The Clymer Diaries
The Clymer Diaries
“…trying to have my eyes in thirteen while my hands make a bed in eleven. The patient in thirteen has to be watched the one in eleven is so afraid of a draught that I have to keep the door closed” (Clymer, no pagination).
The more things change…
If you’re a nurse or nurse in training today, you’ve probably felt overwhelmed by patient care. So did Clymer when she wrote the above more than a century ago. As a young nurse in training, she put her personal observations and lecture notes into two volumes, or “diaries” that provide us with a record of medical practices, conventions, and schooling in the late 19th century.
Two Volumes, One Training Course
Clymer left her notebooks at the Hospital of the University of Pennsylvania (HUP) Nurse’s residence when she graduated, perhaps intended for a friend who was writing a history of the training program. The first volume contains Clymer’s lecture notes taken in class, the second contains much the same material, recopied. Comparing corresponding pages of the two volumes reveals how her course work was structured.
|
Volume One (Page 10R)
Clymer had to write quickly to keep up with her lectures. Note the casual script, use of abbreviations such as “hrs”, and misspellings (“life” for “lift”, “scarped” for “scraped”). Along with formal lectures, Clymer recorded her observations as she served as a nurse-in-training, and the tips and tricks she learned. In volume two, Clymer recopied her earlier notes in neater handwriting, paying greater attention to clarity and grammar. This volume was then turned in for grading as part of the training course. |
Volume Two (Page 36R)
Lecture notes weren’t just a crucial part of Clymer’s course work—she would also have referred to these notes as a working nurse, along with her professor’s corrections. In addition to corrections, phrases such as “Excellent” (written above in red pen) appear in the second volume. These aren’t just a comments, but the actual grades she received for this assignment, as the Hospital of the University of Pennsylvania (HUP) didn’t use letter grades in the 19th century. |
Volume One
Clymer Diary Vol. 1
[Loose note, 1r V.1]
middle. take 10-15 min- in eye & put it on pellet in few minutes dissolved & you can get it all, then eject the oil by holding in vertical position.
2 methods 1 English pinch up fold of skin quickly put in between the skin & under lying tissue give slowly the stretching of the skin gives pain & then abscess likely to put the needle all the way through if at all nervous
2 free from large veins biceps- fore arm thigh or calf. Draw from the back & insert straight down in muscle-
[Loose note, 1v V.1]
it in order always wash out the barrel after using (first water also through the needle wipe off & put the wire in the needle or it rusts or clogs with dirt.
Whiskey will shrink the piston, put cap back
If dry unscrew the cap at the head flatten out the leather & soak in tepid water, Metal better as it will not break when putting it back) Fill with water & face it out next medicine pellets in spoon or bottom of saucer bott of goblet best as it is hollow in
[Loose note, 2r V.1]
drop on goblet pellets are not soluble. Labor case uterine Hem occurs- pressure over uterus ergot & cold give a syringe full & inject it into the Abdom- wall-
Brights dis convulsions. Pilocarpine 1/8 Consider justifiable although some may censure. Do not buy a complicated one. Mustard plasters are too severe & expensive at druggists. 2 mus- 3 flour- mix together then use warm water if cold it will not call forth liberate the active principle, Hot destroys
[Loose note, 2v V.1]
if solution unfit may make abscess- time to give when Dr. says Emergency may arise first get Dr. if possible & use mild means if these fail use Hypo- Abdom- mus. poul. stupe. typhoid if he does not come give 1/8 or ¼ of morphia if hemorrhage give it at once, apply cold & ergot Dr. would advise Phthisis. pul. Hem. give ¼ of mor- Heart failure without a cause- rapid pulse livid lips Dysp- 1 per cent solution Nitro. Gly.Volume Two
Clymer Diaries Vol. 2
[page 1r V.2]
Mary V. Clymer
Tardville Mercer Co. N.J.
[page 1v V.2] blank
[page 2r V.2]
Lecture Delivered by Dr. Pepper to the Probationers of training school on Nov. 11th 1887.
The Importance of Sleep
The importance of sleep in both Chronic and Acute cases of disease. The condition & circumstances required to produce sleep of a healthy kind. Also some of the reasons why many sick persons cannot sleep. The following are some of the conditions of the body during healthy sleep.
Tranquility of circulation, blood moves more slowly.
Pulse softens. One of the reasons why sleep gives us a fresh lease on life is that during sleep the blood reaches every part of the body. The skin & the internal organs carrying a fresh supply where they have become exhausted through the exercise or labor of the day. Sleep allows the blood to act on our internal organs as a bath cleanses & purifies the skin&
[page 2v V.2]
persons. The symptoms of some diseases become worse at as night approaches. We were urged to look carefully after patients during the day if we would have them sleep well at night. This is particularly true of cases of fever, diseases of chest & lungs, also in organic diseases of the heart. In disease of the lungs, fever is apt to be higher. Shortness of breath & generally discouraged. In cases of fever, the temperature is higher delirium is worse, often very restless. One reason for this is too much blood in the brain. And too little is another cause. The sleep of a fever patient is often an unnatural one. We were told to carefully watch our patients & learn to distinguish different kinds of sleep, to be able to tell whether it is healthy sleep, stupor, or coma. Stupor is motionless & on being roused the patient does not seem refreshed from having lain so.
In cases of lung disease report to Physician about cough, expectoration, & fe
[page 3r V.2]
food. see how different kinds of food act & in most diseases see that very little & very plain nourishing food is given at night. Sometimes a cup of gruel or beef tea given just as a patient is getting ready for sleep will assist very much in inducing sleep. Never wake a patient to administer food or medicine unless ordered to do so by Dr. Some more of the reasons why fever increases at night are too much excitement during the day, disordered nervous action, absence of sunlight & others that I do not remember. Things conducive to sleep. Darkened room, Temperature of the same. Ventilation very important. Some things for the relief of fever if higher at night. Ice cloths or ice cap applied to head. Sponge bath will often lessen the temperature of the body, quiet the nerves & induce sleep. Antipyrine is not an opiate but will often cause a patient to sleep by removing the cause of sleeplessness. Bowels and Bladder are to be watched with great care.
[page 3v V.2]
Lecture by Dr. Curtin On Medical Nursing Nov. 17th
1st The difference between Private and Hospital nursing. In the latter everything is at hand that one can possibly need for heat both wet and dry, for poultices bathing & all outward applications. In the former we will have to depend on a much more deficient supply of all these things. For dry heat we can have bags filled with salt, sand, ashes, & iron in any shape. Observe all points for Drs. benefit, never be curious. Do not talk & tell symptoms before a patient. Be watchful but not officious. Use eyes & ears but not the tongue. Be careful to take and record temperature correctly. Do not take it in the mouth of a delirious patient or one whose nose is stopped up. Nothing either hot or cold to be given before taking it. The best time to get the lowest temp is 8 A.M., the most elevated 6 P.M. Notice whether skin is moist dry burning or pungent. observe how the skin&
[page 4r V.2]
if respiration is fast, slow, irregular or jerking, wheezing at night. In cases of Bronchial diseases if excitement affects & how, Observe how a cough occurs. whether in the throat, with a whoop, dry or hacking, If any expectoration & what kind. In Pneumonia rusty sputa is to be looked for if there is any doubt about it save it for the Dr. to inspect. If offensive may be mortification of lungs. Clean the vessel often & if necessary keep a small quantity of carbolic in the bottom.
Alimentary canal. See how the lips are, if Blue, Red, or pale. Tongue, coated or not rough or smooth. Stomach may be sick. Tell whether it is nausea, retching or vomiting. if vomiting what is vomited. Belching another thing to note. (The refined name is eructation) Regurgitation is food raised without being nauseated. Note when a patient vomits. always watch the appetite & see if a change of diet is wished. Watch the bowels & if there is anything unusual sav
[page 4v V.2]
Administration of medicines. By Mouth, skin, hypodermically. Bowels, enema or suppository. Pills may be given in rice paper or any jelly like substance. Flat ones are the best to swallow. Powders if a light one put in a spoon then add water, if a heavy one add powder to water. Effervescing drinks keep well corked & turned upside down in a pitcher of water. Volatile medicines must be taken as soon as poured out or they will lose their effect. Take oil in hot drinks, glycerin and oil flavored with orange give it in porter, shake the porter until it froths put porter in bottom of glass pour oil in middle put froth on top. Before and after taking cod liver oil rinse the mouth well with strong brine. Carefulness in handling medicines was very strongly urged upon us, one precaution was always read the label twice before giving or taking it. Keep them out of patient’s sight & throw old ones away. Always pour out on the opposite side from the label.
[page 5r V.2]
clean. Never wake a patient to give an anodyne, never ask a patient if he is ready for his medicines but take it & tell him it is now time for you to take your medicine.
Mary V. Clymer
Physiology. Dr. Leidy Nov. 18th 1887.
Functions of life in man. in health.
Pathology. Disease.
Biology. Life in general.
The Organic cell is the foundation of all life.
These cells are not all shaped alike. Each organ has a cell peculiarly its own. All is composed of a substance called protoplasm. Those that come in contact with the air are called Epithelium. Those that do not Endothelium. Red corpuscles carry Oxygen. There are three necessities for the sustenance of animal life. Heat Moistu
[page 5v V.2]
Dr. Westscott on Fever or Pyrexia. Nov. 21st ’87
Fever is marked essentially by a rise in temperature. The thermometer is the only correct way of telling how great the rise above the normal heat of the body. Before this was done it was estimated by feeling & touch of skin. There was liability of making great mistake as there are so many things to affect the skin. The best way is to feel of a portion of the body that is well covered.
Temperature may be taken. In the mouth, axilla or arm pit & sometimes in the Rectum or Vagina. Always higher in Rectum. Child’s temperature may be higher than an adult’s. Normal 98.2. Slight fever 98 to 101-103 Moderate. 103-105 High. Above 105 is Hyperpyrexia. 106 & above is very grave, if of long continuation fatal.
Sunstroke, Rheumatism, & Brain Affections have a high temperature. May be sub-normal. This occurs in cases of surgical shock, in collapse, also in heat exhaustio
[page 6r V.2]
by mild muttering or mild delirium. Fever is divided into three stages. Invasion, Acme & Decline. To be continued.
M.V.C.
Nov. 28th
Types of Fevers.
Continued fever is one where the temperature remains above normal during the whole course of the fever. Remittent is where the fever remains for some time above normal, declines & rises again. Intermittent. A low temperature in the morning commences to rise in & reaches its height in the evening. begins to fall & is lowest again in the morning. Malaria & Hectic may be classed under this head. Hectic occurs frequently in suppurating processes where the suppuration comes in contact with the air. If a temperature is very high & a patient is put in a cold bath, always him from the bath when the temperature has declined to 100 as it will decline for some time after & instead of a normal temperature it may result in a state known&
[page 6v V.2]
an abnormal condition dependent upon complex nervous influences, which is caused by some sudden strong impression made upon a vital tissue, such are surgical injury & operations, hemorrhage, “rupture of the bowel,” always followed by shock. Some ways of distinguishing shock are low temperature (this is always essential) In cases of slight shock you may see pallor of the face & slight nausea. A greater degree of shock will occasion cold clammy sweat, feeble action of circulation pulse, almost imperceptible, respirations short & gasping, dizziness, hearing may be interfered with. Vomiting is always often a symptom of recovery. Cure or relief of same. Stimulate. It is always safe for a nurse to stimulate by dry heat.
Surgical injuries. What to do until a surgeon arrives. Before having a patient
[page 7r V.2]
apply tube above the wound. Hemorrhage of venous blood from a flesh wound may be controlled by inserting pieces of lint wet in a solution of Bichloride of mercury. Scalp wounds, apply cold compresses & bandage tightly plenty of dry heat and cover warmly in all of these instances. Never undress a patient unless Physician says so. Forbid all exertion on the part of the injured one. Then last but not least take temperature in the axilla.
Syncope or fainting. Were told how to distinguish this state from one of shock. One of the sure symptoms was in shock a person is conscious, in syncope always insensiblefainting is due to a failure of the heart’s action deficient supply of blood to the brain & extending to the respiratory organs. Quite common in heart disease, also in deficient supply of blood in body, great pressure upon any of the large arteries. occurs also in cases of poisoning, blo
[page 7v V.2]
If the cause is apparent remove it or take the patient away from it, place in a horizontal position. head very low. loosen clothing. the smell of ammonia will often assist recovery. cold water dashed in face. Internal stimulants may be required, nurse may give aromatic spirits of ammonia, always rub towards the heart & apply sinapism or muster plaster.
[page 8r V.2]
Lecture On The nursing of fever by Dr. Curtin Nov. 24th
Fever cases need a great deal of care as they are very ill for a short time & if a nurse is willing to be taught to be great in small things there is no doubt but what she will be a good nurse. All that a Dr. can do will be of little use with a poor nurse. If a nurse has a choice of a room for her patient she should select one with plenty of light, an open fire place is a good source of ventilation. Select a quiet a room & avoid a glare of light on the bed. The fewer the people allowed in the room the better. Have bare floor whenever practicable as woolen will retain the germs of disease longer than other fabrics. Have the floor cleaned frequently with hot water, but do not slop it. Keep bed & everything clean and away from the wall. Wire spring & hair mattress the best, never have feathers. Have bed wide enough to move patient from one side to the other, a
[page 8v V.2]
ventilation. Do not have patient in a draft. See when admitting fresh air from outside that hands & feet are kept warm. Fresh air from outside is ventilation. Sponge baths are often resorted to, sometimes a simple warm water one always this unless told to use other things. frequently Vinegar or alcohol is used. In cases of very high temperature patients are sometimes put in a wet pack. Two comfortables covered with a wet blanket wrap him in a sheet wrung out of cold water, cover over with blankets and comfortable this is continued for twenty or thirty minutes if it seems to be beneficial. Frequently give cold drinks, also ice if ordered, food generally liquid. Bed sores are a result of pressure on the bed. Cleanliness & dryness very essential, air cushions often of great use. Contagious disease are those that are taken by the poison thrown off by skin or lungs. Infections carried by clothing or anything that comes in contact with the patient. One preven
[page 9r V.2]
digesting & absorb when it is empty. Personally be very clean bathe & change clothing very often.
The first appearance of a bed sore the flesh becomes Red then Bluish Black wash thoroughly then bathe with alcohol or whiskey & alum.
Typhoid fever is a disease of the rich while Typhus is a result of squalor and dirt. Typhoid is a continued fever with ulcerated bowels, if these ulcers break death ensues. The stools contain the germs of the disease & should be thoroughly disinfected. Chloride of lime is the best it is a compound of chlorine & lime. Keep some in the room under bed, bureau & near the door. change it every day. Keep some in the chamber & always remove as soon as used. Put chloride of lime in closet. In Typhus sponge the body with some nonirritating fluid. In Scarlet fever send all persons away from the house if possible. Wash the hair & do not mingle with other people if it can be avoided. A wineglass fu
[page 9v V.2]
once & give it often. If the temperature falls suddenly patient break out in cold perspiration labored respiration. This may denote ruptured blood vessels or peritonitis drawing up of the knees is one of the symptoms of the latter. Solid food will almost invariably cause death. Scarlatina is Scarlet fever & a patient requires as much care after having it as in a bad case of Scarlet fever. In the first stage there is very little danger of chills as the fever is too high. During desquamation or scaling be watchful as the lining of the kidneys is diseased. Dropsy is a serious symptom. Save specimen of urine for examination. Keep patient in five weeks after scaling as commenced. Sponging often relieves itching. Cosmoline a piece of bacon and various ointments also used for the same purpose. Bare only one part at a time. This disease is both contagious and infectious. All diseases of this class are best kept at the top of the house. A sheet wrung out of some
[page 10r V.2]
Dec. 22nd. Dr. Wharton on Difficult Breathing & The Treatment
The disease known as croup either the ordinary kind or Membranous. Foreign bodies in the air passages. Symptoms of croup, voice is suppressed, patient cannot speak above a whisper. Respiration is embarrassed both inspiration & expiration is labored. face becomes purple because the venous blood is retarded. neck is drawn in at the top of Sternum. lower ribs also drawn in, extremely useless. head thrown back. Nurse’s duty is to remove the clothing from chest & keep some loose garment on woolen is best. Have the temperature of room from 75-85- moist atmosphere if you have no atomizer to make it so boil water and have the patient inhale the steam. Slack line in room. The object of a moist atmosphere is to keep the expectoration mucus soft & to assist expectoration. Carbonate of soda, Glycerin & water is good to take in only to soften
[page 10v V.2]
wrapped in a towel will answer. Either hand instruments or sponge around. Instruments needed are a scalpel forceps, scissors, artery forceps. Turkey feathers are the best to clean the tube with. After operation patient breathes easier moisture must still be continued, not continuously unless so ordered. When the windpipe is opened if the mucus is moist & easily thrown off the chances for recovery are much better. If dry & hard it is seldom successful. If a child is afraid of the steam from an atomizer make a paper cylinder to conduct steam to it. Observe what is coughed up. There is seldom any difficulty about taking food. it is usually liquid but if liquids escape semi-solids may be given. Keep patient on back from 12-24 hours after operation clean tube with feather or small plugs of cotton. If membrane obstructs the tube it may be extracted with curved forceps. See that a moist warm atmosphere is brought in contact with the tube.
[page 11r V.2]
Dec. 23rd Dr. Leidy On Medicines
Gives hypodermic slowly but insert the needle rapidly. Place finger over spot where it is inserted. Never give alum inwardly if it can be avoided, as it is very injurious to the teeth. Take iron through a glass tube. Dilute acids well. Nitro Muriatic & Hydrochloric are the same. Opium. Pupils contract when respirations go to twelve quit giving the drug & send for doctor. Ether must always be given in cold water. Never give chloral unless patient is in bed. Nitrite of Amyl for epilepsy. It can be taken internally or inhaled. It will relieve pain at the heart almost instantly. Howler’s solution is one of the arsenic compounds, Symptoms when enough has been taken. Puffiness & discoloration under eyes. Diarrhea cramp & vomiting. When these are present, inform the Dr.
Mercury or Hydrag.
Corrosive. Calomel should never be given in water as it is insoluble. Give d
[page 11v V.2]
Iodide of potassium may be given to excess if produces iodism, the symptoms are bad breath pimples, discharge from the nostrils. Iodoform will cause headache.
Colchicum will kill as it causes inflammation of the gastric membrane, of the stomach & intestines. Croton oil may be dropped on the tongue, watch it carefully when applied to the chest. Turpentine is given internally for typhoid fever, as well as applied outwardly in the form of stupes. It often causes strangury. Jeborandi Pilocarpine is the alkali of Jeborandi they both produce profuse perspiration Keep patient quiet after taking it or it may cause paralysis of the heart. Hot & cold applications Dry heat first if temperature goes below 97 then always use hot applications. Heat may be applied in several forms. hot air baths or fomentations. for moist heat fill glass bottles with hot water & wrap a wet towels around them. For cold bath start with cold or lukewarm water then iced water
[page 12r V.2]
as temperature may fall rapidly. Antipyrine or Antiper is being introduced. List of medicines to be kept on hand. Whiskey & brandy, Liquid Ammonia, Nitrate of Amyl., Atropia, Belladonna, Caffeine, Cocaine, Mustard, Sulphide of Zinc, Gallic acid, Hoffman’s anodyne, Ergot, & Pilocarpine. Never give Iron & Gallic acid together Belladonna causes dilation of pupils Hyoscine produced dryness of the throat.
Dec. 2rd. Dr. Leidy Anatomy
Dropsy is oozing of the liquid portion of the blood. Circulation. Heart, two ventricles two auricles. Right Auricle to Right Ventricle then to the lungs to be purified. Then back to the left Auricle and ventricle when the arteries carry it to the various portions of the body. The veins carry it back to the heart to go through the same process. Pulse is the forcing of blood from the left ventricle through the arteries. In an adult from 68-72, child 100-120. Position ch
[page 12v V.2]
is no pressure on the artery, wrist is the best place to count it. Hemorrhage in the forearm may sometimes be checked by bending the arm. Nursing of heart disease Heart beats slower when lying down. Rest is often a relief. Acute diseases of heart must be kept very quiet. Indigestion will cause heartburn. In cases of dropsy that affects the abdomen & tapping is resorted to always have in bandage to make pressure so the fluid is removed. If you want assist circulation always rub towards the heart.
Dec 9th Dr. Leidy Lungs
Air passes through the Nose, Larynx Trachea Bronchial tubes. Important to have fresh air to afford oxygen. Temperature to be kept from 65-70. To get fresh air lower window at top & raise it at the bottom at the same time. Pneumonia can be conveyed by the breath. Chloride of lime is the best disinfectant. Carbolic acid is only useful when it comes in contact with what you want to destroy. Coppers&
[page 13r V.2]
& count respirations. Tonsillitis is inflammation of the tonsils, Laryngitis of the larynx. It is always means inflammation. Pneumonia is inflammation of the lung structure. Pleurisy is inflammation of the Pleura the membrane encasing the lung. If poultices are being applied never remove the old one until you have a fresh one by the bedside ready to put on. Be very careful to keep the patient warm. Watch pulse. If urine is scanty or high colored report to Dr. Always have stimulants at hand & have ergot in case hemorrhage should occur.
Dr. Westcott on Fractures
Simple fracture is one where the broken bone does not communicate with the air. Compound is where the broken bone or bones communicate with the air. Comminuted is broken fragments of bone at the seat of fracture. Complicated fracture means a fracture in connexion with something else. If care is taken in handling a fracture a simpleone may often be kept from&
[page 13v V.2]
To avoid making a simple fracture of ankle a compound one place pillow under foot. Fractured forearm use a simple handkerchief sling. Humerus bind arm close to body & put forearm in a sling. To make paste board splints, dip a piece of binders board in hot water then mould it any shape desired.
208 bones form the skeleton. The joints of the skull are immovable. The vertebrae have a slight motion & the shoulder joint can be moved every way. Joints are covered with cartilage. The synovial membrane is a closed sac. Covered over this on the outside of the joint are the ligaments. Dislocations (Luxations or pulling out of place) are more common than fractures.
Eye Dr. Risley
Temperature not too high. Care must be taken to have neither dust or smoke in the room. When cataracts are removed an incision is made in the ball of the eye. after operation a patient must not be allowed to chey chew or the wound will not heal. Nev
[page 14r V.2]
under lid open at once, but first put drops in the lower part then get them to look down raise the upper lid last. Use a camels hair brush to put powder in the eye. To raise an eyelid lay a lead pencil or any small stick on the outer part of the lid then raise the lid by the lashes & so turn it inside out to see if there is anything in the eye. Roller bandage should be 5 yards long to bandage both eyes 3 ½ for one eye 2 ½ inches is the ordinary width. It is usually made of flannel. To get pressure bandage tightly, if you do not require much put a piece of linen under bandage. In a hospital use absorbent cotton or wool. After an operation on eye wash the eye either with Bichloride or Boracic. 1 to 1000 wash first lower then upper lid. Ointment may be applied by something pointed. In some disease of the eye, spraying will often give great relief. For hot & cold applications use square pads of old linen or lint. Keep a large vessel of hot water for compresse
[page 14v V.2]
a hot iron on the top of a pile of compresses. For cold ones have a large block of ice covered with oiled silk or rubber. Place weight on compresses on top of the ice. Cups should be applied on back of neck near the roots of the hair. The importance of careful nursing of infectious diseases of the eye cannot be spoken of too strongly. Babies eyes should be washed every hour night & day. Clean knife with cotton other instruments in the usual surgical lotions.
Dec. 14th Hygiene and care of the skin in illness
By Dr. Stelwaggon
The skin is divided in three parts. 1st The Scarf or outer skin, 2nd the skin proper, 3rd the fatty part. The scarf is removed by washing. Sweat glands, oil glands, terminus of blood vessels & nerves is in the skin. The fatty skin protects the bones & ligaments. Typhoid destroys fatty skin, pressure from within & without causes
[page 15r V.2]
water are cast away by the skin in 24 hours on all of us. The human body has four outlets for refuse matte skin. lungs, Kidney & intestinal canal. In brights disease the skin assists kidneys is doing their work. By sweating the temperature of the body is maintained. The oil glands keep the skin soft and prevent too great evaporation. Both removes all the excessive products collected on the skin. Casting soap will usually do, use another unless ordered. When you cannot rub use carbonate of sodium, borax. Soothing baths are sometimes ordered. Bran or gelatin sometimes a protective powder is ordered, apply with brush or tie it up in an old linen cloth. Always rub powder through fingers to see if it is gritty. Lotions are used, not only as antiseptics but for healing the skin, simple ones apply with a sponge or cotton. If it contains sediment, apply with cotton or old linen. Pour a little out of bottle in a small vessel & keep rest well corked. Ointment is
[page 15v V.2]
smear ointment on in Scarlet fever & when a large surface is to be covered in ointment spread on lint cut it in pieces & it will be more comfortable. Oxide of zinc is used for burns & scalds blisters. Camphorated oil is often used to prevent bedsores. Alcohol hardens skin tissues & so prevents them. Croton oil tartar emetic is a stimulating oil, it must be rubbed into the skin, not left on as oxide of zinc. Be sure to spread all ointments so they will not stick. We can learn very much by carefully examining the skin. Scarlet fever rash first appears on face, measles on body. Shingles is an eruption extending from sternum around the chest to spinal column. If there is symptoms of Typhoid always look out for spots.
Dr. Westcott. Kinds of Wounds Jan 2nd
A wound is a division of the continuity of the soft tissues of the
[page 16r V.2]
being thrust straight in the flesh. this is more dangerous than some other kinds as the tissues near the surface are inclined to come together & leave an opening deep down among the tissues. Contused wound is a contusion & a breaking of the skin at the same time. Poison is where some poison is inserted at the time a wound is given, as the fang of a snake. Gunshot is very much like a punctured wound.
Dr. Hart Hemorrhage & Circulation Jan 12 1888
Circulation Veins have valves that prevent the blood from flowing only one way. There is a Pulmonic and Systemic circulation. Pulmonic drives blood from heart to lungs. Systemic sends it through the arteries and veins back to be purified.
Fibrine is the principal thing in the blood, a clot that forms at the time of a hemorrhage in time becomes a part of the vessel. There are three kinds of hemorrhage Primary, consecutive &
[page 16v V.2]
(Secondary) this occurs after ligature has been removed. Arterial bleeding is in jets. A dilated artery is an aneurismal sac. Varicose veins are not often accompanied by pain. Hemorrhage from lung is frothy. from Stomach may be clotted or dark like coffee. From the bowels is not easily detected unless stolls are carefully watched.
Hemistatics are remedies for the suppression of Hemorrhage. There are Vital, Chemical, Local & Internal. Local is applied to the mouth of a vessel, cold air is valuable, as it will cause vessels to close also cold water or ice, use syringe to force water against the wound. Warm water will make bleeding worse, but Hot water at a temperature of 190 degrees or as hot as can be borne is very good. Alcohol, or turpentine applied on a small piece of lint. Ergot acts on the muscular coats of arteries. Acetate of Lead Aromatic Sulphuric acid & Laudanum.
Chemicals act on the albumen & so assist coagulation. Monsell
[page 17r V.2]
acid Nitrate silver, Alum is best applied in solution use it with hot water. Mechanical gravitation is another means. Raise the extremities to check bleeding anywhere near them. Flexion also by simply bending a leg quickly with a pebble under the knee joint it may often be checked. Digit pressure will control almost any place if applied at the right spot. Place finger over femoral artery in the groin and it will stop all hemorrhage of the leg. Hemorrhage of the forearm press brachial below the elbow. Compresses are sometimes put in the wound. Spanish Garot Tourniquet. In applying a tourniquet always have the buckle outside. put a few turns of a bandage around then use the rest as a compress over the vein. This is very painful to wear for any length of time. Ligatures made of catgut usually absorb & pass away. Tortion is twisting the vessel. A hot iron is actual cautery the proper heat is Cherry Red. For varicose veins put a small pad of lint over the vein&
[page 17v V.2]
place in a recumbent position, give Ergot & ice apply ice over chest. Stomach may be cancer or ulcer ice swallowed in pieces is very good. Bowels give Ergot. Nose bleed cold application and squirt ice water up nose and plug nose with cotton. Uterus give Ergot & insert tampon. Hemorrhage after a tooth is extracted Put a small compress outside cut a piece of cork & insert. bandage tightly for 24 hours. Leech bite pressure will control if it where you can get it, use cold compresses & adhesive plasters. If this does not control, heat a knitting needle & plunge in the wound. use Monsell’s solution on a compress.
[page 18v V.2]
Lecture given by Dr. Goodell Mar. 14 1888
Nervous diseases are often mistaken for uterine diseases they may be determined by various symptoms as fretfulness, mental weariness, sleeplessness, troubled dreams, often becoming unnaturally selfish, easily annoyed, often becoming a terror to those in their households such may be better treated away from home & that moral nursing was as essential as physical. The nurse must be kind, firm, gentle, & possessing a good deal of magnetism. Often by holding the hands & gently stroking them the patient with be soothed & fall into a restful sleep. Nervous patients are subject to hysteria for such a dose of ipecac would do as well as anything ice rubbed down the spine is very effectual, if unable to pass water it must be drawn, but not too often. They should be compelled to hold it until the bladder is filled. The Dr. should decide how often & often while she is sitting on a commode&
[page 18v V.2]
A little higher than the head. If she should have histeria do not be frightened but treat with coolness & unconcern they will recover sooner. To treat nervous patients they should be put to bed, Do not allow too many visitors, Keep them from worrying & invent anything for diversion that will make them happy. Give milk diet, skimmed is best. Bathe with warm water every day. If too weak for a complete bath bathe a part, dry thoroughly then let her rest awhile before proceeding. The bath should be given one hour before massage or electricity is administered. The temperature of the room should be regulated as the nurse may require for her comfort as patient may have extra cover if needed.
Ovariotomy
To prepare an ovarian for operation. The day before she must have a cathartic in the morning, Castor oil is the best but should be given without the patie
[page 19r V.2]
if strong enough she can get into the bath tub & wash herself, she should have perfectly clean clothes on & not be put into the room before the operation she must have only a cup of tea or coffee if operation is to be at noon. The morning of the operation the rectum & vagina should be syringed with 1-2000 Bichloride. clothing should be warm stockings and shirt, must wear drawers & night dress but no petticoats. Patient must be etherized on the bed unless too large to be lifted on the table. the nurse rolls up a sheet and places it under patient’s back a little above the hips after carefully rolling back the clothes so they will not get dirty. A rubber sheet of mackintosh previously placed under the patient with slip sheet over it, this will protect blankets & such that are on the table.
The nurse should see that plenty of water & basins are provided for the Dr. to wash hands in. After operation four hot water bottles
[page 19v V.2]
be given. There is danger of too much heat rather than cold. If patient gets too warm remove bottles then blanket, go by her feelings. If the bowels bloat up with wind, the nurse must aid in the escape. A soft rubber catheter passed into the rectum will effect a relief. Opium suppositories must be used as little as possible because they tend to paralyze the intestines. Liquids should usually be given by rectum instead of mouth for as soon as it enters the stomach the intestines begin to move & interfere with the adhesion of the dissected parts. The patient should be turned upon her side by means of a draw sheet & by allowing her to help turn herself by taking a firm hold of nurses hands & pulling herself over as this will give less pain & injure less than any other way. The patient should be taught to pass urine in a recumbent position before operation. If after operation she is unable to pass it, she must be catheterized as often as she feels&
[page 20r V.2]
In some cases hot milk will seem to suit much better than cold, do not boil but scald. Success often depends on the care used in preparing & administering food. If anything is required to be very cold put the glass containing it in a bowl of ice. Skim milk is often best. Buttermilk is unfit for use unless known to be fresh then it is very good &. Milk does not contain water enough to quench thirst we must always see that a patient is always supplied with water or ice as it is impossible to digest food without it.
Peptonize milk twice daily. Make milk lukewarm or the temperature of the body. Add to one pint of milk so heated. fifteen grs of baking soda five grs. pancreatine (Fairchild’s) Seven minutes after you have added these begin to taste of it & as soon as you can detect a slightly bitter taste remove it & note how many minutes it has been on. then if patient objects to the taste remove five minutes before that length of time.
[page 20v V.2]
to suit taste. A very good remedy to assist in digesting food is the soda water that we have in syphons it being plain water charged with carbonic acid. Dry champagne contains no sugar & may be given in peptonized milk. Starched food First, boiled flour, gruel, second, Arrowroot, third, rice flour, fourth, oat meal, these are named in the order proportionate to their strength & may be prepared in many ways. Wine whey can often be given when other things are of no value. To Add one oz of sherry wine to four of milk. Meat Beef tea is valuable as a stimulant but we must recognize the difference between Nutrient & stimulant, alternated with milk it is valuable. Cut the meat in small pieces and put in a glass bottle place in a vessel of cold water & let the temperature rise gradually but do not let it boil. This is a very slow way to prepare it but the best way as we only have the juices of the meat. There is very little difference recognized in bro
[page 21r V.2]
strength as well as try to make it. If these pints of milk are taken in twenty four hours it will maintain life & not allow too great a loss of flesh. Measure carefully all that is taken and it is well to do so before taking it into the sick room.
In some cases the stomach will refuse to retain any food & only small pieces of ice allowed to be given. sometimes frozen beef tea may be given in small quantities.
When a patient very low & temperature is low too elevate the temperature of the room. Inunctions are valuable when a patient cannot retain any food. Two oz of coconut butter may be rubbed in at once. Butter or olive oil may be substituted for cocoa butter if that cannot be got. We must see that these last named are not rancid. Another means that is often made use of is nutrient enemata. This must be given in very small quantities at first, as the first inclination will be to expel it. give 1 ½ oz or 2 the first time then increa
[page 21v V.2]
1 oz Peptonized milk, 2 oz beef tea 1 oz cream, 2 drachms of brandy. If it is very urgent you may give ½ oz of brandy. The giving of brandy in this way is always dangerous as it is dang an irritant to the mucous membrane.
Beef peptonoids may be used but they are not in general use. Does not approve of eggs when patients are very sick thinks they are too strong. But when beginning to convalesce they with oysters are among the best. First the white then the yolk. The great importance of preparing food when Typhoid case were in a state of exhaustion after the third week of the fever was very clearly shown as also that the vessels used for administering food must be kept separate from those used for medicine & any little change is often beneficial.
[page 22r V.2]
Dr. Strawbridge on the treatment and care of eyes.
To wash an eye, always have patient put the head back & hold it to one side so that the cotton or whatever is held will absorb the wash & not allow any to enter the mouth. The use of Atropia is dangerous if not used properly. Put the pad of lint next the nose to put this in the eye as there is a small duct next to the nose that will allow it to go to the nose & so be distributed through the body. Put a drop in, wait a moment, then allow the lint to suck up any that may remain & so proceed until as many drops are put in as the Dr. ordered.
Flannel used to be always used for bandages but the lecturer thought cheese cloth preferable to flannel as it would allow air & was more comfortable for the patient as flannel was so warm. Cheese cloth bandages should be placed in a hot oven for one h
[page 22v V.2]
pad than if it is only done to protect the eye. Pad it well toward the inner pad of the eye. To bandage go once around the head firmly then reverse if both eyes are to be covered reverse each side. In cases of contagious diseases of the eye, where only one eye is affected it is necessary to have a protective bandage for the well one that will protect it from contagion & yet allow the eye to allow fresh air. Make of a piece of adhesive plaster with a glass in the center to look through [drawing] fasten it down the nose & across the top leaving open at bottom and one side. Nurse or attendant ought to have protective glasses to wear while attending to such cases. if not put a piece of cotton on the outside of the lid and gently move the lid up & down & if there is any secretion it will be absorbed & so rendered harmless. & the danger of it spurting out be stopped. Hot applications are sometimes used, if required to be very hot pla
[page 23r V.2]
lying flat on back were as a rule very much broken down. Opinion of the lecturer was that a patient ought to be made comfortable. Have head high or low & be allowed to move it from side to side. One very important point was the attendant ought to always assist them to move. After a cataract has been removed do not let a patient get up until the following day. If nervous or irritable let them walk around the room but give spoon food for 24 hrs. Thinks patients over 60 need stimulants, either port wine, brandy or quinine. Light must be modified but sunshine must be had. Put a piece of Black silk over the first roll of the bandage to protect the eye. When through with bandages glasses are often used either Blue or smoked of different shades. Thought there was no material difference, use whichever the patient preferred. Eyes may be protected too much & so injured as much as if cared for too little. The use of belladonna was spoken of but from what he said&
[page 23v V.2]
to how long to use it. It dilates pupils & also has an anodyne effect on the eye (as much as Morphia when taken inwardly). If the eye becomes very much irritated after using for a times the cessation of it will cause the irritation to rapidly subside. It is very common for newly born children to have sore eyes wash with lukewarm water if this does not cure & there is a greenish discharge use a wash of Nitrate of silver 2 grs to an oz of water put one or two drops in the eye.
[page 24r V.2]
Nursing of Fever May 10th Dr. Tyson
1st General principles governing all fevers. There are different degrees of severity & infection & these rules must apply accordingly. Nurses watchwords for nursing fevers are Rest & Quiet. Both of these vary with the severity of the case. Patient should maintain a recumbent position. Not one position all the time but not allowed to sit up, as a very common occurrence is heart failure. Fever patients are always weak and often before Dr. or nurse grasps it the patient is very feeble. Quiet, never wear creaking shoes. Dropping things or unnecessary noise with tongue or coal scuttle are to be avoided. There is a great difference in nurses temperaments & their ability to quiet a patient & keep him so after being disturbed. Do not allow the patient to remain too long in one position as there is great danger of causing abscess & bed-sores by this. During fever the tissues are d
[page 24v V.2]
thoroughly. Bathing whiskey, alum & water or cologne may be used. Any odor that is unpleasant should not be used. Ventilation, light & temperature of the room are very important. ventilation very important in fever cases. A patient with fever will very seldom take cold with necessary ventilation. One of the best sources of ventilation is an open fireplace with fire in it. if too warm to have a fire burn a lamp or candle in the fireplace, but a brisk fire is the best. but fresh air must be got in as well as foul air out. best to lower window at the top & if you cannot ventilate enough by this raise at the bottom & place a piece of board or something stiff before it to cause the air the pass up & so avoid a draught, also protect patient with a screen if you have it. Light must not be excluded & it very seldom occurs that a patient objects to it, but if it disturbs very much modify it for a time but as soon as possible admit light & su
[page 25r V.2]
Light aids disinfection or is very destructive to infection. Temperature from 65-70. Habits of the American people will not admit of a lower temperature. It is said to be kept lower in English hospitals.
Food for fever patients should always be Liquid, never solid. Never violate this rule unless Dr. says so. More relapses occur by giving solid food than by anything else. Cold drinks should scarcely be limited but there are some methods to be observed. It is not safe to allow a large drink to be taken at once & always have just what you want the person to take in the glass or feeder. never say take part now & the rest later as it is very trying to one who is parched with fever to stop as long as they have any left. The patient ought not be disturbed to give food when in a healthy sleep unless there are extraordinary symptoms, then the Dr. will set the time for waking. Waking causes fright & often a rise of temperature. My part to reduce temp
[page 25v V.2]
shock ice water might be used. Never wipe dry but leave a thin layer of water on the skin to evaporate as it is not application, but evaporation that reduces temperature. It is impossible to realize how much good this will do reducing the temperature from ½-2 degrees. If temperature is any below 104 does not think patient will die from high temperature. When sponging is not sufficient a folded sheet around a patient & water squeezed over it makes sheet thoroughly wet sprinkled water squeezed over to make sheet thoroughly wet with ice water at short intervals, keep in this condition for ½-1 hour.
The use of drugs is in the Drs. hands, but the Lecturer said external means were far more satisfactory than drugs as they are fitful in their action. If a cold bath is ordered do not put them in a bat of 60 but if temp is 104, make the water 100. Then add ice and so reduce it. Temp must be taken while in the bath & as soon as it is 100.
[page 26r V.2]
To prevent contagion. There are various kinds of contagion & so demand caution in various ways. Contagion is a something that may be taken by cuts, air passages or mouth. Typhoid is only contagious through the bowls, so if the discharges therefrom are properly taken care of it is seldom communicated. Soiled linens must never be left to dry. Stools must be removed at once. Put anything of linen kind in boiling water or a temperature of 212-240 dry heat sometimes fails to kill contagion, boiling is far better. Whatever is used for patient, keep for them alone.
Typhus fever is far more contagious than Typhoid as it is not known where the contagion resides, so it is difficult to avoid. Proper treatment of clothing. Boiling water again. Keep a pail of Bichloride 1-1000 or Carbolic acid 1-19 & place all linen in this until it can be boiled. We must not be cowardly but there are certain precautions we can take. Do not be reckless on the other hand. Never
[page 26v V.2]
Smallpox is a fever and the contagion is in the pustules or rather in the pus they contain. Everything of linen kind should be placed in Bichloride of or Carbolic acid before being taken from the room. Suspend a sheet opposite the door wet in a solution of Bichloride of mercury 1-1000 and keep it wet all the time. Put a patient at the top of the house if possible with this disease. In measles the contagion resides in the tears & catarrhal discharges from the nose which are very free in this disease. Best to use old linen & burn.
The most serious after effects are, pneumonia or bronchitis, consumption often follows with children. The reason for this is the mucous membrane of the lungs has the same eruption asthe outer skin. Great care must be taken not to allow to take cold. Scarlet fever is one of the most contagious. Use every precaution & if there are other little ones send them away from the house if possible. If not, keep patien
[page 27r V.2]
The contagion lasts as long as this continues & this is a long duration as it begins about the 8th or 10th day. If convalescent in two weeks put in a warm bath & it may be repeated in two or three days. The object of anointing & bathing is to keep the particles of skin from flying about also to make patient more comfortable. Sometimes it is very difficult to tell whether the case is scarlet fever or not. safest to keep them in the house for six weeks. The complication to be feared is kidney complication & the great majority of Bright’s disease of the kidneys is believed to have been cause by scarlet fer. This disease is inflammation of the kidney, caused by the skin failing to do its work in throwing off the impurity that is usually does & the kidney tries to do double. The Lecturer believed this to be the cause instead of the prevalent belief that it is always caused by cold
[page 27v V.2]
activity as well as exposure. Patient should be kept quiet & confined to one room
Mary V. Clymer
Most Excellent
Lecture on Contagion by Dr. Warner
Contagion is the means of communicating diseases from sick to well. There are two wats of doing this directly & indirectly, directly is where the well person come sin direct contact with the sick one & so takes the disease. Indirectly where it is carried in some article that has been where the person is sick with the disease. The particles or bodies which convey disease are called contagion & are lower forms of animal life. Specific diseases are those that arise from one cause & pursue one course. As Cholera & Typhoid are contagious but only in a specified way as the contagia is in the secretions & must be inhaled form them, otherwise these diseases are not contagious. Small-pox, mumps, measles, diphtheria, &am
[page 28r V.2]
fever are some of the most contagious. The latter is said to be especially so. Contagion is worse at different stages of these diseases. The desquamating period is the worst in Scarlet fever also in Measles also in tears and discharges from the nose in measles. Small-pox as long as there is any scaling from the eruption of the disease as the germs are in the pus skin. The isolation of the patient is one of the best means of prevention. If the disease arises from a well or sewer gas the isolation applies to this also. Select a front room if possible & have a stove or grate fire not on account of heat but the ventilation. Shut off the heater. Remove everything from the room that is not absolutely necessary for the comfort or convenience of the patient, be sure & remove carpets curtains & everything that is woolen as they retain the germs. Use a mattress that can be destroyed. The nursing of contagious disease is very trying to a nurs
[page 28v V.2]
impossible for you to get any outdoor exercise for a time. Wash all dishes in the room & the one who brings them must not enter the room. Have two pails filled with some disinfecting solution to plunge things in to kill the germs before removing them from the room. Keep a sheet wet with this & suspended inside the door. Be very careful to keep it wet as dampness attracts the germs & by keeping it wet they are destroyed & so prevented from going further. Do not sweep or dust the room as it sets these particles moving but if it necessary to clean the room, wipe floor furniture and woodwork with a damp cloth & so confine them where they are. A good disinfectant is made of 1-1/2 pounds Sulphate of iron to a gallon of water empty all discharges in this before taking from the room. Another is four oz of Sulphate of zinc and 2 ozs. of chloride of sodium (common salt) to a gallon of water. Combining zinc & salt produces chlorine & this is a
[page 29r V.2]
cannot get either of these use boiling water & let whatever you put in it soak for 6 or 8 hrs. & then carry it through the house moist as all of the germs may not have been destroyed & by taking them away damp, it will confine them to the same. The patient should be greased with vaseline or camphorated vaseline & the old time remedy of greasing with salt pork is a very efficient one. This should be done 3 or 4 times during the every 24 hrs. as it not only lessens contagion but is a great relief to the patient. After desquamation is over & this lasts from 6-12 weeks & moreespecially on the tender parts of the body like under the arms in the groin & back of the knees. The first stage of desquamation is flakes then a very fine bran like substance. Give the patient a bath for four days in succession before sending back to the family either of Bichloride or very hot water. Change all linen after first bath & the last night al
[page 29v V.2]
every Dr. before told me it would kill whatever it came in direct contact with. Wash all the wood work and floor of the room in the sulphate solution. Then the room must be fumigated which is done by gases. Chlorine is good but not practicable. Sulphurous gas is made by burning sulphur in the room. 18 ozs. of rolled sulphur will thoroughly fumigate a room of 1000 cubic feet. It is inflammable so take a large tub & put six inches of water in the bottom then put a coal scuttle in this or place a pan on two bricks every closet should be open & all clothing hung on a line. Close all doors & windows sometimes a window may have to be open two or three inches to prevent the gas escaping through the house, keep shut for 24 hrs. then repeat but only 12 ozs. of sulphur need be used this time. Paint must be scraped and repainted wall repapered & furniture varnished. We must be sure & tell whoever is called to do these things that there has been contag
[page 30r V.2]
patients like Scarlet fever but one is as contagious as the other. Keep smallpox patients in a dark room. For some unaccountable reason these diseases are sometimes only slightly epidemic & in a very mild form. As an example of the spread of disease through carelessness & ignorance spoke of the awful typhoid at Plymouth. Burning is the best way to destroy all linen that has become infected & if there were more health crematorials it would be better.
Mary V. Clymer
Most excellent
[page 30v V.2]
Dr. White on the Principles of Antiseptic
Antiseptic Surgery is
The methods directed against the putrefaction, a spoiling of the discharges in wounds. As a small portion of yeast plant applied to sugar will set up fermentation & produce alcohol & carbonic acid gas. Animal fluid like blood if protected from the entrance of these little bodies (of which mention was made later) it will keep sweet & pure. If we put beef tea, pus, blood, & urine out to the air it will decompose and be offensive by the entrance of bacteria. If preserves are not covered at once these little bodies will enter & set up fermentation or decomposition. Urine if exposed to the air will soon smell badly but boil it & put a cork of Bichloride cotton in it & it will keep. Beef tea will do the same. The cotton filters it & keeps the microbes out. There is s
[page 31r V.2]
Surgery
cause putrefaction always act as if we knew it. A cubic yard of hospital air is said to contain ninety thousand of these little living bodies. While the air on the Street contains fifteen thousand. The only places where they are not found is mid ocean & on mountain heights. Various things are used to kill them, they increase very rapidly but if brought in contact with something to kill it, it does not multiply but remains the same & shortly shrivels away. Bichloride of mercury, carbolic acid & Iodoform are the strongest known to kill them & are named in the order of their strength. There are others but these are the best known at present although each has disadvantages. Bichloride will produce irritation. Carbolic is volatile & Iodoform smells badly & is not as active as the others but when wet is very good. Prevent the
[page 31v V.2]
microbes from entering or kill them as soon as they enter is the object of antiseptics. If allowed to remain they will cause pyemia Septicemia Erysipelas & Hospital gangrene. They may enter through carelessness & by being allowed to remain will enter the blood & so cause these various forms of blood poisoning. Lister lost from thirty to forty per cent of his surgical cases before antiseptic measures were discovered & from this it has gradually diminished to one third of one per cent by the use of antiseptic measures. His cases were the same kind as come to this & all hospitals. Boracic acid is valuable but not as actives as those spoken of first. These germs are often carried into an open wound by the surgeon’s fingers or instruments not surgically clean. Hands of both surgeon & all assistants should be washed first in with soap & water to remove ordinary dirt then in alcohol & then in a solution of equal parts carbolic ac
[page 32r V.2]
towels wrung out of bichloride. The skin of a breast case contains hundreds of these germs & should be cleansed the same as surgeons hands, some hours before the operation & a towel wet in the solution of Car. and Bi. placed over it & kept there. Car. is more penetrating than Bi. If Bi. were not so imperious to instruments, it would be better to put instruments in it as it kills the bacteria instantly so car. must be put on one half hour before using them as it does not act so quickly, but it does not injure them, but dipping is not sufficient. So if the patient & instruments are ready the surgeon washes his hands & proceeds. Be sure no tape is hanging from sleeves & the nurse ought to help the surgeon in all these details. Sponges ought never to be used twice as they can be prepared at a very trifling cost, never leave them sitting around dry in the ward. Dressings must be kept moist & in glass or tin cans covered tightly. Do not d
[page 32v V.2]
hands every time you take hold of anything dry. Dressings must not be laid down on anything dry but kept moist. If there is much oozing reinforce the dressing by putting Bi. Cotton over it & binding it fast with an antiseptic bandage. The reason for this is that as soon as the blood comes through it has dissolved the Bi. as it came & so made a channel for the introduction of bacteria into the wound. Do this at once or instead of a wound healing by first intention or adhesion we may have suppuration & fever & a long time for granulations to form. So that promptness may save the case. It is as essential that everything be as clean for a dressing as an operation as the danger remains the same as long as we have an open wound. For an antiseptic dressing, first use Iodoform, then protective, or a piece of wax paper wet in Bi. The Bi. will soon be gone from the latter & it will protect the wound from the irritating effects of Bi. T
[page 33r V.2]
skin, Fourth the epidermis or true skin is reached. Fifth the tissue. Sixth muscles & nerves & bloodvessels & all the way to the bone & sometimes the bone is burned. Dr. Gross divides into simple & complicated. But Dr. Agnew classifies them best. 1st Reddening of the skin. 2nd vessication, this is a blister filled with serum or the watery part of the blood. 3d skin is destroyed & comes off in a slough. 4th all parts are involved from skin to bone. The cause of the redness is the small bloodvessels become partially paralyzed. In vessication they are completely paralyzed & the blister if white is filled with serum and sometimes the red corpuscles of the blood. The slough in the third must follow if it is burned deeper than a blister as the blood supply is partially cut off & in the last it is entirely so. The pain of burns in the first degree may be much more than in the others as only t
[page 33v V.2]
is not there. Many burns occur through the careless handling of coal oil matches & by exposed vats in manufacturing places. If a burn covers more than one third of the body it is very dangerous & a burn of the first degree that covers a large surface of the body is more dangerous than a small portion burned to the sixth. Children & old people bear burns badly. A burn of the trunk is worse than one of the extremities as the viscera is so near the skin. Shock is as bad with burns as a railroad accident. The pulse is rapid and feeble, Breathing is rapid & shallow. Whole body is cold & patient complains of being cold. stomach is irritable & very often rejects liquid or food. Many die in this condition for although the heart is acting rapidly it also acts feebly & the liver & other organs suck the blood up like sponges while in this stage. If they recover from the first stage and reaction begins and then follows the inflammatory stag
[page 34r V.2]
like after operations. If they survive the stage of shock, as a the second stage results of results in Pneumonia and Duodenum ulcer. Why this occurs is not known but one out of five have this & it may even cause perforation hemorrhage or peritonitis. This may be recognized by bloody stools or vomiting of blood. This occurs from the tenth to fifteenth day of the inflammatory stage. For the treatment of burns shock must be treated first apply dry heat & if the skin over the abdomen is not broken, a large turpentine stupe will be of great benefit. The temperature has been known to be as low as ninety two. Internal medication must be attended to as well. Ammonia is the most rapid stimulant. Whiskey Alcohol comes next. Digitalis is slower in its action than either but it is very good. The quickest way to administer ammonia is to pour some of our strong ammonia water on a towel and hold it first to one nostril & then to the other as it w
[page 34v V.2]
Both may be given hypodermically. When the stomach refuses to act very often the rectum will retain what the stomach will not. Beat an egg & add whiskey & turpentine to it & give by the rectum. Carbonate of ammonia should be mixed with mucillage of acacia. The pain must be stopped by opium usually one sixth of a gr. of morphia is given & opium suppositories are also used. The local treatment is to keep the air from the wound or burn, all ointments & oils are good but the best is oxide of zinc. is good but carron oil the best and good. It is made of equal parts of lime water & linseed or sweet oil beaten together. Linseed oil is the best as it forms a film over the burn & so excludes the air but it is objectionable on account of its odor. Cold water is good for a slight burn, as soon as you remove the burned part from water, cover with ointment or oil. Then cover with oiled silk or wax paper & apply a bandag
[page 35r V.2]
dressed as long as it smells sweet but if it smells badly at the expiration of twelve, 24, or 36 hours, it must be dressed. Then only expose a small portion at a time wash with some disinfecting solution. Permanganate of potash is safest as there is danger of too much bichloride being absorbed into the system where there is a large broken surface of the skin. Then only trickle over it as there is danger of starting hemorrhage where the veins are close to the surface. If blebs have raised & filled with serum, snip with scissors & let it out but be careful to let the skin drop back in its place as it may adhere & it forms a better protection than any that we may apply. Envelope the part in cotton if it is one of the limbs. If ulcers come the process of ulceration & sloughing must come before the healing. This begins at the sides & is told by a Blue line this is only seen where an ulcer is healing by granulations which
[page 35v V.2]
sometimes form to fast & bleed. Support with a piece of surgeon’s lead plaster, a strip drawn from one side to the other will support & aid in the healing process. Rubber plaster does not do as it irritates the skin. Unless the part is watched carefully it will draw up out of shape so if it is a leg apply an extension with a very light weight. If an arm bandage firmly to a splint. If on the neck make them keep the head straight. Skin drafting is very good when you have a healthy ulcer & it makes it stronger and less liable to break after it is healed, very small pieces of skin may be taken from the individual, or from anyone as it is only the cuticle that is removed. Some claim that merely scraping the skin over an ulcer will cause some of the skin cells to be transferred to the ulcer & so strengthen the granulations. But had not had any success with the latter. the former is usually successful & unites in 24 hrs. These ulcers sometim
[page 36r V.2]
who has been burned, never remove the skin by roughly pulling the clothes off, but rather cut them & lift the patient out of them.
Would like to speak to us again on the way heat & cold affects a person & the similarity in the looks of a burn & a frozen part after a few days.
Excellent Mary V. Clymer
[page 36v V.2]
Lecture By Dr. Seiler 11-6
On the care of the Nose and Throat in Health & Disease
In the nose & throat are located the upper air passages.
If a child has a severe cold in the head, what do we do to help it get well? Nothing but try to make them comfortable & this is the province of a nurse in all cases, while the Drs. province is to assist nature in recovering itself. It is necessary for us to know how the immense importance of the work these organs have to do & something of their construction in order to know how to take care of them. The gullet is the upper part of the throat leading to the nasal cavity. The Septum is the cartilage dividing the nostrils. The nose is divided int
[page 37r V.2]
back of this is the sphenoid this contains a number of small cavities & between these are upper lower & middle channels leading into the air passages. All the nasal cavity is lined with mucous membrane & the nostrils are lined with skin. All of the lower animals breathe through their nostrils & so do babies because they do not know how to breathe through the mouth. The nose is the organ to breathe through because it prepares the air for reception into the lungs. The lower part of the nose filters it with hairs that are just inside the nostrils & so prevents any large particles of dust from going to the lungs. While the finer particles arecaught by the mucous which is secreted by the mucous membrane & in is warmed by going over the large surface made by the curled bones & now we see why the tissue is filled with arterial blood for without this warm blood the air could not be the right temperature to go to the lungs. This spon
[page 37v V.2]
to pass down the throat into the stomach. This moistens the air. In the lower classes of animals this is the moisture that we see on the outside of the nose. So the nose acts in a threefold manner first it purifies second, warms, last moistens. The throat is the part we can see by a person opening the mouth. The hard & soft palate, posterior & anterior pillars back of this we ought only to be able to see a smooth Pink wall but if the tonsils project far enough to be seen we may know they are diseased. Sometimes small white cheesy patches will appear on the tonsils & if possible it ought to be removed as it is very impure & will generate bacteria by the million to be distributed through the system. The nose & throat should be kept aseptic. Larynx is below the tonsils. The epiglottis is over the windpipe to keep foreign bodies from entering the air passages. Below the epiglottis is two sets of bands the first are the ventricular bands & t
[page 38r V.2]
are the vocal chords. If these chords become swollen, we have hoarseness & loss of voice. Larynx regulates the breath in speaking & economizes the air in the lungs or it would all come out when we begin a sentence & so have none left to keep on talking with & it prevents the food from entering these passages.
Fever patients and those suffering from a bad cold in the head breathe through the mouth because the inside of the nose is swelled & inflamed too much to allow the air to go through the proper channels. In breathing through the mouth, the air is not moistened or warmed owing to the absence of the secretion that we have in the nose & not warmed as there is no tissue filled with arterial blood for it to pass over. The temperature rises. So we must breathe through the nose to be healthy. Fever dries up the secretion in the nose so we must have something as near like the natural as we can get it & spray the n
[page 38v V.2]
in the hand & sniff it up the nose & also gargle the throat which many people cannot do. Take one drachm of soda, one of salt, one tablespoon of glycerine, add on quart of water & some mild antiseptic like Thymol. This will afford so much relief that one will not object to the trouble. For children & delirious patients the nurse will have to apply the remedy & the best way is with an atomizer. Present this just inside the nostril & be very careful not to start bleeding by scratching the septum & so cause perforation of the septum. This is frequently seen after typhoid fever. Many say this is due to syphilis but it is not so as this attacks bone before cartilage. Never put powder in the nose it may stimulate the tissues for a time but reaction may will come & cause catarrh. This is decay of the turbinated tissue & even the bones decay so that instead of the large surface made by the curled bones we may have a straight wall. The&
[page 39r V.2]
Powder may be used for the tonsils, roll up a piece of paper into a tube by rolling it over a pencil put the powder in this & with the bulb of the atomizer blow it right where we want it to go. Prefers this kind of tube to any other as it can be thrown away & a new one made as often as it becomes soiled. To apply cold to the throat of a child in Laryngitis take a piece of rubber tubing wind it around the throat place a bucket of ice water a little above the level of the throat & an empty one under the bed such the air out of the tube & we have a continuous flow for brain fever sew it inside a cap of ordinary muslin & let the end come out of the top & use the buckets as in the other case. To make a joint in the tube (join two pieces together) soak a piece of paper in paraffine or put a quill from one to the other or a glass tube. In cases of croup or disease where the temperature of the room must be higher than normal we must do somethin
[page 39v V.2]
in this condition. Make a tent with an ordinary mosquito canopy by pinning two sheets over it & hanging a thermometer & appliances for making steam inside. then we can have fresh air for ourselves & by pumping or raising the sheets up from the bottom every little while we will get rid of the carbonic acid gas & so have pure air both for yourself & patient. The way we take cold is by exposing the neck, the way to avoid doing so is to wash it with cold water. This should be squeezed from a large sponge over the nape of the neck & allow it to trickle around to the front.
- V. Clymer
Excellent
7
[page 40r V.2]
Dr. Reeves on Diphtheria 11-13-‘88
In order to understand about This disease it is necessary to understand something of the anatomy of the parts. The cavity of the mouth e
[page 40v V.2]
The patch may be picked off. You will remember his illustration with absorbent cotton, but it cannot be loosened as in follicular tonsillitis.
Sometimes the temperature is 103 but quite often only 99 & this only for a few days. For some reason it falls & we often see a subnormal temperature the rest of the course of the disease. In the beginning child will be restless, irritable & may complain of sore throat although quite severe cases have occurred where they have never made any complaint of sore throat. Be very gentle in examining the throat & with the spoon or depressor make a firm but gentle pressure & very soon the set of muscles will become tired & offer no more resistance. The question asked as soon as any patches appear on the throat is, is it diphtheria, as it resembles several other diseases. It appears in small gray irregular patches which show a tenden
[page 41r V.2]
this membrane & nurses must be careful not to allow any of this to touch eyes or get in mouth or nose. If it affects the nose it will extend to the throat & cause suffocation unless relieved. Tonsillitis resembles it somewhat but the patches are round & do not run together unless two or more are near together. then if you take a probe you can work it loose only in the center & instead of a raw surface underneath we find healthy membrane. The patches are whiter. Thrush also resembles it. If the patient gets hoarse & talks husky, there is danger of the disease extending into the larynx we ought to notice about this. Catarrh may cause it. Diphtheria usually occurs from 3-10 years of age although adults 70 the oldest case had ever seen. A healthy rosy child will become pale in a very short time seems to be blood poisoned vital powers seem to fail & many die from exhaustion. Feeding is of most importance in the treatment of this disease soft
[page 41v V.2]
a large quantity of alcohol can be taken with good effect as much as 4 or 6 ounces & not be affected visibly, soft eggs egg nog, milk with lime water. It must be given at regular intervals if giving milk do not give after an astringent medicine like iron or acids. It is often a great deal of trouble to get children to take medicine must try every way to induce them to take it if we can gain their confidence it will help very much in nursing them will often take it through a tube when in no other way put brandy on scraped ice. After applications are made to the throat it is necessary to wash off all that will come, a Burgess atomized filled about half full will throw a continuous spray. If an insufflation is used keep the finger on the bulb until it is withdrawn & the tube wiped off to keep the tube free from the particles of membrane. Many die from exhaustion or starvation in this way they die peacefully, but if the membrane extends down the larynx the
[page 42r V.2]
it is necessary to use the very delicate forceps that belong to tracheotomy instruments to withdraw the membrane that may form below the tube. To insert the tube in intubation cover the child with a blanket all the way to the neck and hold it firmly. Very often a child will seem to be suffocating & as soon as the tube is inserted will obtain such relief that it will sleep for some hours one of the dangers is that the membrane may be packed down & keep on extending below in this case the tube is only a palliative. To insert it it must be put just below the epiglottis if it is not in the right place it will be coughed up. In an emergency we may have to insert it keep the silk attached so as not to allow it to be swallowed. If the membrane extends below the larynx nothing can be done. Tracheotomy is best in my opinion said the lecturer. After diphtheria all of the parts of the throat may slough, this is awful. Many other conditions follow. Paralysis of
[page 42v V.2]
follow. Hearing may be destroyed especially if the Eustachian tubes have been affected. Paralysis of the heart occurs even after a patient begins to recover may sit up in bed & die instantly. In regards to disinfecting it is not indirectly contagious but directly so. That is we cannot carry it to other people but may take it ourselves by getting some of the particles of membrane on our hands & touching mucous membrane with it. A nurse must have a sufficient quantity of sleep. We must never allow anyone to drink from the same vessel as the patient. To disinfect a room, sulphur is the best disinfectant and use it just as Dr. Musser told us last winter.
Mary. V. Clymer
Excellent
8
[page 43r V.2]
Preparation and Administering
of hypodermics. Application of plasters practices & stupes. First important to have a good syringe & may necessary for us to have it & be sure it is in good condition for use, especially in the country. In the lecturer’s opinion metal barrels were preferable as they are not so easily broken. The leather washers shrink more in the glass than in the metal & often break the glass barrel while inserting (after they have been taken out for repair). See that the piston will return itself after being drawn out & be sure that there is a cap to fit over the needle end. To make solutions get tablets that are prepared by druggists, they do not decompose like solutions. A few that we ought always to have are ¼ gr. Morphia 1/100 of Atropia 1/8 of pilocarpine Ergotine. Nitro glycerine one per cent solution. Always wash out the barrel with water then force a syringe full of it through the needle, wipe dry and pu
[page 43v V.2]
be allowed to become dry unscrew the head of the syringe remove piston & press leather out soak in warm water for a few minutes, this will usually remedy it. Always try the syringe with water before using medicine. The pellets may be dissolved either in the bowl of a spoon on the bottom of a saucer, or a goblet is best as there is a small hollow on it so you can get every drop. Take 10-15 minims in the syringe put it on the pellet & as soon as it dissolves it is ready to be injected. Eject the air by holding in a vertical position & gently pushing the piston until a drop or two of fluid is ejected. There are two methods of giving, the first is an English one. Pinch up a fold of skin insert needle quickly but give fluids slowly. this is between the skin & underlying tissue. The stretching of the skin gives use rise to pain & if the fluid is at all irritating causes abscesses to form. & if the operator is at all nervous the needle may be&
[page 44r V.2]
cause an abscess but the danger is much less than when given by the first method. There are times when we may give a hypodermic without an order from a Dr. The following are a few emergencies when the speaker thought it would be right to do so. Always get the Dr. if possible. In case of typhoid, if taken with severe abdominal pain try mild means first like mustard plasters, poultices & stupes if one 1/8 or ¼ of morphia, if intestinal hemorrhage recurred give morphia at once, apply cold across abdomen & a Dr. would usually leave an order as to what quantity of ergot to give. Phthisis, if pulmonary hemorrhage took place, give ¼ of morphia at once also ergot & ice. Heart failure without any apparent cause & which may be distinguished by rapid pulse, livid lips, Dyspoaena give one drop of one-per cent solution of nitroglycerine, pellets are not soluble in water, drop it on bottom of goblet. Labor & uterine hemorrhage occurs make pressure over u
[page 44v V.2]
mustard two parts wheat flour 3, mix with warm water as cold does not liberate the active principle of it & hot kills it. Alwaysask if it poisons if it does use some other hot application. Spread on muslin & allow edges to turn over like poultices & put a piece over face of plaster. Never allow it to blister watch & as soon as skin reddens remove 15-30 minutes is the usual time, remove then as it has been known to redden 24 hrs. after & blisters, it is best to remove. Fomentations may be simple or medicated wring them out of hot water with a towel like we do for stupes. For stupes, take two pieces of flannel lay one dry over the abdomen then wring the other out of first boiling water, then turpentine that has been previously warmed. Fold a blanket in a stupe put it under the patient then fold it over the stupe to retain the heat. Did not tell us how to make poultices as nice as we know.
Mary V. Clymer
[page 45r V.2]
Dec. 4th ’88 Dr. DeLand on feeding the sick
This constitutes fully one half of a nurse’s duty & the enormous importance of it cannot be overestimated. We must be observant & note the effects of a prescribed diet & we are expected to know when not to administer the diet as ordered. A great deal depends on our tact as to the quantity a patient may take. Foods are divided in two groups 1st starches, sugars and fats. 2nd Albumen (white of egg) & meats. Water acts as a food for 70 per cent of the body is composed of water. In cases of fever more water than usual is required, it aid digestion & nourishes the body. In the 2nd & 3rd week of typhoid fever, the patient may be in a sort of stupor & there may be a want of attention & they fail to ask for water, we must then supply th
[page 45v V.2]
Milk contains 86 percent water 5 albumen 10 of sugar & butter so you see we have both & water in addition. Our success depends largely on the way we can give our patients milk & overcoming their antipathy to it. If patient hates it say we will not give it & proceed to get them to take it some way either skimmed milk or buttermilk may be substituted & it is not always necessary to tell them what they are taking. In certain conditions if digestion sometimes whole milk cannot be borne, dilute with lime water usually two tablespoonfuls to a tumbler of milk. When a patient is entirely dependent on milk we must especially see after it & see that it is pure and fresh twice daily be sure & have a clean fresh covered vessel to keep it in & keep it in the refrigerator. In the last five years a great deal of milk already digested has been used in the shape of peptonized or predigested. This is done with pancreatine. Take of some good extra
[page 46r V.2]
a clean bottle stand it in cold water & let it come to the temperature of the body. this we call lukewarm & it is about one hundred degrees. It usually takes 20 minutes but as soon as it is digested it becomes bitter taste it & as soon as there is a slightly bitter taste remove & put it in a very cold place & the change of temperature will stop further digesting. Different preparations required different times. If objections is made to a slightly bitter taste, remove a few moments earlier the second time. It should be prepared twice daily. Along with these go starchy foods milked with milk arrowroot boiled flour is very good put it in a bag & boil for ten hours remove & bake for the same length of time & you will have a substance hard like stone grate & add two or three tablespoonfuls to a glass of milk and give. Koumiss is fermented milk & is valuable to make, take one pint of milk 1 tablespoonful of sugar & a small
[page 46v V.2]
always taste it & if it has a very acid taste, do not give as it is apt to disagree when it tastes very sour. Oat meal gruel may be given prepared with peptonized milk. Attention paid to little points will be of greatest value. Have cold things very cold & hot ones as hot as possible to take it. If a small quantity is to be given put it in something small & it will look more appetizing. Always have the vessel you give it in hot or cold as you give either of them. We all know a glass tube is nice to use when one is lying to take both food & medicine & a cup with a handle on will assist a patient very much for they will often take it & drink themselves without knowing how much they are really taking. In fever like typhoid how much will sustain. 1 pint in 24 hrs. will sustain life for a few days 3 will retain strength & flesh & when we go above this we are adding flesh. We should always note carefully the quantity time & kind o
[page 47r V.2]
overeating as the appetite is so strong. When fever is gone we may begin to add arrowroot to our milk bread cut thin & toasted with the crust cut off & soaked in milk. There is an article can be purchased at shores called --------- this is simply twice toasted bread. Oysters with the hard part removed. At this period we may administer cautiously & experimentally eggs, when examined these seem to be very nutritious but disagree with many people. The white is more delicate than the yolk as the later contains not less than one third butter substance, give the white beaten with milk or poached in water. Food is any substance that will maintain life & produce flesh when taken into the body. It is often necessary to add alcohol & the quantity required cannot be told as in some cases of typhoid very much is required, in some 2-4 ounces will be sufficient while in others 16-20. When taking too much the odor may be detected on the expired brea
[page 47v V.2]
One of the most acceptable stimulants is wine whey & where there is constant vomiting a teaspoonful of this can often be given & retained when others fail. To make (for Dr. DeLand) take one part sherry wine to four of milk, put this away like the milk. In cases of irritable stomach it may often be given with crushed ice, so can dry champagne. Carbonic acid is often used & we may obtain a syphon at a drug store. This is simply water charged with carbonic acid, add one third the quantity to the milk. Never keep a basin where a nervous patient can see it (the one they use to vomit in). Sometimes it is impossible to give food by mouth then we must resort to other means. The inunction or rubbing of oil into the skin is very valuable. Olive oil or cream of butter may be used and be sure to have the butter fresh from one to two ounces may be rubbed in & made to disappear entirely. Then nutritious enemas are often resorted to the syringe ought to hold&
[page 48r V.2]
the proper amount. There is one made of metal that is entirely under the control of one hand milk, here is again preeminent & begin with one or two ounces & increase as the patient becomes habituated to its use. The addition of cream will increase the value of the enema. Brandy may be added if stimulant is required. It is of enormous importance to have rectum retain the enema so great care must be taken both in the amount & in theadministering. If it irritability begins diminish the quantity & frequency. Brandy is a local irritant & will often cause the whole to be rejected. The following is a good recipe for a nutritive enema. Two fzs [fluid ounces] peptonized milk fzs of cream, 2 or 3 fzs of brandy every four or five hours. Blood used to be given, but is used very little at present as it decomposes so rapidly. Broths of different kinds are also good. Told us the same about beef tea as I have written so often.
Most
[page 48v V.2]
Food & Its Digestion By Dr. Bruen 12-18-‘88
In feeding patients we must remember that they themselves or some of their relations know more than either Dr. or nurse. The following rules suit the majority but we must flex them to suit each persons tastes, for what is harmless for one is injurious or has a different effect on another both in medicine & food. Digestion is a complex process which begins as soon as food enters the mouth. The act of chewing causes the salivary glands to secrete a fluid called saliva, this is emptied in the mouth. When in health this is present in a normal quantity. But there are certain conditions when it is lessened a febrile condition is one. The stomach is an organ of various size the gastric juice is secreted by it, which is only secreted during the periods of digestion, between these periods, the stomach is empty. In fever this is diminished also. We should not eat when we are tired as the stomach will not&
[page 49r V.2]
very sweet drink of punch or lemonade to a case of phthisis they have a sour stomach caused by the fermentation of the sugar, if we omit this the drink will be beneficial. Digestion is carried on in the small intestine which is 18 feet long, the large one is 4 or 5. The conversion of the starch foods into grape sugar is begun in the mouth & finished in the small intestine by the action of the pancreatic juice secreted by the pancreas or sweet bed, the bile is secreted by the liver & empties in the small intestine near the beginning of it as it acts on the food also. Absorption is done by the large intestine & can be done injuriously. When feeding by the rectum we must give food that has been predigested or is capable of absorption. Said we could readily see how injurious it was to allow constipation. Sugars are digested in the mouth. Cane sugar is very good when it is converted into grape sugar in the mouth but is apt to cause fermentation if it en
[page 49v V.2]
If disease of the pancreas or liver is suspected, the stools are examined to see if undigested fat is present as that will follow a deficient supply of these fluids. If the starch foods are not digested there will be a fullness of the stomach. The principle food for the support of the body are digested in the stomach, these are the albuminoids, meat, milk, eggs, fish are the constructive foods of the body, we may starve upon starch foods as it & fats supply largely the heat of the body & tend to make fat. The albuminoids are the food for the sick. In health we required a mixed diet, to increase digestion. In fever we must remember that all the secretions of the body are deficient, medicines are given to evoke these juices. That is the reason why foods are taken that will be of the most advantage. Told us all about milk & said we must only use peptonized milk & lime water temporarily as all these things tend to throw the stomach aside, a pinch o
[page 50r V.2]
patient weighed when commencing to take it and again at the expiration of a week in order to determine whether they are being nourished or starved. Milk mixed with starches prevents coagulations or the formation of the unhealthy curd and promotes digestion. If fed upon a highly concentrated food for a long time, the bowel is not distended enough to allow it to contract & so causes constipation. All milk as soon as it enters the stomach is curdled but not in a solid mass each one is as separate as flakes of snow.
Condensed milk cannot be given to adults for any length of time, to bring it up to have a proper amount of nutriment so much as to be added to the water that it is too sweet to be used. Would not give it to children over six months old. The cooking of albumen spoils it just in proportion to the time we cook it. Broths contain only a very limited supply of nourishment & are considered only a pleasant change. Always use rare meat. In diar
[page 50v V.2]
Starches should not be given to whose digestion is impaired or only in very small quantities & then very well cooked for this breaks up the starch & helps digest it. Throw it aside entirely in fevers also sugar or use it very cautiously. Do not give fat where there is fever even in the fever of phthisis. Water is never objectionable unless too cold, water of a right temperature assists digestion but ice water retards it. The only wine that is really of much use is dry champagne this contains a large amount of carbonic acid so it is understood why this can be given, almost all other wines ferment. Alcohol is a food as well as a stimulant in acute disease, but only that for a time it prevents the wear & tear of our system. It is of no use in chronic cases. Generally dilute it well, but after hemorrhage from any cause whatever or in the nausea which follows ether, this is caused by a want of blood in the brain. Sometimes brandy on cracked ice will pav
[page 51r V.2]
times.
M.V.C.
Excellent 8
[page 51v V.2]
1-8-‘89
Prof. Ashurst on the duties of a nurse at Surgical operations
We have a threefold duty first the preparation of room and patient, the assisting at the operation & care of patient after. We may have to say what room if it is convenient not overlooking neighbors or disagreeable in any way have the light from the north then we will not have the direct rays of the sun, have the room properly heated or may take cold & die from pneumonia. 70 or a little above some operations for instance tracheotomy requires a warmer room 75. Take away all superfluous objects both for convenience & the germs that are opposed to antiseptic surgery that they may contain. We must be careful & not distress the patient on this as many other duties that we may have to perform our zeal must be tempered with judgment. Have table or bed prepared just as we&
[page 52r V.2]
anesthetic has been administered. Be sure and have an abundance blankets for use during operation & afterwards, as many die from not being kept warm enough while exposed during operation. If it is a capital operation have an old blanket or a tray filled with sawdust to catch the blood. We must have hot bottles or bricks (anything that will hold heat) wrapped in blankets. Have stimulants at hand brandy & whiskey are the best. Ask Surgeon what kind of dressing will be needed before to avoid anydelay at the time. Have room thoroughly cleaned & use an antiseptic spray if Dr. says so, either car. bichlor. To prepare the patient, give laxative the day before & it may be necessary to give a simple enema in the morning. Urine must be passed just before the operation use catheter if necessary. If it is practicable have the shave the part before the ether is given, do everything that can be done always to lessen the time that they have to remain
[page 52v V.2]
case only put one arm in the night dress & be sure & have the one exposed that is to be operated upon. Wash the part with turpentine. In fact, prepare just as we do all the time. If operation is before noon, give only a glass of milk or cup of coffee or tea, if later in the day give a light breakfast. We can influence those that we come in contact with & often cheer & encourage them. We must always be dignified & grave never forgetting that all we are trying to do is for the good of the patient. We must wear clothing that will not rustle or deter us from getting around quickly, avoid both levity and grief. A surgical nurse ought to be strong as they often have to lift & hold a limb while it is being amputated, this must be held steadily & a little inclined. We must be patient with Drs. as well as patients. We must have moral & physical endurance & we must be self-forgetting & self-denying. We may have to get the instrume
[page 53r V.2]
artery & hemistatic forceps, sutures & ligatures, scissors curved & straight drainage tube retractor with two tails where there is only one bone to be cut, three tails if below the knee or elbow. Begin with the saw at the left & lay them in the order named. For a solution to put the instruments in, carbolic is preferable because it does not corrode, we may use a large meat dish or a waiter to hold them, use 1-40 carbolic. Catgut must not be forgotten chromosized or prepared with the oil of juniper. If the silk is not provided & we have to get it do not cut it to waste & hank or skein will cut twelve lengths unless it is to be used for hemorrhoids, then it must be twice as long. Wax silk with beeswax to prevent tangling. Lead suture is good for if there is much swelling of the part, they will break, if silk is used it is usually black as it can be seen needles sharpened on both sides are t
[page 53v V.2]
clean and soft. If a splint is needed, we must have it padded & it if nice to cover it with silk oil cloth. We may have to give ether after the patient is once under the influence of it. As long as the face is Red the patient is doing well, but, if the face becomes Blue or ashy, suspend at once. When chloroform is being given if pale, do the same. Watch the breathing & if it stops put the thumb back of the jaw & press forward if that will not restore it pull the tongue forward. Nasal stertor is of no consequence but laryngital that is very dangerous. In cases of excessive stertor, dip towels in cold water & slap in the face. It is well to have a battery at hand. In cases of asphyxia from chloroform invert the patient, it is sometimes necessary to hold them up by the feet for 30-40 minutes. The side to be operated upon must always be next to the edge of the bed or table. If wet towels are used we must be careful & not let them touch the pati
[page 54r V.2]
tourniquet may be used and be sure to have it strong, clean & dry. The latter to prevent it from slipping. To apply this, make a pad of the end of a roller bandage then 2-3 turns around the limb & place what is left of the roller obliquely over the pad so as to be sure we secure the pressure on the artery. Have dressing large enough to cover all of the wound & put antiseptic paper between the gauze to make the discharge diffuse itself over all the dressing before communicating with the air. The rest of the dressing is the same as we use all the time. Oil instruments before putting them away. M.V. Clymer
[page 54v V.2]
The Nursing of Pulmonary Disease
By Dr. Musser
The bronchial tubes, lung structure, & pleura all have disease of their own, separate & distinct. There is both acute & chronic bronchitis. Asthma is spasms of the bronchial tubes. The one disease of the lung structure is pneumonia. Pleurisy is a disease of the pleura, this is the membrane that lines the chest, water air or pus may get inside this cavity, if the later it is empyemia. Children contract bronchitis from cold & it is very quick in its action & the symptoms (unless one is on the alert for them) are not marked enough to attract the attention of an ordinary observer. The symptoms are quick breathing, little cough prostration often accompanied by a stupor which if the child is aroused from it will quickly fall into again. It develops so gradually that one hardly notices it & i
[page 55r V.2]
pulmonary disease develop differently from adults. Not with quick breath fever & pain in the side. There is a passive congestion or very low form of pneumonia, this may cause the heart’s action to be very weak. In old or insane patients the symptoms may be a little increase in breathing, little cough little fever at night loss of appetite restlessness, drowsy, pulse does not necessarily increase so we cannot always judge by that. If the tongue becomes dry & brown, we can be sure a low form of pneumonia is progressing & we must always let a physician know as soon as we see these symptoms. These are four or five symptoms common to all these diseases. In addition, we have hemorrhage. In consumption or tuberculosis, we have pain, cough, shortness of breath often accompanied with hemorrhage. We can do many things to alleviate a cough for this is a very trying symptom to infants, old people & weak & debilitated. Just simple draughts of hot&
[page 55v V.2]
In hot water. Flax seed & irish moss tea are good & may be rendered palatable by the addition of lemon juice. Sometimes an inhalation of steam from simple hot water is very soothing. Gum Arabic water is very good. Compound lime of benzoin (or Turlington’s balsam as it often called) is very valuable remedy. Give a teaspoonful of this in on the top of hot water creasole may be used. These five are the best that we can use. There are various applications that can be made to the chest. Mustard plasteis hot-flannel or plate wrapped in flannel & place on the chest. Poultices should on be used under Drs. care. The dangers of poultices arise from the moisture. A hot water bag is one of the best ways of applying heat to the chest & relieve cough or irritation. Anodynes in disease of the lungs both in children & old people are dangerous. They depress the nerves of respiration which are using every effort to to throw off the carbon & obtain&
[page 56r V.2]
is danger of carbonic acid poisoning. So we must never resort to opiates unless Dr. orders it. Shorten of breath is common & is due to accumulation of of phlegm or inflammation of the air tubes the inflammation causes the lessening of the culibre of theair tubes. In middle life we can throw off the phlegm & so the tubes do not close so much. This is the reason why adults can do not have the same symptoms as children or old people. To relieve shorten of breath we must give stimulants that stimulate these organs. Hot brandy or ammonia & hot water Hoffman’s anodyne (compound spirits of ether) is a most valuable remedy especially for old people, but it cannot be given to children (or infants) give in doses of one half to one teaspoonful, ammonia five to forty-five drops. Heat applied externally stimulates the respiratory nerves. Turpentine liniament or hortshorn or chloroform liniment are all valuable remedies. Turpentine stupe is another
[page 56v V.2]
a good lineament [liniment] may be made by taking one cup of vinegar, one egg, one half cup of turpentine & shaking them well together in a beer bottle. Pain is usually in connexion with pleurisy & is caused by the rubbing together of the inflamed parts of the pleura all of the outward applications before spoken of may be used.
Hemorrhage seldom occurs but in consumption although it may occur entirely independent of the lungs & we may often encourage a patient that has had hemorrhage by telling them this. There are some diseases of the heart that hemorrhage relief relieves. Blood that comes from the lungs is Red & frothy. Examine the back of the throat & see if you can see the point where the blood is coming from. A person that is suffering from hemorrhage is usually very much agitated & the cough & breathing must be quieted to do this we have to give opium. Paregoric in doses of a teaspoonful every half hour until&
[page 57r V.2]
be of great service. Always have patient lie down if it is possible or as near it as you can. Then instead of heat use cold. The ice pack or cloths wrung out of very cold water. Gallic acid is sometimes given in ten gr. doses. Ergot is also used Astringents are of very small service except where a healthy person has a hemorrhage then these may all be of great service. Always have the bowels relieved at once when a healthy person has hemorrhage by means of enema. People seldom die when having a hemorrhage.
M.V. Clymer
[page 57v V.2]
Obstetrics By Dr. Hirst
The lecturer thought we could be taught this kind of nursing much better practically than theoretically. But there are a few points that we ought to know the theory of. There are many little things that we must use our tact about. We must bear in mind that a woman during pregnancy, labor, & after confinement is very much like a little child in nervous irritability. One thing is very important & if we realize how important the use of antiseptic measures are in surgery it is even more so in obstetrical nursing. For a woman after confinement is very much reduced, the blood has undergone a change & contains less of iron & salt & all the nutritive qualities thereby inviting the entrance of the microorganisms. One way is through the discharges which are made up of blood & if any of this is allowed to return by any carelessness it comes in contact with the raw surface of the whole genital tract, &
[page 58r V.2]
use of these measures it was almost impossible for a woman to be delivered of a child in a hospital it was more dangerous than laparotomy is now & where one out of ten died, the mortality is one hundred fold less now & a ward if properly managed is the best place to be delivered. The measures to be taken in a ward after child birth. Wards. First Septic infection occurs by the germs coming in actual contact with the raw surfaces. May be carried by the fingers of Dr. or nurse, by the bed clothing, & even by the atmosphere. Three may be delivered then the ward must be cleaned out. Move the blankets with the patient to the convalescent ward. Then shut the doors open the windows & clean the room. The bed must have mattress covered with a rubber sheet tied fast to the bedstead then a linen sheet, every time there must be a tag put on this in order to tell how many times it has been used & after using ten times, the mattress must be torn up, over&
[page 58v V.2]
like we do a slip sheet this can be taken away & leave the bed clean without turning the patient, sheets must be changed twice a week if necessary change oftener than this. Everything that has come in contact with the blood or any kind of discharge must first be soaked in a solution of washing soda or potash to remove the stain & then placed in a solution of bichloride of mercury, 1-4000. Over the first A piece of an old blanket a small piece of rubber put the rubber under the blanket, the latter must be folded into a pad, & a canton flannel napkin put over it to absorb all discharge. This should be about three feet square & should be change every four hrs. during the 24 following the birth. The antiseptic preparation before consist of a bath as soon as labor commences, & if there is a discharge from the vagina a douche of bichlor. 1-2000, as the discharge may be such as will injure the woman & destroy the childs eyes. It is of the
[page 59r V.2]
clean, they must not only be washed but scrubbed with a nail brush. The best soap for this purpose is the soft potash soap that we can get at a drug store. This is almost as strong as a disinfectant as Bichlor best to dip hands in Bichlor 1-2000 after using this soap. All metallic instruments must be clean by carbolic as Bichlor corrodes. As soon as the placenta is expelled give a douche of 1-2 quarts of Bichlor 1-24000 with a fountain syringe & glass tube. Everything that is soiled must be taken from the room at once. We must keep the skin clean from blood as blood is an animal matter & full of microbes. Do not use sponges but something that can be used once & then thrown away. Dr. Hirst prefers burnt or baked cotton. Place a roll of it in the oven & let it remain until the outside is quite brown. A tin box that will close tightly is best to keep it in. use a piece of it once dipped in bichlor & then throw it away. Glass t
[page 59v V.2]
they ought to be cleansed with some disinfecting solution. Another subject that there is great danger of is hemorrhage we must always be ready to recognize this, veins are torn across that are as large as the jugular vein & if it were not for the great contraction of the uterine muscle every woman would bleed to death. To assist this contraction make pressure on the abdominal wall over the uterus with the hand. This is all that is required usually. The symptoms of hemorrhage here are the same as in all secondary hemorrhage. Another accident & one that comes very suddenly is convulsions. Like a child any serious difficult is often ushered in by a convulsion. The premonitory symptoms are a sharp headache, failing vision, often see double, pupils contract, dilate during the convulsion. These symptoms last for a very short time. Then the mouth twitches eye is drawn down arm drawn up over the chest this is followed by a violent convulsion. The only thing to
[page 60r V.2]
through. The handle of a tooth or hair brush with a handkerchief or towel wrapped around it & put back between the teeth will prevent this from happening & these are usually at hand. Always send for the Dr. at the first approach of their symptoms. The Dr. usually allows a skilled nurse to tie the cord & although this is easily done it is important that it be properly done. It may be tied right at the time but after giving the baby the tape or whatever the Dr. has it tied with may become lose & so allow hemorrhage to occur. A safe way is to tie an ordinary surgeons knot then pass the ends around & tie in a bow knot opposite the first knot until after the bath has been given then untie the bow & leave the original if it is right. To cut the cord take it between the middle fingers of the left hand & direct the scissors toward the palm of the hand & so avoid clipping anything but the cord. A newly born baby is a very
[page 60v V.2]
clean. It must first be well greased with cosmoline or sweet oil as the cheesy varnish it is covered with is perfectly soluble in oil. Then it must be washed some Drs. prefer having them put in a bath others do not. Dr. Hirst does. be sure & oil the scalp well & all the creases of the skin. The temperature of the bath should be 98 it had better be too cold than too hot as the latter will cause convulsion & death ensue. Test a bath with the elbow as hands become accustomed to heat and are callous. Use as few pins as possible & always use safety pins & do not make clothing too tight. Busy Drs. fail very often to tell a nurse when the baby ought to be nursed. Just as soon as it is washed although there is no milk it is of great value in three ways it learns baby to nurse, draws out the nipple & as there is great sympathy between breast & uterus, it assists uterine contraction. During first 48 hrs. put it to the breast every 3 hrs. Afte
[page 61r V.2]
at night, think eleven p.m. & five A.M. are the best hours then all can have six hrs. uninterrupted sleep. A baby can be taught very early regular habits regarding food & sleep.
Mary V. Clymer
Most Excellent 10
[page 61v V.2]
Temperature Fever Respiration & Circulation
By Dr. Osler
If you heat a bar of iron to the temperature of 98 & then expose it to the air & it will gradually cool to the temperature of the surround air. Not so with man the heat of whose body is 98 normal & is retained there or between 98 & 100. This is a remarkable feature of the higher animals. Man may live in a cold climate or in the tropics & his temperature is the same. It is kept so by means of the process of oxidation inside the body. We take food which is digested & taken to all parts of the body & consumed or burned. It is this consumption that keep up the bodily heat. The temperature is constantly kept so by the combustion or oxidation in the interior of the body. There are three ways or means of so doing, 1st the skin 2nd the kidneys 3rd the lungs. When the external temp. is high there would be too much heat in the body, b
[62r V.2]
of heat the temperature is kept ever between 98-99 any disturbance in the heat production or regulation or both cause an increase which we call fever. Fevers are of various kinds. 1st Continuous fever is where the temp. never sinks to normal during the whole course. Typhoid is a type of this. Also of the 2nd. Remittent is where the temp is not retained at the same height there are remissions but it never falls to the normal. It may be 103 in the evening & 100-101 in the morning, this is called exacerbation. 3rd Intermittent is when the temp. sinks to normal & remains so for some time & then rises again. There is a distinct remission. Ague is a good instance of intermittent fever. Temp sometimes rises every day sometimes every other day for a few hrs. to 104-105, these rises are called paroxysms. We estimate fever by the hand but better by the clinical thermometer held in the mouth or axilla & sometimes in the rectum,
[page 62v V.2]
than the external. Fever is an exaggeration of the temp. of the body. The furnaces are overheated or ventilation has been cut off. Sometimes the temp falls below normal, it is not unusual at the termination of typhoid fever for the temp to be 96 or 97. The morning temp of consumption often is 96. debilitated people or those suffering from the effects of poison Alcohol, Opium & [blank] the temp. falls as low as 95-96. These are called collapsed temperatures. Circulation has for its object 1st the distribution of nourishment to all parts of the body 2nd the removal ofwaste material. For this purpose there is a central pumping engine & distributing pipes, the station is the heart, the pipes the bloodvessels. The nourishment is carried to all parts of the body by these pipes or arteries which form a system of elastic tubes & into these the heart pumps the blood, each pump drives into them a certain amount which ex
[63r V.2]
the main tubes 3rd the capillaries a system of minute bloodvessels 3000 of which would only cover an inch if packed close together in these tiny vessels the nourishing part comes in contact with the air all parts of the body. From these the blood is collected by a 4th set of vessels, the veins these are wider than the arteries & do not pulsate, the blood is taken in through the arteries & out through the veins. The heart has four chambers two auricles & two ventricles, the ventricles are the largest & have thick muscular walls because they have to do the pumping between the right auricle & ventricle is the Tricuspid orifice, between the left Aur. & Ven., the Mitral orifice. The left Ven. is connected with the aorta & leading from the right Ven. a smaller orifices connecting with the Pulmonary artery. The course of the blood then is from the left ventricle to the aorta & its branches, the arteries, then to the ca
[page 63v V.2]
orifice to the right ventricle from there by the Pulmonary artery into the lungs where it is purified & returned to the left ventricle through the Pulmon vein. The number of throbs of the heart vary according to age, infant’s pulse beats range from 130-140 per minute 1 year 120 Adults from 72-80. (Another lecturer told us from 68-72). It is more rapid in women than in men. It is increased by positio, the rising from the recumbent to the erection posture will increase it 15 beats per minute, exercise, food, fever, the various emotions. The emotion of fear may be fainting which is a temporary enemia of the brain. Place in a recumbent position head lower than feet allowing the blood to flow by gravity, therefore more freely. The refuse or waste matter is got rid of by three chief means. Kidneys skin and lungs, this waste matter called excreta if kept in the body would be detrimental. It is of two ki
whose function it is to get rid of the Carbon & take on oxygen they are placed in the thorax & communicate with the air by the Larynx & wind pipe which divides & the air passes to all parts of the lungs, the taking in of the air is a muscular action called inspiration, that forced out is a passive action called expiration. The ultimate structure of the lungs is of tiny little spaces or cavities, in reality air cells which have a thin covering or sac, on the walls of the sac are numerous minute capillaries so that the blood comes into the closest possible contact with the air. The blood is a clear fluid in which float small corpuscles a few being white, the most red & it is the red ones that give the color to the blood. these corpuscles which are small enough to pass through the capillaries represent a little boat which has to carry a certain cargo when the blood is driven out each&
[page 64v V.2]
oxygen the blood is red but as soon as they exchange for Carbon de oxide it is blue or the color of that in the veins where it is called venous blood. This carbon must be got rid of or it poisons the system, hence it is sent to the lungs where the little boats unload the carbon they have gathered through the veins & take on oxygen when it is changed at once to red. If from any cause the air cannot reach the blood, as in Diphtheria, food fast in the throat, Pneumonia or inflammation of the lungs & the patient becomes blue it is due to the corpuscles being overcharged with carbon di oxide & not being able to exchange & the result may be failed. Copied from Miss Brobson’s.
[page 65r V.2]
Disinfection & Disinfecting
By Dr. Horatio Wood.
Preventive medicine has nothing to do with Antiseptics. Acute disease is the presence of a poison in a body. Contagions are living. Miasms are noxious emanations, not living 1st Organic germs are multiplied in the body. The Small-pox germ for example. 2nd Comes from without & does not multiply like Intermittent fever or ague. 3rd Alkaloids or gases come from sewers, & such act like strychnia or other poison. Remedy. Remove the source. Remedies for these different germs are known as Antiseptics & Germicides. Anti. kills the individual germs of disease. Salt as an anti. kills putrefaction. Germicides are all anti. but all anti. are not germicides. Some of the anti. that are not germicides are AlcohAlcohol, Borax, Salt, Lime (Chlorine, Carbolic acid & Corrosive Sublimate are both). Nature disperse
[page 65v V.2]
The place to fight germs is where they are produced. Miasmatic poisons or germs are produced often by stagnant water & filth in low places without any way of changing it or making it pure. The only way is alter the conditions of production. The Typhoid germ is contained in the passages from the bowels. While Scarlet fever is in the breath & urine. Always have a disinfectant in the vessel before receiving any of these discharges & it is killed at once. For filth use something that destroys & makes it innocuous at the same time. That it is prevent poisonous gases from arising. Don’t use an Anti. as this only purifies the outside while the large mass may be reeking with germs. Lime is the best for filth if there is no germs. If there are germs, use lime & plaster of paris this keeps it dry & prevents gases from arising. Excessive heat is the best germicide we have & moist is surer than dry. Cold kills Miasmi 140 moist heat kills&
[page 66r V.2]
to be spread out thoroughly, 212 will not kill the spoor of germs but the addition of salt will make it more effectual. The way to disinfect is not to have any superfluous articles in the room like sofas & wardrobes in the first place. Then have everything scrubbed, not washed but thoroughly scrubbed. Car. acid is of the least value. Corrosive Sublimate & Chlorinated lime are the best. First go over everything with water, then a solution of bichloride 1-1000 or 1-500 use no soap until last and then use plenty of it. Tie up the bedclothes & plunge them in boiling water, keep them there long enough to make them clean.
[page 66v V.2]
Dr. Hare. Poisons & their Antidotes
Drugs have a very different effect on people. They very often act in a very peculiar & untoward manner. Antipyrine produces a habit & sometimes 5 or 6 hours after taking it a rash appears which looks like Scarlet fever, or Measles. It is very hard to tell what a rash it. Measles are said to come in a crescent, while Scarlet fever is said to be pointed. Antipyrine may resemble either, remember this if it is given in large doses it changes the blood. Lips, ears, & fingertips may be blue. Antifebrin in small doses produces the same effect. The base of the nail is where the darkening first appears, watch this. Sometimes face looks as if they were choking. Salycilic acid for rheumatism produces same symptoms. This will cause collapse or a great fall of temperature. Urine becomes of an Olive Green this comes sometimes before the temperature falls. Iodoform causes fatty degeneration of all the tissues &&
[page 67r V.2]
of this remain even after its use is discontinued with the dressing. The poisoning from this drug resembles meningitis or concussion of the brain. Contracted pupils, high fever, Stertorous breathing. If a surgical patient has these symptoms remember whether much of it has been used on the edges of a wound. Examine urine sometimes high colored & sometimes the reverse. Where delirium occurs it is screaming delirium. Meningitis is muttering delirium. Iodine poisoning always dark urine. All people have idiosyncrasies toward some drug. Quinine will cause rash with some people while other it will make blind & deaf. If rash appears on a child always find whether it is taking quinine or not before saying it is Scarlet fever or measles it also causes congestion of the brain & Gastritis. If taking it for malaria stop it if congestion occurs. In all cases of poisoning keep up external heat. Always apply the first over the abdomen. In Typhoid if
[page 67v V.2]
toward morning patent seems weak always apply heat. Carbolic acid is much used for disinfecting drains but it is of very little value & next to Prussic acid the most violent poison. Creosote is identical with it. Creosote is made from Beech wood and Carbolic from coal tar. If this has been taken we can tell by the odor on the breath, white lips, it spots the tongue they are white first then they change to brown in the center then outside of this white it is either Red or Purple. Then the tongue & roof the mouth is all puckered like the fingers that have been in a strong solution of Carbolic. Become unconscious or & respirations begin to fail, give salts at once no matter how long after the drug has been taken the antidote will find it. Give the same for lead poisoning.
[page 68r V.2] blank
[page 68v V.2] blank
[page 69r V.2] blank
[page 69v V.2] blank
[page 70r V.2] blank
[page 70v V.2] blank
[page 71r V.2] blank
[page 71v V.2] blank
[page 72r V.2] blank
[page 72v V.2] blank
[page 73r V.2] blank
[page 73v V.2] blank
[page 74r V.2] blank
[page 74v V.2] blank
[page 75r V.2] blank
[page 75v V.2] blank
[page 76r V.2] blank
[page 76v V.2] blank
[page 77r V.2] blank
[page 77v V.2] blank
[page 78r V.2] blank
[page 78v V.2] blank
[page 79r V.2] blank
[page 79v V.2] blank
[page 80r V.2] blank
[page 80v V.2] blank
[page 81r V.2] blank
[page 81v V.2] blank
[page 82r V.2] blank
[page 82v V.2] blank
[page 83r V.2] blank
[page 83v V.2] blank
[page 84r V.2] blank
[page 84v V.2] blank
[page 85r V.2] blank
[page 85v V.2] blank
[page 86r V.2] blank
[page 86v V.2] blank
[page 87r V.2] blank
[page 87v V.2] blank
[page 88r V.2] blank
[page 88v V.2] blank
[page 89r V.2] blank
[page 89v V.2] blank
[page 90r V.2] blank
[page 90v V.2] blank
[page 91r V.2] blank
[page 91v V.2] blank
[page 92r V.2] blank
[page 92v V.2] blank
[page 93r V.2] blank
[page 93v V.2] blank
[page 94r V.2] blank
[page 94v V.2] blank
[page 95r V.2] blank
[page 95v V.2] blank
[page 96r V.2] blank
[page 96v V.2] blank
[page 97v V.2] blank
[page 98r V.2] blank
[page 98v V.2] blank
[page 99r V.2]
New York Nipple Shield
Manufactured expressly for Hagerty Brothers & Co. No. 10 Platt St. New York
Pineapple Sherbet Miss Picker’s Recipe
Chop one pineapple fine. add one large cup of sugar let it stand for a while. Pare three lemons. Pour one pint of hot water on the rind. To the juice of the lemons add one pint & a half of water & two cups of sugar. Put the pineapple through a sieve add the lemonade & the water off the rind just as it begins to freeze add the whites of six eggs beaten to a stiff froth, freeze hard.
To prepare arrowroot Food for children
Take four ounces of water, let it come to boiling point. add one teaspoonful of arrowroot made into a paste with cold water. as soon as it boils add twelve ounces of milk let it come to a boil. add a little salt & sugar.
[page 99v V.2]
Mrs. Holcombs’ Recipe for yeast for medical
Get a pint of brewers yeast 1 qt of water & a large handful of hops 1 small teacup of malt (get it at brewers or drug store) boil this all together rye flour enough to thicken a little, use wheat if you can’t get rye, ½ teacup of brown sugar, teaspoonful of ginger, tablespoonful of salt, let it cool then add the yeast let it ferment & bottle, cork tightly.
Poultice. Cook oat meal very soft let it cool, add yeast. put a few drops of turpentine if the bowels are swollen. pour some laudanum over it & if bowels are very much swollen sprinkle pulverized charcoal over it. If the patient is an adult, put a mustard plaster on & let it redden the skin then use poultices & linment alternatively. Liniment ½ pint Brandy, 3 teaspoonfuls of Turpentine, 5 tea. of laudanum, 4 “ [teaspoonfuls] of sweet oil. Put on a flannel and apply warm.