have a sample in a clean bottle ready each day for the physician’s examination.

Keep the nose and throat clean with mild antiseptic sprays or washes. Relieve pain in the throat, unless otherwise directed, with ice-poultices or hot-water compresses.

MEASLES.

Measles is an acute contagious disease characterized by moderate fever of about a week’s duration; by an eruption on the skin, appearing on the third or fourth day as small red spots that soon coalesce into crescentic blotches, remain three or four days, and then disappear with a branny desquamation; and by catarrhal symptoms involving the eyes, nose, and bronchial tubes (conjunctivitis, coryza, and bronchitis). The most common complications of the disease are catarrhal pneumonia, inflammation of the gastro-intestinal tract, and inflammation of the middle ear.

=Management.=—The preventive measures described in connection with scarlet fever are applicable in measles. The room should be maintained at a temperature of 70° F., and should be moderately darkened. The bed should be so arranged that the face will be directed away from the light. Milk, broths, and gruels are suitable forms of nourishment. The temperature, pulse, respiration, hours of sleep, quantity of nourishment, amount of urine, and the effects of therapeutic measures should be carefully noted as in other fevers. Daily inunctions of the body with cold cream or olive oil are useful. Spraying the nose and throat with a mild antiseptic solution, and washing the eyes with boric acid solution (15 grains to the ounce of water) are usually ordered. Hot baths and hot drinks are indicated when the rash is delayed. Fever is generally controlled by sponging. Great care is necessary during convalescence to avert complications.

DIPHTHERIA.

Diphtheria is an acute contagious disease characterized by moderate fever of an irregular type, and of from one to two weeks’ duration; by considerable weakness and prostration; and by the formation of a grayish or whitish false membrane upon the throat, nose, larynx, and adjacent parts. The exciting cause of disease is the bacillus of diphtheria, which is found chiefly in secretions of the affected mucous membrane. The constitutional symptoms are due to the absorption of a toxin produced by this bacillus.

Diphtheria involving the larynx is sometimes termed true croup or pseudomembranous croup. This form is characterized by irregular fever, hoarseness of the voice, croupy cough, and progressive difficulty in breathing. Death frequently results from suffocation, unless tracheotomy or intubation of the larynx be performed.

The chief =complications= of diphtheria are pneumonia, degeneration of the heart-muscle, inflammation of the middle ear, and paralysis the result of an inflammation of the nerves.