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Hippocrates had a better understanding of the effects and value of massage than many physicians today. He said: “The physician must be experienced in many things, but assuredly also in anatripsis, the art of rubbing up; for things that have the same name have not always the same effects. For rubbing can bind a joint that is too loose and loosen a joint that is too rigid. Rubbing can bind and loosen; can make flesh and cause parts to waste. Hard rubbing binds; soft rubbing loosens unuch rubbing causes”parts~to waster moderate rubbing makes them grow.”
Some things that grown or fairly mature patients may do while convalescing may be mentioned here. Games for two, such as dominoes, checkers and various card games, especially cribbage, are excellent if not too exciting. Solitaire may be played by the patient himself part of the time. “Cut-out” and other puzzles may be worked with. If he has a collection of snapshot pictures these may be put into an album and cap-tioned; or a scrap book may be filled with any material of interest. Drawing and coloring or painting; wood or leather carving; whittling blocks and wood for little cottages, log cabins, bird-houses, or toys; clay modeling; tatting, knitting, crocheting, basket-weaving, picture framing; making calen¬dars or small lamp-shades, trimming hats, making ribbon flow¬ers or articles from crepe paper or sealing wax, etc., etc.—all these are excellent.
Working with potted flowers, watering and light weeding, planting seeds and other light work will be possible later, also perhaps light bench work for men patients. The interest must be maintained, while always guarding against fatigue. Ten¬sion during any pastime must not be allowed; the work must be changed, or, if necessary, rest must be insisted upon.
Walking should be encouraged, within safe limits, for the benefit of the exercise, fresh air, sunlight and the mental diversion provided by a change of scene. Automobiling is excellent, also, but must not be long continued or tiresome, or without adequate protection against wind and cold. Special cushions will often be necessary at first. If walking is per¬mitted at all, the patient may be allowed out of the car for a while somewhere along the way for rest through change of position and for the exercise. More strenuous activities will come later, their nature and amount depending upon the prog¬ress, sex, age and natural strength of the individual.
NURSING CHILDREN.—The hygiene and care of infants and children are discussed in Volume IV (Sees. 4 and 5.), so need not be considered here. It should be kept in mind that the conditions of life during infancy and childhood are differ¬ent from those of adults or persons close to maturity and some features of nursing will need to be changed for the immature patients. Except in one’s immediate family, a nurse who may prove satisfactory for adults may not be at all suited for the care of children. In some measure, the present high mortality of infants and small children is doubtless due to poor nursing. When the nurse is the mother she is tempted to yield to the desire to give children things they should not have, or to take them in her arms, possibly to rock and weary them.
Don’t stay in the room all the time. Don’t remain in the room all the time the doctor is there unless he requests it. Don’t allow visitors to remain in the room during a doctor’s visit. Don’t fail to have things all ready before starting any treatment or change of bedding. Don’t expose or move the patient more than necessary during any treatment. Don’t walk about unnecessarily; step outside for your exercise. Don’t walk with a heavy tread; wear rubber heels, never leather or wood. Don’t rock in a rocking-chair.
Don’t stare at a patient while sitting doing nothing else. Don’t rattle newspapers or magazines or slop-jar lids, or other things capable of making irritating noises. Don’t wake the patient for food or treatment. Don’t touch any part of your face after contact with the patient until your hands are washed. Don’t forget that observation of symptoms, espe¬cially in acute disease, is important if treatment is to be prop¬erly adapted by the nurse or the physician. Don’t do anything without considering its possible or probable immediate or ul¬timate effect upon the patient. Don’t become careless during convalescence. Don’t forget to do as you would be done by were you in the patient’s place.
Do’s IN NUKSING.—It is impossible to enumerate all the things that one must do in nursing. But many mean the dif¬ference between the comfort and satisfaction of the patient, on the one hand, and discomfort and dissatisfaction, on the other. Among these may be mentioned the following:
Keep the patient clean. Keep the bedding clean. Keep the surroundings clean. Change body and bed linen often enough so the patient will feel fresh. Smooth out the bedding often. Change the position of a helpless patient frequently. Place a pillow under the knees or use a foot-rest part of the time to ease tension of the back and at the back of the legs. Supply a foot-stool when the patient sits in a chair. Place a small pillow at the small of the back occasionally when the patient lies flat on the back. Keep the patient comfortable as to temperature—amply covered and the room comfortably warm, but neither in excess. Keep the bedclothes loose over the feet. Adjust pillows frequently, turning them and fresh¬ening them. Keep the room quiet. Keep the light adjusted according to the patient’s needs. Darken the room for an hour’s rest daily. Give all treatments carefully, but quickly and confidently and with as little fuss and muss as possible. Serve the food regularly if the patient is being fed and make it attractive. Keep pieces of old linen for expectoration, burning them after use. Keep the room well aired.
Leave the patient alone at times. Be cheerful and opti¬mistic. Know when to do nothing. Know as far as possible, without a call from the patient, that a thing is necessary— in other words, study the patient’s needs. Keep the patient free from depressing news or information, of the world in general and of things and conditions about the home. In case of quarantine, even though it may be inconvenient and seem¬ingly unnecessary, observe the regulations. Certainly no harm can come from it.
DON’TS IN NURSING.—Don’t become impatient. Don’t forget that tact is necessary in the sick-room. Don’t consideras too arduous any task which can contribute to the comfort or ultimate good of the patient. Don’t talk too much. Don’t talk about the patient’s illness. Don’t fail to tell the patient he or she is looking better when such is the case—and some¬times when it isn’t. Don’t hurry, thereby irritating the patient, and don’t hurry the patient. Don’t forget that the mind greatly influences the body; hence don’t fail to cheer the patient when he is especially downcast and often even when he is feeling well.
THE MEDICINE CHEST.—It is not expected that the physi¬cal culturist will have a typical “medicine” chest, for there will be no giving of medicines during illness. The first-aid kit or closet may contain simple remedies for local application. To these may be added a few others. Or there may be some special place for these additional preparations and articles. The following articles and preparations, the uses for which will be readily understood, may be kept on hand: Olive oil, vaseline, boracic acid (powder and fresh solution), Baume analgesique (to rub on for pain), baking soda (bicarbonate of soda), mustard powder, lime-water, packages of sterile cotton and gauze, sterile gauze bandages (one- and two-inch widths), adhesive plaster, rolls of old flannel and linen, oiled silk or rubber tissue, fountain -syringe bag or enamel irrigat¬ing can, tips and tubing for syringing, hot-water bag, ice-bagsor ice-cap, measuring glass, eye-cup, medicine dropper, nasal douche, nebulizer, sprayer and so forth.
MEASURES.—A teaspoonful is approximately one dram; a tablespoon approximately half an ounce; one ordinary glass eight ounces; two ordinary glassfuls one pint
For those who want the additional safeguard of fumiga¬tion, the best method is as follows: Pour seven ounces of fresh potassium permanganate crystals into a deep galvanized pail and pour over these one pint of 40 per cent, solution of formaldehyde diluted slightly with two ounces of hot water. Within about a quarter of a minute there will begin a “boil¬ing,” and soon a dense column of formaldehyde gas will be given off. Before this treatment is started, all openings, cracks and crevices (including the keyholes) through which air may enter or the gas escape must be sealed, paper se¬cured with flour paste being excellent for the purpose. The quantities mentioned are for each 1,000 cubic feet of room space (10 by 10 by 10 feet). The room should remain closed and sealed for twelve hours.
The treatment must be given just as mentioned, or there will not be satisfactory disinfection. It will be better if the deep pail is placed in the center of a large wash-tub; other¬wise several thicknesses of newspapers covering an area of three or four feet square should be placed under the pail. Any bubbling over of the fluid upon the floor will make stains that are not removable. The room should be thoroughly aired for several hours, preferably for a day and a night, before being used again.
DISINFECTING A ROOM.—It was formerly a matter of rou¬tine to disinfect, by fumigation, the rooms that had been oc¬cupied by patients having some form of communicable dis¬ease. It is now generally considered that such treatment is of little value. These diseases are most dangerous (most easily communicated to others) long before the period when fumiga- tion can be used. The room itself, with the clothes and other cloth materials in it, dust, books and other objects which the patient has handled, need be given little consideration.
With such things as dishes and the immediate bedclothes of the patient the case is different. The dishes should be boiled after each use and kept separately from those used by others in the household. The bedding and clothing of the patient (after such diseases as diphtheria, scarlet fever, meningitis, smallpox, tuberculosis, typhoid fever and poliomyelitis or infantile paralysis) should be thoroughly disinfected by boil¬ing. The pillows and mattress likewise should be disinfected; but as this is sometimes difficult, many physicians insist upon their being burned. Thorough airing and sunning, for several days, however, should make them safe.
As they progress in convalescence, children may be en¬couraged to do, or be assisted in doing many things. Cutting paper dolls, fitting their dresses, and making furniture for them out of paper and cardboard; making other cardboard, toys; making things out of paper; dressing regular dolls and sewing and knitting for them; modeling clay; coloring pictures with crayons; drawing with crayons and pencil, making scrap-books of pictures, advertisements, postcards, stamps, jokes, poetiy, etc.; stringing beads and making things of beads; plait¬ing, weaving.and making knots; putting picture puzzles to- gether and working other puzzles; playing children’s card games; working with flowers; studying flowers, trees, birds; working in little gardens, out of doors or at the window; play¬ing with mechanical toys; making some sort of collection, such as of stones, shells, leaves; blowing soap-bubbles; sailing boats or floating toys in a basin or a tub of water; etc., etc. Later, as the little patients progress and grow stronger, walking, play¬ing in a sand-pile, riding and other outdoor amusements and activities will be taken up.
STERILIZATION.—By sterilization is meant making an ob¬ject free from germs. This subject is taken up briefly under Relation of Sanitation and Hygiene to Health (Vol. I. Sec. 6.)
When a child is over the gravest or most serious part of its illness and is on the mend, it may be allowed to play with small toys. But the crib or the bed should not be loaded with playthings. It is better to give but one at a time and let the interest be exhausted in that before giving another, changing, perhaps, several times at each playtime. Children find more amusement in simple toys, or in something from which they can “make something,” than from expensive, elaborate play¬things. If they are old enough, let them have cardboard, paper, scissors and paste. It is often better to leave the child to himself and his own devices for a good share of the time than to try all the time to amuse him.
In reading to children select stories that are not too excit¬ing, long or tedious. Something that is quietly amusing or entertaining and suitable to the child’s state of mental devel¬opment is best. There should be no attempt to teach during illness; the object of reading and story-telling is to entertain. Children easily tire of another’s reading and, for that matter, of anything that is long continued. If the child does his own reading, be especially careful that the light is arranged at the back, or back and side; that it is not glaring; that the print is of good size; that the child is in good position and holding the book properly, or resting it properly upon an adjustable reading board; and do not allow long reading periods or ex¬citing stories.
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