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Milk soaked over cereals or bread, especially whole wheat bread or its toast, or bran, then strained, is valuable and ap¬petizing. So also is milk diluted according to taste or needs with thin oatmeal gruel, or barley or rice water or gruel.
Parched sweet corn, ground in a coffee mill or otherwise crushed and then soaked in milk, imparts a delightful flavor and some nourishing elements. Root vegetables may be made into a thin puree and added in small amounts to milk. ” Lemon or lime juice may be slowly stirred into milk until curds form. This mixture is easily digested because the curdling is already accomplished—as with other soured milks.
Ovaltine, malt products, malted milk, dry milk, condensed and evaporated milk and numerous other products may be used, either part of the time with additional milk, or to change the flavor and digestibility of sweet milk in certain cases. It should not be forgotten, however, that no milk preparation can surpass ordinary fresh milk, or freshly soured or cultured milk. Many people who cannot take milk at body tempera¬ture, or slightly cool, can take it with relish and digest it sat¬isfactorily when given hot. Occasionally when warm milk is distasteful, cold (not iced) milk is appetizing.
It will be seen from the above that until one has tried nu¬merous ways of preparing or altering its taste and nature, a patient cannot say that he cannot take milk. If it is indicated in the patient’s condition, the chances are that it can be modified, by some of the methods mentioned, so it may be taken with satisfaction and benefit.
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The milk diet (described in detail in Volume II) prob¬ably will be given to the majority of patients after a period of fasting or other preparatory diet. But often patients can¬not take milk without modification. Diverse variations are possible. The milk ma}- be diluted with plain water, or with a small amount of lime water. Soda and vichy are often added, also, but we do not approve of either of these. When there is constipation, or an acid condition of the stomach, or a gastric ulcer, a teaspoonful of milk of magnesia may be added to each glass of milk. Predigested milk (peptonized) may be used. Rarely is it permissible to add a little salt to the milk. Removal of the cream frequently makes milk more digestible, without interfering appreciably with its nourishing qualities.
Buttermilk can be taken by many people who cannot take sweet milk; but there are other forms of sour milk which are also highly beneficial. Creamery buttermilk is the same as soured milk, except that most dairies or milk companies use their own culture of souring germs, thus imparting charac¬teristic flavors. Acidophilus and Bulgarian buttermilk are beneficial and appetizing. Bernarr Macfadden’s “sumik will take the place of either of these when they are not obtain¬able. This is merely milk allowed to sour in an air-tight vessel until a solid curd is formed, then whipped to a creamy consistency.
Kumyss, Matsoon, Zoolak and other specially cultured milks may be used similarly, but some of these are decidedly acid and will not appeal to the majority of patients. All these so-called fermented milks are not only good food but aid in correcting and preventing intestinal putrefaction. Whey, the watery portion of milk after separation of the casein, is ex-cellent when milk disagrees, or when protein is to be omitted from the diet or used in only small amounts. In whey are the sugar and the mineral elements and some of the vitamins. It is easily digested and has a slightly acid taste.
The patient should be raised on pillows to a comfortable, suitable height and position, but the head should not be pressed too far forward. The shoulders should be well covered, but the arms free. The tray may be on a towel on the bed, or on a small table beside it. A good way is for the nurse to sit facing a’ table near the head of the bed, her feeding arm next to the patient. A napkin should be under the patient’s chin. There should appear to be no haste on the part of the nurse, else the patient’s digestion may be disturbed. The food is carried to the mouth slowly, carefully, then placed on the tongue, not merely to the lips.
Hot soups and broths should be given in small amounts at first until it is found that the temperature is correct. It should not be necessary to say that they should not be cooled by blow¬ing upon them. Raise the spoon carefully so the fluid will not run down the mouth corners. Solid foods should be cut in small pieces and given slowly. Semi-solid and soft foods should be given by spoon.
If the patient can drink fluids they may be given in a glass (two-thirds full), or by an invalid’s nursing cup (a spouted and partially covered cup), or through a glass tube from a glass or a cup. Even a clean rubber tube, with glass end for the mouth, may be used, or soda straws, if other conveniences are not available. A bent glass tube is best when the patient must recline while drinking. The cup or glass containing the fluid should be placed in the curve of the patient’s arm in this csse, to be easily reached. If the helpless patient is given fluid from a glass, the head should be raised by reaching one hand under the pillow rather than under the head. A special tray with legs for use in bed is best when the patient can feed himself.
SPECIAL FOODS.—It might be well here to give a few sug¬gestions regarding special foods often given to patients under varying conditions. The volume devoted to Foods and Diet covers in the main all the foods that will ever be required in building, maintaining and recovering health, but some sim¬ple modifications will be given here that may be useful in time of sickness.
The treatment of a bedsore is the same as that for any other similar sore or wound. Simple removal of the pressure will do considerable, but more than this may be necessary. Usually the physician will take charge of the treatment. When the sores are on the hips or the lower end of the spine special care is necessary to prevent fecal matter or urine from coming in contact with them and possibly infecting them.
One should not forget that a person continually confined to a chair may also develop pressure sores. In fact, it is sometimes necessary to keep a patient ordinarily spending hours daily in a chair in bed until there has been complete or considerable healing of sores about the buttocks. From resting upon the arms of the chair the elbows likewise may develop sores, and if the chair back is not comfortably padded such - sores may develop on the shoulder-blades. All these are bet¬ter prevented than corrected, by suitable rings or other pad¬ding. In any case, air-pillows and rings give great comfort to the patient.
FEEDING THE PATIENT.—The helpless and semi-helpless patient will have to be fed by the nurse. The nature of the food, the quantity and frequency of feeding cannot be taken up here. It will all depend upon the patient’s condition. Here merely the method of giving the food will be discussed.
Hot-water bottles partly filled with air make good pillows for small areas, though an open ring is better. The latter is almost necessary for the back, especially the lower end. If the position on the ring (which shouid be only partly filled with air) is uncomfortable, the body may be supported else¬where with pillows, as a pillow under the small of the back when the ring is at the end of the spine. Rubber rings and cushions should be slipped into pillow-cases. Cotton rings are serviceable when the air-cushions are not obtainable.
They should be carefully made and covered with bandages, then perhaps slipped into a pillow-case, though not necessarily. In making these rings the cotton (cotton batting being cheap and satisfactory) should be rolled into a suitable ring and then wrapped about several times with gauze, leaving a hole in the center so the finished ring resembles in shape a doughnut or a life-preserver. These are so inexpensive that they may be renewed often. Rings may also be made of strong material and partly filled with bran or fine sawdust. If filled full they are uncomfortable.
When bedsores are developing there is usually a sligbt burning or stinging of the part, especially when alcohol is rubbed over itThis indicates that the skin is nearly broken. When breaking occurs the use of alcohol should be discon¬tinued and oxide of zinc ointment or stearate of zinc powder applied instead. Bathing in fairly cool salt water is also excellent to strengthen the skin, even though temporarily it may cause smarting. Immediately remove all pressure from the part, and do any rubbing toward the affected area, not away from it, as the latter will have a tendency to tear the skin if it is weak.
It is a wise precaution to ask the patient occasionally if he experiences any stinging during the alcohol rub or at other -times, lest he be one of the stoics who think it is the duty of a sick person to put up with pain or discomfort. If the parts subjected to pressure are bathed with cool water twice a day and then dried thoroughly and rubbed well with a little oil, bedsores, except in some abnormal cases, will usually be pre¬vented. Rubbing with alcohol after this treatment is beneficial also, because of the “toughening” influence of the alcohol. So also is salt used in the bath that precedes the oil rub.
Talcum applied after the treatment will be of additional value.
. At the least suggestion of redness of any part exposed to pressure, before the patient himself makes any complaint of burning or stinging at such points, remove the pressure from the part. The simplest way to do this is to turn the patient. If this cannot be done it will be necessary to use cushions, or rings of rubber or cotton, or air-pillows, or an air- or a water-mattress. Pillows or cotton rings must be made to fit about so no pressure will come upon the part but all upon the normal tissue surrounding it.
Always in giving external heat to a patient it is important to avoid a too high degree. Often the patient’s sensation is dulled, sometimes completely lost; and often the condition of the skin, circulation and other tissues and functions are decidedly defective or the patient may be unconscious. In these cases the patient cannot determine what is a suitable temperature and sometimes a seemingly suitable one causes some degree of disturbance. Blistering of the patient is inexcusable and may lead to more or less serious consequences.
A fomentation wringer is good to have at hand in case fomentations are required. One may be made by taking a piece of coarse toweling about eighteen inches long, making a two-inch hem at each end, then running a thin round stick somewhat longer than the towel is wide through each hem. The fomentation is placed on the toweling and wrung by twisting the sticks in opposite directions. Another excellent wringer may be made by tacking circularly around the end of a round stick a piece of heavy ticking or duck, then similarly attaching the other end to another stick, having the duck or ticking between the sticks at least a foot long. The fomenta¬tion cloths are placed in the opening in the wringer cloth and the sticks turned in opposite directions. If nothing better is available, a towel may be used as a wringer, without the sticks.
Many people believe in the efficacy of the turpentine stupe as a counterirritant. The turpentine itself has no medicinal effect when used in this way, but it does increase the effect of a fomentation upon the skin. If its use is desired, apply as follows: Have the fomentation material ready, also a tea-spoonful of turpentine mixed with two teaspoonfuls of olive oil. Stir this mixture and apply with gauze or cotton to the part to be treated, then apply the fomentation in the ordinary manner.
BEDSORES.—When a patient is confined to bed for a con¬siderable time, especially if helpless or poorly nourished, sores are likely to develop upon those parts exposed to pressure.
These pressure sores are usually called bedsores. Paralytics, if confined to bed, are almost certain to develop them. The usual locations are the lower end of the spine, shoulder-blades, elbows, inner surfaces of the knees, ankles, heels, toes and the back of the neck. Bedsores are difficult to heal, because of the continuation of the conditions that bring them on. Hence in caring for the bedfast patient efforts should be made to prevent these developments if possible—and it usually is.
flexed. Lower the top covers to the feet, covering the patient with sheet or bath
blanket. Raise the hips and place the douche-pan beneath, putting a folded bath towel on the back edge of the pan to make it more comfortable. The bag containing the solution should be secured twenty to twenty-four inches above the patient. The external parts should be washed if there is any discharge.
The hands now should be well washed with hot water and soap, rinsed and dried on a thoroughly clean towel. The sterile, lubricated nozzle is held over the douche^pan and the water allowed to flow gently until the nozzle is warm. Hold the nozzle near the external parts, then insert it into the vagina, somewhat downward and backward, about four inches and allow the water to flow in a slow steady stream. Turn the nozzle round and round so that all parts of the vagina will be cleansed.
Remove the tube before the solution is entirely exhausted, first closing the stop-cock. Leave the patient on the pan for a few moments, then dry the vulva with cotton or gauze. Re-move the pan carefully so as not to spill any of the contents, dry the patient’s back, pull down the gown, draw up the covers, arrange the pillows and let her rest.
FOMENTATIONS, COMPRESSES, PACKS, ETC.—In the section on Water and Health (Vol. VI, Sec. 2.) are directions for ap¬plying these treatments. There is practically no difference in applying them to a -bedfast patient, as they have to be given in any case with the patient recumbent. In all cases care must be taken to make as little exposure of the patient as possible, usu¬ally all parts but those to which the application is made being covered with sheet or blanket or entire upper bedclothes. In summer, or when the room temperature is at summer heat, and with a member of the family, there need not be the extreme care to keep the patient fully covered, or to prevent all ex¬posure of the body, that should be taken under other condi¬tions.
THE VAGIXAX DOUCHE.—The purpose of this is to cleanse the surface of the vagina, or to apply heat internally. The ordinary fountain-syringe outfit or the porcelain irrigation (enema) can will be required; also a douche-pan or bedpan, sheet, towels and the solution to be injected. The nozzle should be the hard-rubber or glass, longer than the enema nozzle and with holes in the sides. It should be sterilized by a proper solution of lysol or other antiseptic. From two to eight quarts of water are used, according to need and purpose, usually at 105 to 110 or 112 degrees F., also depending upon the need and purpose. Nothing but plain boiled water (cooled to the required temperature), or salt or boracic-acid solution, should be used, unless especially prescribed by the physician.
SPECIAL CAKE OF FEMALE PATIENTS.—During illness, even when the menstruation ordinarily is normal, there is often an aggravation of the symptoms of the illness during men¬struation. Depression is common and the appetite is usually less keen or further reduced if it has been deficient. If the appetite is diminished or finicky, reduce the diet and give mainly the blood-cleansing and alkalinizing vegetables and fruits. If the bowels are not functioning normally (and most likely they will not be), give neutral enemas daily. There need be no omission of the daily general bath; but if this has been at any temperature other than neutral or tepid, or barely below the body temperature, it would be better to give it at one of these temperatures. The hot or the cold or decidedly cool bath during menstruation in bedfast illness may cause chilling or other more or less disagreeable symptoms.
The patient should be kept quiet and free from worry. Glare from windows or lights should be especially prevented at this time and the patient should not be permitted to do much reading. If it does not have any tendency to produce headaches, a little reading may be permitted. But since read¬ing takes energy it is not advisable for a bedfast patient, unless chronically ill, to do any appreciable amount of it; else there will be retardation of progress. During convalescence the amount of reading permitted may increase according to the gain being made.
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