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CARE OF THE SICK.
For the system of the latter requires every possible assistance to regain its natural condition ; indeed, medicines and nursing are of no avail if the patient is compelled to breathe the emanations from his own diseased body, and thus to keep up a continual supply of material injurious to the system.
No odors of any kind should ever be perceptible in the sick room ; their presence is evidence that the ventilation is imperfect.
Care must, of course, be taken not to injure the patient by chilling him while providing for a proper supply of fresh air. By fresh air, we mean not air which has passed through other rooms, but air admitted directly from the outside. If there be a fire-place in the room, a draught of air sufficient for most purposes of ventilation can be secured by lowering the sash of a window a few inches from the top, and by keeping a fire burning in the grate.
The temperature is another point of importance in the care of the sick room. There is generally such an anxiety to avoid chilling the patient, that the room is kept at a very high temperature. It should be remembered that there is most danger of taking cold when the room is heated to an improper degree, since under such circumstances, the admission of air from the outside, even during the opening and closing of the door, causes a decided impression upon the patient, which may be sufficient to chill him.
The temperature of the room should, as a general thing, be somewhat higher in the morning than in the afternoon ; for this there are two reasons : first, that the outside air is usually warmer in the afternoon, and second that the patient's vital powers are less vigorous after the night's rest.
It is extremely important that the excrement of the patient be at once removed from the room. If it be necessary to use a vessel at short intervals, it should be kept well covered in an adjoining closet. Such vessels should be frequently emptied and cleansed; a failure to do so results in the formation of noxious gases which escape into the room and exert injurious effects.
While the exact temperature of the room may vary to advantage under different circumstances, the best general average will be found to be about JO degrees F. A feeble patient, one who is exhausted by some wasting disease, may require a temperature several degrees higher than this ; a patient suffering from some inflammation such as " lung fever " may, on the other hand, be benefited by a temperature of 60 or 65 degrees F.
An important auxiliary in the treatment of the sick is light.
Vigorous plants become pale and sickly in a dark room ; and we cannot expect a pale and sickly person to become vigorous under the same conditions. Light is essential, not only to a healthy person, but also to the restoration of health in a sick person. There are, it is true, certain affections of the eyes which can be cured only when no light is admitted to the room ; but aside from these a sick room should be well lighted.
The cleanliness of the house, while always a matter of importance, is absolutely essential in the treatment of the sick. By cleanliness is meant not simply the absence of dust and dirt from the floors, but also freedom from noxious gases in and around the dwelling. In the country the most frequent source of these is the collections of water and of refuse in the yard or under the house.
A little stagnant water and refuse in the yard or under the house is a frequent cause of disease, and serves to prolong an illness which may have originated from other sources. The premises about the house, as well as underneath it, should always be kept dry and clean.
In cities and towns a frequent source of sickness is defective drainage. It is a familiar experience in city practice to find several cases of typhoid fever in the same family living in a house whose atmosphere is permeated with gases derived from the escape pipes. Inspection often shows that the traps and pipes of the house are so defectively arranged as to permit the sewer gases to escape into the rooms.
" The importance of a good supply of pure air is not nearly so well appreciated generally as is the necessity for free supplies of pure water. Mankind has ever sought to get a clear and sparkling water, and objects to it if its smell be unsavory ; but of the finer and subtler contaminations he has remained, until recently, profoundly ignorant. The curious relations of cholera to water supply furnish a case in point. In one outbreak in London thirty-seven per ten thousand of those who drank the water from the Thames above the city died ; but one hundred and thirty per ten thousand of those who drank water brought from the Thames below London died. Here is an unquestionable piece of evidence that a constantly impure water supply leaves the system less equal to resist an epidemic form of disease. It is not that water is often the direct source of disease, as diarrhea and typhoid fever, but it is commonly a cause of a gradual steady deterioration of the health, which is revealed by the inability of the system to withstand the strain of some acute intercurrent disease. If temperance, or rather teetotalism, be a good thing, its advocates ought at least to secure their adherents from the dangers to which they are thus exposed, for outbreaks of typhoid fever have been found to seize the water drinkers of a house, while the beer drinkers have been free from attack. In our relations to the public as medical men, we must be impartial, and sentiment must not warp our intelligence ; we must be as ready to acknowledge the dangers of water drinking as we are to admit the destructive consequences of excessive indulgence in alcohol. It is not in towns only that the evil effects of a contaminated water supply are felt ; indeed they have been too rudely awakened by irrefutable facts to be any longer oblivious to the consequences ; but also in the country, where wells lie close to sinks and midden steads ; where the village stream furnishes to those at one end of the hamlet as a beverage, the sewage of the houses placed further up. In few villages is the water to be trusted, unless it be the product of some well-cared for spring or some exceptional well. The repeated outbreaks of typhoid fever have accumulated evidence on this matter which is sufficient to convince the most skeptical.
" Closely connected with our water supply is that of our sewage. We know that many outbreaks of disease are occasioned by our water carriage of sewage. Not only is sewer-gas apt to diffuse itself from the water-closet trap, and so to poison the inhabitants of the house ; but leakage from sewer-pipes is apt to penetrate the water supply, and so cause disease. When the water supply its cut off sewer-gas finds its way into the empty tubes, which exercise a suction action as the water runs out of them, and then follows disease. If there be any typhoid fever in the town, the poison will get universal diffusion when the water is again on, and an outbreak will result. The possibilities of water contamination by our sewage are so numerous that it would be simply impossible here to indicate a tithe of them.
" A great source of danger in connection with the water-closet is the liability to so introduce sewer-gas into the house. When the water supply or waste-pipes of closets in the upper part of the house are in communication with those beneath, the rush of water to the lower outlets causes a rush of air to take the place of the vacuum so made, and sewer-gas is often so introduced into a house. At other times, especially in houses, at the summit of each sewage area the pent up sewer-gases rush up the waste-pipes, and from the water-closets infect the upper rooms of the houses. Especially is this the case if the sewerage opens into a tidal river.
The waste water-pipe should be broken in its course, so that sewergas may escape without rising into the house ; or a shaft should be carried up and out beyond the roof, so that if pent-up sewergas should rise in the pipes it would find a ready outlet into a comparatively safe external air. "-FothoegilL
CONTENTS OF CARE OF THE SICK.
-Disinfection. -Proper Bedding.-Isolation.
-Food for the Sick.-Chicken Broth.-Mutton Broth.- Gruels.-Jellies.-Iceland Moss.-Irish Moss.-Tapioca.-Rice.
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