Part 28

One can of lye, 10 cents; Lump of ammonia, 5 “ Salts of tartar, 5 “

Put in a stone jar and set it in the open air. Pour over it 1 gallon of boiling water. Use ½ cupful to a boiler of clothes and add ½ bar of soap. Soak clothes over night in cold water; then place clothes into the boiler and boil for twenty minutes. Plain pieces need very little rubbing. Rinse two or three times in clear water before hanging clothes out to dry.

INCUBATION PERIOD AND QUARANTINE.

A constant period of incubation is not to be expected. In most instances, as will be seen from the following table, the difference between the maximum and the minimum period is not very great. It seems remarkable, however, that a disease should show such extremes as typhoid fever:

Normal. Maximum. Minimum. Variola 12 days. 14 days. 9 days. Varicella 14 “ 19 “ 13 “ Measles 10 “ 14 “ 4 “ Rubella 18 “ 21 “ 8 “ Scarlatina 2 “ 7 “ 1 day. Influenza 3 “ 5 “ 1 “ Diphtheria 2 “ 7 “ 2 days. Typhoid fever 12 “ 23 “ 5 “ Mumps 19 “ 25 “ 12 “

It is a peculiar fact that the diseases in which the period of incubation is shortest are those in which the infection persists the longest.

The period of quarantine must be guided largely by the period of incubation, hence the subject is an important one for a variety of reasons. The “Medical Magazine” (London) states that the period of quarantine should be at least a day longer than the maximum period of incubation for each disease. This is a very uncertain rule, however, for the patient should be free from all signs of illness, and especially from fever. The period of infection is very doubtful. It may be greatly prolonged by complications. This is especially true of small-pox, diphtheria, typhoid and scarlet fevers. The period during which a disease may be infectious cannot be stated definitely. It varies with different diseases, and must be determined according to the symptoms and character of the case. Measles, chicken-pox, and mumps lose the direct power of infection very early, and the infective principle does not remain active for a long period in the room in which the patient has been ill. Measles, mumps, and chicken-pox may be infectious in the earlier stages before becoming definite in character. Smallpox is not actually dangerous until the eruption appears.

THE CARE OF THE SKIN AND MOUTH IN FEVERS.

BY HARRIET HIGBEE, Graduate Illinois Training School for Nurses.

From the American Journal of Nursing.

The prevention and treatment of bed-sores have been and are frequently discussed in medical books and journals. But as it is a subject that often taxes the nurse’s ingenuity to the extreme, it can not be dwelt upon too frequently. Many preventive measures are familiar to us, as the soap and water bath for cleanliness, followed by rubbing with alcohol and dusting with boric-acid powder, or boric-acid powder and bismuth subnitrate in equal parts for dryness. The relief of pressure is most important. Make use of air-cushions, cotton-pads, pillows, water-bed and frequent change of position where that is possible. In addition to these, there are a few measures not generally used which after a thorough test have proved satisfactory. One is a simple inexpensive contrivance used to relieve pressure of heel, elbow, and ear. It is a pig’s bladder filled two-thirds full of either warm or cold water, as the case requires, tied securely, and placed under a cotton ring. The weight of the head or elbow rests on the ring and the tender point rests on the soft fluctuating mass. If the skin is inactive, as in paralysis, or there is frequent or constant moisture from perspiration or involuntary evacuations of urine or feces, the alcohol and boric acid, etc., are of very little value. They do not prevent the absorption of the moisture by the skin and its subsequent softness or excoriation, which is commonly followed by infection. In such cases the back should be washed with soap and water every six or eight hours, or after every involuntary evacuation, and thoroughly rubbed with a small amount of oil-substance, as camphorated oil or a mixture like the following:

Mutton tallow, ℥j; Olive oil, f℥j; Carbolic acid, 95 per cent., ♏︎j.

Render out mutton tallow on the back part of the stove; do not brown it. Strain through a piece of muslin; add the olive oil and carbolic acid; set dish into cold water and beat its contents until set. This will make an ointment the consistence of vaseline, and it will keep indefinitely. If the skin needs a great deal of stimulation, camphorated oil or, better still, castor oil may be substituted for the olive oil in the above recipe.

When the skin becomes excoriated the part should be cleansed as mentioned before, not with soap and water, but with boric-acid solution, normal salt solution, or sterile water; then gently painted with oxide of zinc ointment made into liquid form by the addition of olive oil, castor oil, and balsam of Peru in equal parts, or castor oil alone, and covered with a clean cloth fastened on with a binder. Gentle massage may be used around the excoriated surface with excellent results.

The =treatment of bed-sores= is usually directed by the physician; but if it is left to the nurse, she will find the following method helpful. If there is necrotic tissue or suppuration present, she may irrigate the cavity once daily with peroxid of hydrogen, one glass syringeful, followed by normal salt solution, boric-acid solution, or sterile water. Then apply a hot boric-acid dressing, one inch thick, every four hours until wound is clean. If the stimulation of the tissues is needed, fill the cavity with a sterile dressing saturated with balsam of Peru and castor oil, equal parts bovinine, castor oil, or camphorated oil alone. When the depression is filled with granulation tissue, it can be treated as an excoriation.

THE MOUTH.

The subject of the care of the mouth in fever nursing is equally as important as that of prevention of bed-sores. An unclean mouth is not only very unpleasant and often painful to the patient, but is a source of infection. The accumulation of food and mucus is a fertile field for the lodgement of bacteria. If this infected material is allowed to remain, it can easily spread to the middle ear and the mastoid cells, and cause abscesses or be carried by the food to the already overburdened alimentary tract to add to its infection. When the accumulation of sordes is profuse and persistent the patient’s mouth ought to be cleansed after every feeding. This may be done by wrapping a two-inch square piece of linen or gauze, saturated with the mouth-wash, around the little finger and wiping every portion of the cavity—not far enough on back of the tongue to provoke nausea. If it is necessary to clean the throat, a small swab may be employed. For thorough cleaning of the mouth several sponges are necessary. These may be received in a piece of paper and at once burned. While cleaning the mouth of a delirious patient the nurse for her own protection must place some hard substance between the patient’s teeth. A rubber cork is the best, but if that is not available, a fork-handle may be used. Its prongs must be carefully wrapped to avoid an accident. If the cork is used, the nurse must hold it in place to prevent its falling down the patient’s throat. There are numerous preparations used for cleaning the mouth, as:

1. Listerin, f℥j; Water, f℥ij.

Dobell’s Solution. 2. Borax, ʒss; Sodium bicarbonate, ʒiv; Listerin, fʒj; Carbolic acid, 95 per cent., ♏︎viij; Warm water, f℥x.

3. Boric-acid solution, f℥j; Alcohol, fʒss; Glycerin, fʒj; Tincture of myrrh, f♏︎j.

4. Glycerin, Water, of each, f℥ss.

The following three formulæ have been found excellent for special cases:

For Mucus-coated Mouth.

1. Sodium bicarbonate, gr. x; Glycerin, fʒij; Water, enough to make, f℥ij.

If the coating be of long standing, thick and dry, this solution may be applied with an applicator every five or ten minutes for one hour, and then the cleansing may be done with sponges. In these cases it is necessary to use a toothpick to gently loosen the sordes between the teeth.

For dry or fissured lips and tongue, and for anointing the baby’s nose, the following will be found useful:

2. Lanolin, Vaselin, of each, ℥j; Oil of gaultheria, ♏︎xxx. Apply small quantity several times daily.

In rare cases there is a persistent bleeding from the gums. The application, several times daily, of the following solution is effectual: