F

BATHING IN TYPHOID.

RANK S. MEARA, in the Journal of the Medical Sciences, thus describes the technique of bathing the typhoid fever patient:

The patient's nightshirt is removed, his genitals covered with a napkin, bound about the body, or the whole body covered by a sheet, under which he is bathed, which later method is a little more awkward. He is given a half ounce of whisky, or a cup of hot strong coffee (4 ounces), the face bathed with cold water, a folded bandage a couple of inches wide, bound around the forehead and tied below the occiput, to keep the water applied to the head from running into the eyes and streaming down the face, and he is then ready to be lifted into the bath. To do this, the best way is for one attendant to rest the patient's head on one arm while he raises the upper part of the body by lifting under the shoulders, while another attendant lifts the lower extremities, the patient being requested to stiffen himself out.

Another method, which has advantages if the patient is very stuporous, is to spread a hammock netting under him or a strip of canvas with straps tatached, and lift him on this into the tub and by the same means out of it. The head should rest on a water-cushion ring or air-ring.

As soon as the patient is immersed in the bath, the equally important part of the procedure is begun-the friction, gently applied (not kneading) to all parts of the body except the abdomen. The back must not be forgotten. At intervals during the bath, cold water, at 50° F., should be poured overe the head. While in the bath the bed should be prepared for his reception, by placing on it a double blanket, on the side he will

occupy; a pillow is covered with a towel, the blanket is covered with a linen sheet, and hot water bottles are placed at the foot.

The patient is then lifted onto the bed, the napkin is removed, and he is surrounded by the sheet, the edges an ends being tucked about the neck and under the arms. He may be allowed to

lie in the sheet for five or ten minutes and then dried with soft towels, or more immediately if the temperature is low and he is shivering. The tub is best emptied by a siphon.

The temperature of the water Brand set at not more than 70° F., and not less than 65° F. The frequency he advised was every three hours, if the rectal temperature was above 102.5° F.; the length of the bath, fifteen minutes. These rules laid down by Brand have met with but slight modifications where satisfactory results are obtained. Slightly lesser temperature of water is used at times, a little higher temperature of the body taken as the indication of the bath, and the initial bath begun at a milder temperature. St. Luke's Hospital, in New York, the tub bath is given at 80° F., and in selected cases as low as 70° F. The bath is continued fifteen minutes. It is given every four hours, if the rectal temperature is 103° F. At the Presbyterian Hospital, in New York, the tub bath is given at 85° F. for ten to fifteen minutes, at four-hour intervals, if the body temperature is 102.5° F.

At

It is fully appreciated by the advocates of the Brany system that the reaction to a bath at 65° F. cannot be anticipated in markedly toxemic cases, so that a patient seen in the third week or latter part of the second, who is very toxic, should be subjected to a bath of higher temperature (75° F. or 80° F.), and for

a shorter time. Our hospitals rarely get patients in the first week, and the higher temperatures adopted are better suited to their class of cases.

If a tub bath cannot be obtained, a substitute for one can be constructed in the bed by running a clothesline around the bed, at a suitable height above its level, attaching a rubber sheet to it by clothes-pins, thus making a tub of the sheet. Other contrivances can be resorted to, to approximate a tub in the bed, as building around the sides and foot and head with rolled blankets, and the use of the rubber sheet as the receptacle for the water. When the patient is put in the water one expects a sudden shock, deep breath, and gasping. These are in themselves beneficial. The patient may shiver, the skin may be shrivelled, and the nails cyanotic, and yet not contraindicate the bath; but if the face is cyanotic, shivering marked, and chattering of the teeth occur, and the patient does not react well on being taken from the bath, then the next bath should be at a higher temperature and less long. Cyanosis of the face or threatened collapse should lead to immediate removal of the patient, warmth to the body externally and internally, and stimulants-hot coffee or hot whisky.

Many untoward symptoms in the bath are due to failure to appreciate the value of, and failure to apply properly the friction during the bath.

USE OF THE HOT WATER BAG.

Emily Bleazley, in the British Journal of Nursing, says: To make your bag last as long as possible never fill it with boiling water. The water may be quite hot up to 200 degrees Fahr., but not boiling, as it swells and cracks the rubber. Never fill the bag while the kettle is on the fire or gas; thus bringing the bag close to the flame and risking burning it. But take your kettle off. Stand it on one side for a few minutes, or quicker, add a little cold water, and then

fill your bag, first taking care to press the air out so as to avoid the splashes. The bag must then be put in a flannel cover and applied wherever required.

If the patient is quite conscious and able to move her limbs, etc., freely, she may, if she wishes, have the bag with its flannel cover next to her nightdress. But in cases where the patient is paralyzed, unconscious, under, or just coming round after an anaesthetic, the bags should never be next her, but must have a good thick fold of blankets between.

POINTS IN THE CARE OF THE
NEWBORN.

The Nurses' Journal of the Pacific Coast offers the following suggestions:

When urination is delayed immediately following the birth, try a warm sitz bath for the baby and give plenty of water, not too cold, to drink.

When the baby suffers frequently from colic and is troubled with rumbling in the bowels and general restlessness, an irrigation of the colon with salt solution, using a medium sized soft rubber catheter, will usually give relief. The solution should be injected a little at a time and continued till it returns clear.

The weaker the baby the more it becomes exceedingly important to prevent heat loss. To keep the baby thoroughly warm, to prevent chilling at any time, and to keep the supply of air pure, are all important points to be watched.

When the cord remains constantly moist a washing with alcohol, about 95 per cent., will help to improve conditions. The navel should always be regarded as a wound, requiring the most exact surgical cleanliness.

When the baby has difficulty in nursing, the application of a hot fomentation to the breast before each nursing, over the nipple, will help to lessen the trouble by bringing the milk to the surface.

A great deal can be learned as to the child's condition by carefully observing stools. The normal stool in the newborn

is dark green for two or three days, gradually becoming brown. The change from brown to yellow is gradual, and by the end of the first week the stool should be a golden yellow. When a baby is not getting sufficient food the color of the stools will remain brownish rather than yellow.

A CASE OF CONVULSIONS.

Dr. A. K. Gordon, in the British Journal of Nursing, admonishes that when the nurse sees a patient for the first time after any fit, she should endeavor to obtain a specimen of the urine for examination, as a convulsion is not infrequently the first sign of grave disease of the kidney, which has not previously given rise to any symptoms except general ill health. If the urine be not examined, it is quite easy to mistake the case for one of epilepsy or even hysteria. This error is a very grave one as far as the patient is concerned, for it means that no attempt would be made to eliminate the uræmic toxins by hot packs, and

so on.

It is also very important that the nurse should observe-when she sees a patient in a fit-in what group of muscles the convulsions begin, and whether they are confined to that group or become generalized. Convulsions that begin and remain in one part of the body point to the existence of an irritant, which is annoying one particular part of the brain, so, in such a case we are often able to determine what part of the brain is affected, and if that part is in an accessible situation, it may be possible to cure the patient by removal of the irritant.

THE "NEIGHBORHOOD SYRINGE." The Bulletin of the Indiana State Board of Health prints a timely satire on this subject. Where, it inquires, is the neighborhood syringe Have you seen it going the rounds? Of course you have,

for you just passed Mother Smith with it under her apron, yet enough of it exposed for your experienced eye to recognize. Mrs. Smith had just been to neighbor Brown's and had there borrowed it to take home to give her daughter, Matilda, an opium and starch injection for the bloody flux. How busy it is kept.

What a time-honored old rubber pump it has become! What a varied service it has rendered. How often it has fought the field of constipation, and brought the obstinate, tight, refractory, and pelletpelted bowels to a generous laxation! How often it has faced the dangers of the unseen micriscopical world, and flushed away, and scattered the enemy without knowing even the A B C of the germ theory! How often it has successfully succeeded in deluging a colony of gonococci who felt their vaginal haunts of stygian darkness well nigh impregnable, and the fluted, tucked, strictured and tortuous spermatic outlet past finding for a through passage! How often is rhythmic gushes, in blissful ignorance have prevailed on theappendix vermiformis to nestle down and be good, the growing host of appendix amputators saith not! Its watery broadside projected against the ubiquitous communis. coli, and its defensive and offensive douching of the nasal cavities for catarrhal affections real or imagined, are to be mentioned among its exploits.

Brave old battle-scarred squirt gun, having had a personal acquaintance with grand pere and grand mere, the parson and the harvest hand, Aunt Betsy nd Mary Jane, sweetest Susan and rollicking Tom, and the children including the babies, thou hast finally succumbed to valvular disease, a sort of endostosis, and also a touch of arterio-sclerosis. "Requiescat in pace."

Mild mannered, quiet, a servant of the people, accepted ever as a harbinger of peace, yet a thing of evil, a sower of disease, a secret Herod, and a constant offender against the surgical and sanitary

code of cleanliness, the high standard of medical science demands your demise.

What a history of neighborhood troubles and scandals this accommodating syringe would unfold in the laboratory of the bacteriologist, as layer after layer of it saccretions should become exposed to the high powers of microscopic vision, or be roused to vehement action by an agar-agar culture tube.

EFFECT OF COLD APPLICATIONS TO THE ABDOMEN,

From a summary published in the Hospital we learn that in the Münchener Medizinische Wochenschrift Dr. Riehl contributes an account of his researches to determine the effects of cold external applications in lowering the internal temperature of the body, especially in regard to the stomach. As the details of the experiments are of no particular importance to our readers, we give only the general conclusions. It was shown that ice-cold applications to the abdomen produced a lowering of the temperature of the stomach 1.8° C., or about 3.2° Fahr., while the rectal temperature was lowered about 2° Fahr. The author infers froin these facts that in herorrhage from the stomach it will be advisable to apply ice to the abdomen, because a fall of three degrees in the temperature of the stomach will promote the coagulation of the blood by reducing the quantity of blood in the gastric vessels and by its reflex action on the vaso-constrictor nerves. This is another instance in which scientific experiment has proven the efficacy of rational nursing methods.

STANDARD BREAD.

W. Harrison Martindale, of Marburg, thinks the physician may possibly be confronted with inquiries as to what "Standard" bread really is, what its advantages are and its disadvantages. At the risk of being told that this subject

has nothing at all to do with the chemist and druggist's work the following few remarks on these aspects of Standard bread may be offered. First of all the "manifesto" by some of the highest medical authorities defines Standard bread as "bread made from unadulterated wheat flour containing at least 80 per cent. of the whole wheat, including the germ and semolina." Those desirous of refreshing their memory as to the structure of a grain of wheat would do well to glance at the excellent diagram facing p. 266 in Jago's "Science and Art of Bread-making." The pictures showing the situation of the "germ" in the grain enables one to understand the reason why the germ is in great measure winnowed away by the roller process of milling. The above definition is quite comprehensive to us as chemists, but the word "semolina" might just as well have been omitted for the simple reason that it may refer to the most various products according to the fancy of the miller. Semolina of wheat is the hardest portion of the endosperm, and is obtained in a granular form by adjusting the rollers sufficiently far apart so as not to crush the granules. This is the semolina that we know any buy in the shops. It is usually prepared from the hardest wheats -i. e., those grown in Southern Europe. The modern roller mills convert the wheat into flour and "offal." Flour for Standard bread has ipso facto to be ground or crushed between the old-fashioned mill stones, thus the product retains the bulk of the grain. Most modern millers in London do not possess stone mills at all. Those who do have recently been putting the old plant to good account. The germ differs remarkably in composition from the other parts of the grain. I have placed side by side (from Jago) the amounts of certain constituents of a wheat mixture, the results of analysis of one of the semolina products-that coming from the second and third "breaks" of "flattened" germ from the same mix

cal values. Eminent physiologists have not been able to agree upon the subject.

Finished

Bran.

Phosphoric acid.

Fat

Cellulose

6.77 3.89 1.53

1.58 1.26 9.076
3.06 3.72 3.62 18.3

With regard to the mineral constituents of wheat, Allen (vol. i., p. 446) gives a table showing the percentage of ash in nine fractions obtained by grinding wheat containing 1.6 per cent. approximately of mineral matter. The first three products constituting fine flour contain 0.483 per cent., and these three products constitute 80 per cent. of the weight of the original grain, representing the composition of good "seconds" flour, and even when we add the next two products the "tails" and the "fine sharps" or "middlings" we only make up 0.723 per cent.-i. e., more than half the ash remains in the products called "coarse sharps," "fine pollard," "coarse pollard," and "long bran." We often read of the "bone-forming" constituents of this ash. Lime, it appears (Allen, p. 447), ranges from 1 to 10 per cent. Magnesium gives an average of 12.11 per cent. magnesium oxide. Silica in the ash rarely reaches 5 per cent., being usually less than 2 per cent. P2O5 constitutes an average of 49 to 50 per cent. of the ash.

Feeding experiments on animals have proved that white bread from which the germ has been extracted does not provide so much nutriment. It is quite conceivable that the removal of the whole of the bran layer which contains so large a proportion of salts (see table), and which may be deemed "bone-forming" constituents, is an erroneous proceeding. The chief difficulty regarding the respective merits of ordinary and Standard breads

A THERMOMETER RETAINER.

J. Leslie Barford, R. N., reports to the Lancet that he has devised a very simple preventive for the promiscuous slipping out of clinical thermometers from between the lips of careless patients. It consists of about 1% in. of stout rubber tubing of about 340 in. diameter, but with a very small lumen, such as forms the essential part of a Foulis' tourniquet. This ring is moistened and passed over the bulb of the thermometer for a distance of an inch or slightly more. Many thermometers have a natural groove here. When the thermometer is put in the mouth of a patient the ring lies between the lips and teeth and is a very material help in retaining the instrument even should the lips be slightly parted. The rings cost next to nothing-one spare bit of tourniquet tubing could be. cut up with a sharp knife into dozens of them. They can be detached with the greatest ease, but there is no obvious objection to their remaining on the thermometers and soaking in the disinfectant in the ward; but in this case a practical point is to employ a vessel with a brim wider than its base. Otherwise, in quickly withdrawing a thermometer, its ring may catch in that of another and drag it out of the vessel with disastrous results. This very simple device should prove useful in out-patient departments. or in establishments such as a boys' training ship, where the temperatures of more or less casual patients are constantly being taken. While in use in the sick bay of the author's ship not a single thermometer has been broken by being dropped from a boy's mouth-hitherto a frequent accident.