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Show LaLsl THE SPANISH I INFLUENZA H GENERAL. PIIEPADATION FOR M NUI18INQ At HOME S. O. f IiECTUIlES' NOS. 1 K AND 2 Hy TO YOUNG LADY VOLUNTEERS BHii , j? ' My DR. RiARGARET PATTERSON H" At Parliament Buildings, Toronto, H Taei'day October IB, 1018 B';v t' LECTTRB NO. GENERAL Kafah SYMPTOMS ' ' i H: Much 6f the tint two lectures ap- k' pitas to every bed case, but la in- Hf-t . . flueaia there are certain aymptoma Htv -we should look after, certain precau-K', precau-K', tloaa It la necessary ,we should take Hf.-)f ud tho more intelligently we can Hp' !?:;''' obeerre .our patleat. watch -for. ao H'r . . dcTeiopmeat C'tkeat ayatptoaa Ki ; tide ur; patleei .aloa without the Hp;k'- aywKoma ae-rokptag, tke more Vf S10 wUllke la the arlata. BjC ' ' - '-'.Wa'ara called upon fo" meet an HitBi; attrgeaey,' ' vary old disease that HL;Vrt - ' omnarattyely new to the present Mpj" generation, that haa ' very eudden k.4. , v oaaet la atott eaiee. la alraoat erery - aae w kara tk aymptomi of a cold B'vv''-' ;w,B h,'h (over; headache and body Hv -' ' spaiiiand a rapidly dereloplng feel-H feel-H A- Ing.of dleeorafort and (ullaeaa In the "y J bronchial tubea and throat. In tome 1 ' casos nausea or Inability to keep food Oh the etomach during the first fowdaye. Tlicso nro symptoms wo must bo prepared to meet, and wo must 'treat theao symptoms as thoy arfad . . . , i . i you may, find your patient suffer-j ing from nausea or vomiting. In tho absenco of a physician, I would nd-vlso nd-vlso you to give the patieno an apcrl-ont-caiomel followed by Epsom-eaiis Epsom-eaiis or something 'of that kind, and apply a "mustard plaster oyer the stomach. If you have a doctor, follow fol-low his directions. It you are making mak-ing a mustard plaster where you want quick action, as In this cafe, to relieve the acute vomiting, you should make It very strong. Take tho mustard and tho flour and mix In the proportion of two level tablespoonfuls of flour to one or two of mustard. Add enough water to make a smooth, rather moist paste. Then take a piece of gauie and spread your mustard, on one-halt ot the gaute and double tke other half over, turning In your edgea. and apply ti over the pit ot the'tWaiiinuet'below'thc "hWt. Keep'K-e. iihtii'thV'Utl.nt com-plaial com-plaial of the warmth oi until you aee the akin red underneath the plaster. Doa't leaVe fc& u.ur'it'c.t.'i'aiy irrltatidn of the skin, bat only until ' tat 'part la red.1 Always; keep yonr patient lying 'down In a' comfortable position 'in whlch-breathrng'Ms easy .and'wlth 'plenty of fresh air, and wearing' a loose, warm nightgown. You 'Should frequently wash the mouth and tongue. Keep tho mouth clean. After the bowels have, acted frAcly your patlont will probably be ablo to retain light nourishing, food and, of course, ' your patient' must j never bo given anything, biit very light, easily dlgestlblo food, if the ' patlont has much fever,-' give only liquids. ' V Another distressing symptom Is tho cough. It might bo a short and Irritating cough or It may bo a I , cough accompanied by a good deal, of expectoration. If your paUent has a cough there are several things you should observe. Notice its frequency fre-quency and duration and whether there Is any apparent cause for It. It your patient des not cough while lying still, but If the cough comes on when he or she moves suddenly then look for the cause of that cough In th throat. Try to relieve it by gargling or swabbing the throat. If your patient complains of great tightness over the upper part ot the cheat, and If that feeling ia accompanied accom-panied 'by expectoration, 70a must try to relieve these symptoms. Apply a mustard plaster. Do aot keep It oVloagTeaeugh'to asake the akin of tke chest sore. Ot course, M'.very strict about keeping your patient la bed,, Have plenty ot trash air In the room but try to. avoid as far aa possible sudden ckaagea of temperature. tempera-ture. If the room seems close or It you detect an unpleasant ,odor when you come In from out of doors, cover cov-er your patient over, head and all, and open the windows and door and (lush out the room. Wash It out with fresh air and then arrange your windows so that thero Is no draught blowing upon the patient, and, then of course, closo your door and un-cover un-cover the head ot your patient again. Fresh air Is an absolute necessity, but It Is one of the things you ,wlll find It hardest to get in a great many of tho rooms, and without plenty of frosh air you arc fighting against fearful odds and must not expect to have very good results. It Is not a case of swallowing drugs; It Is a case of proper hygenlc surroundings, of treating symptoms by common sense methods as they arise and helping vitality ot the patient to. overcome, this poison. When you remove the mustard plaster, rub oil on the chest and then cover the chest with several thicknesses ot flannel or with a pneumonia jacket. The pneumonia Jacket Is simple and easily made of gauze or cheesecloth and you' can' cut It out any time by Just pinning a piece of paper on the back of any-. one who Is about the size ot your patient. Leave the front a little longer so that it cornea up'to meet the shoulder.. "This fits on the patient, pa-tient, covering the chest and back quite' completely. Safety pins are better bet-ter than .tapes to fasten the Jacket It goes on under the nightdress, right .over the skin and Keeps the patient warm. It keeps up the warmth that you have created by the application ot the mustard ana then by rubbing with' trie oil. I consider It Important in the nursing of these cases to have something like a pneumonia jacket to keep the patient pa-tient warm. Usually after the tightness tight-ness is relieved and "the cough loosened," loos-ened," expectoration is quite free and the symptesqe'elear up; , Inthi er cases the temperature may go up possibly the patient will complala,o a feeling of chlllluoss or may have a chili. You will notice a change In the pulse beat and a change ot facial fa-cial expression, and these are dan- L ?r f,rnal1!' .or' tb?r my indicate approaching pneumonia. You have to take in all the details of your patient's pa-tient's appearance, and be' watchful. Even in steep the patient may be restless, probably muttering, probably proba-bly lying in a peculiar position to relieve re-lieve the discomfort that he feels even ev-en in sleep. Then there, Is the change in respiration., res-piration., If there Is much of the j lung filled up so that the circulation if tho blood through the lung Is dl-fflcut, dl-fflcut, your patlont will probably wish to bo raised up In bedt and It Is often of-ten a very good' thing to do so, but always bo careful that you have your patient In the most comfortable position po-sition In which breathing Is easiest. Breathing cannot be easy with tho bead bent over at right angles. Tho broathing Is easiest when tho neck ' Is straight and tho chest expanded. Always try to help your patlont to rolnln tho position that Is most comfortable com-fortable und tho position In which breathing Ms oaaloat, and if ho has difficulty In getting his breath when lying flat on tho bed It often gives great relief to put In a bed rest such ns nn ordinary kitchen chair lnvort- , ed, and If you aro going to put pillows pil-lows on that and" let your patlont ; rest against them, .always put a pillow pil-low or other support under tne knees or against the feet, and put a blanket over the patient's shoulders to protect them from draughts. It Is much better to havo your patient rest In a position such as that described, de-scribed, with the proper ktnd of chair, than to let him sit at the head of the bed with pillows behind him. 'Notice carefully not only the, rate of the respiration, but also whether the1 'respiration is full, expanding the whole chest or whether It is simply Just h quick, shailw movement, of the chest. Notice the color of yohr patient's lips and face. If there is not much air entering the lungs you .will usually find that the lips become be-come more or less purplish or dark blue Instead of red, Which shows the blood 1b not receiving the proper amount. of oxygen. Teach yourself l when you go to attend a case to notice no-tice the patient's expression. A sudden sud-den change ot expression sometimes means a great deal, and Is often a 'serious danger signal. We all know that a sudden palor of the face us-jually us-jually accompanies a falntness and If there is this gradually increasing bluish appearance 0$. the nostrils, lips and checks It Indicates the patient pa-tient is not getting enough oxygen. If this bluish appearance continues, and, in addition, you get a drawn expression ex-pression around the lips and nose, 'it Is a serious sign, and a sign that would warrant you in sending for a doctor. If your patient were lying flat and the face became very much flushed you would think there was an excess, of blood In the head and it would probably relieve him to put him In the position which 1 have described, de-scribed, and 'to put warmth to hla feet, and apply, cold baths to his head. In diseases et the lungs we' some times notlce n bright red 'sbM appearing,, ap-pearing,, sometimes onlyfaa one cheek If 6nerlnng la affected, and usually on the side on which the lung Is affected. Then, of course, we usually have a flushed face In fever. All these symptoms you can detect by simply watching your patient's face and observing the changes that may come. Sponging is a very good way ot reducing a high fever. If a child had a high fever you could probably wrap the child In a blanket blan-ket and Immerse him In a bath, or If not practicable to do that, use a wet pack. The wet pack Is an easy and comfortable way ot reducing rever, but. of course; care has to be I taken that you do not allow tho i .patient to got a chill. I will show 1 you how to put tho patient In a I- pa'ek quickly and comfortably. Sup- I pose tho temperature Is 102. To I prepare the bed you would put over 1 the matresa something waterproof. I If you have a waterproof sheet, all i right, if not, put several thicknesses i of paper, and over that spread a 1 blanket and then take a sheet and wring it out of the water at Just T ,1 ati'out the temperature of the ordln- ' I ary1 room dip your sheet In and j wring It out. Remove the night- V dress. The patient lies on a blanket '). 1 and is covered wlthblnnkets. Then wo put tho sheet around the patient. Bring one end of the sheet around under the arms, bring It well up to $j the axilla, and bring It aeross the- S chest and tuck it In under the other 2 (Continue on Page Seven) l I : ' SPANISH IN- 1" flJUHH K ., (Contiuctl from Pago Sovon) H? 24 to 2G. Tlicro may do rapluiy do- H,'. ' vcloplng tnxomla and vasomotor, do- Hk prosslon with death of tlio patient H ' resulting In many cascR. H J.VCUllATION FKBIOD H ' ' Tho Incubation porlod in thceo In- H ,;fluonzas Is probably very short, but H. J.I dllllcult to obtain accurate figures H , on thin point. 'Tho dlcoaso is pro- H. v bably spread entirely by contact ln- sss '. fcctlon, tho, virus of tho dlacaso bo- , Ing disseminated for short distances H; through droplets drvlon Into the air K in coughing and sneezing. Clrcum- M ' i stances which favor this means of ' spread, such as crowding In cars, fa- -v vor tho spread ot the disease. H TREATMENT B ' Tho treatment of tho disease Is H., v largely symtomatlc. Acetylsallcyllc acid may be given In. a dosage ot 1 H; - gin (16 grains) every three hours, ;' . as advised by Hewlett, or a smaller iiiiiB'' f ' dose combined with 0.1 gm. (1 K ,' grains) of acetphenetidln, until R;y symptomatic relief Is secured. Warm B :;v baths may give relief although In :l numerous eases hydrotherapeutlc ht' ' " methods failed and were discarded. T,V $r . Tho mouth should be kept clean, and Kr tlon stimulated by the free BrH ' n of water and hot drinks. H( ;, tlont should be kept In bed v ' ventilated room until tho fo :Y. r vc u. ,. dlaappeard. Chilling should '-"';; 'bo uvotded. Tho latter precautions ? $$ t will do much In avoiding the occur- BBBsH,lr' iVi ronco of complications.. KA 'r. When pneumonia develops, as in- B:' J$L dlcated by moist rales In tho base of I H ... t . .the lungs, with or without dullness B '$&? " ' or perous8lon, the patient demands H., ftf ..particular c,aro. ; Every effort must BBBBBBBK"'' I-' f ' 1 ' beAmado 'to provide f or an adequate ''. jAlntakeot .fluids and for nourishment ftV. ' wh'lch must bo given in fluid form ;' to a largo extent. Worm packs are t. ofton useful, combined with tho ap- i, j" plication of cold to tho head. With H''-f nn' indication ot falling heart, Btlm' ?i. it , ' ulants are indicated. BBBBBBBSV'"' A mi- ', .- lu the cases ot socondary pneu- B ' ti monta, many of which result fatal- KV- sj'' ly.tho chief conditions to bo com- M"' '- "'. batted nro tho sovero toxemia and B - 'u ' , tlio vasomotor depression. Tho tox- H''. v, mla may be combattod by tho usual H '.: ''' ) uiQthodB.gettlng fluids into the body WV, ?t by mouth or proctoclysis, or oven by, :.. , ' ' hypodcrmoclysls. Small doses of eplno phrln may bo given at tho same time. Tho removal of tho toxemia tox-emia may bo aided by securing elimination, elim-ination, giving large doses of salt?, such ns magnesium citrate, or by the giving of calomel. In sevcro easel venesection may prove extremely valuable. val-uable. If a marked cyanosis occurs as Is frequently the caso, this may bo combattod by the use of oxygon by Inhalation, porhaps according to tho mothod devised by Moltzor, or even as has been suggested by Dr. V. Tlce, by injection of oxygen under un-der tho skin. Tho prostration Is to be combattod by tho uso of tho usual us-ual stimulants, such as cnffeln and sodium bonzoats, digitalis, strophantus strophan-tus or camphorated oil, usually hy-podermlcally. hy-podermlcally. Tho final stages in this pneumonia aro frequently a massive mas-sive exudation Into the lungs and bronchi. Efforts havo be.9n mado to combat this by tho use of morphln and largo doses of atropln, in some cases ob much as 0.0025 gm. or 1-25 grain, being used. Specific measures are not available avail-able In the treatment ot Influenza. With certain Identification of the causal agent, we may hope for some special protective measures, and porhaps por-haps for some specific therapeutic serum. fc In the absence of a specific virus to be used In Immunizing animals, there remains but one source of theraputlc serum at the present time. This Is in the blood of the persons recently recovered from tho dlsoase. It Is quite probable that tho blood of convalescent patients contalis antibodies for tho specific agent ot the dlacaso. it would be desirable to inject citrated convalescent convales-cent blood Into the muscles of patients pa-tients with pneumonia at least. Naturally, Na-turally, with such blood should be known to give a negative Wassor-1 Wassor-1 mann reaction. In view of the strikingly strik-ingly beneficial results from convalescent conval-escent serum in scarlet fever secured secur-ed by a number ot observers, It seems unreasonable to try this In influenzal in-fluenzal pneumonia, especially as it is dovold of any harmful effects. nioriiYnAxiS ' 'Tho measures to be taken to pro-vent pro-vent the spread ot the disease comprise com-prise all thoso which interfere with .transfer of tho Infectious materials from tho sick to tho unaffected. This Includos Isolation of tho patlont and the intelligent use of' proper gauze masks by tho attendant. In tlio itme ot n ncpldemlc, prompt and efficient .isolation ot tho first cases In a corn munlty could accomplish much. If this has beon neglected and the Infection In-fection has spread among tho population, popu-lation, measures which prevent the coming together ot numbers ot por-eons por-eons in close quarters aro to he employed. em-ployed. Tho desirability ot closing schools In a largo city in tho presence pres-ence of an epidemic is a measure of doubtful value. In smaller places this is more reasonable, and the danger dan-ger of Infection when children are outdoors should be less than when they aro brought together in a school room. |