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happy.

Many of the changes in old age reverse the developing process of childhood. In youth and age extremes meet, and the care of the aged presents certain marked similarities to the care of little children. Both require simple food, occupations suited to their strength, and protection from infections, from fatigue, and from nervous strain; both are dependent, more or less helpless, and for their happiness both need the affectionate care of their own families. But in one respect their needs are fundamentally different. In childhood formation of proper habits is all important, and in caring for children the future effect of every word and act must be taken into consideration. Old people, on the other hand, since they live largely in the past and their habits are irrevocably formed, may be indulged without harm in ways that would demoralize a child; with a clear conscience one may make them happy in ways both great and small. This difference makes possible one of the greatest pleasures that come to one who cares for the helpless and the sick, for of all enduring satisfactions few are greater than the power to fill with comfort and happiness the closing days of life.

EXERCISES What is meant by a physical defect? Name some of the most common defects. Name some permanent injuries to the body caused by defective teeth; by diseased or enlarged tonsils and adenoids; by faulty posture. Describe some common symptoms of eye strain in children; of enlarged tonsils and adenoids; of deafness. Name several possible causes of round shoulders, and explain why urging a round-shouldered child to hold himself erect is seldom enough to make him correct his posture. What measures should be taken to overcome nervousness in children? Describe in detail the health work carried on in the public schools of your city or town. Considering the important part played by uncorrected physical defects in causing permanent physical disability among adults, do you think in the long run it is cheaper or more expensive for a community to spend money in protecting the health of school children? Discuss the particular needs of convalescent and of chronic patients. Explain the effect of activity upon recovery, and explain why it is desirable for invalids to have occupation. What special needs should be provided for in caring for old people? FOR FURTHER READING Invalid Occupations—Tracy. Occupation Therapy—Dunton. Handicrafts for the Handicapped—Hall and Buck. When Mother Lets Us Make Toys—Rich. Amusements for Convalescent Children—New York State Department of Health, Albany. Essentials of Medicine—Emerson, Chapter IX. Civics and Health—Allen. How to Live—Fisher and Fisk, Chapter III, Section II; and Supplementary Notes, Section III. Health Work in the Schools—Hoag and Terman. Medical Inspection of Schools—Gulick and Ayres. The Hygiene of the Child—Terman. Posture of School Children—Bancroft.

CHAPTER XV

QUESTIONS FOR REVIEW

I. Show how you would:

Make an unoccupied bed. (Notice the number of minutes it takes you to do it well.) Remove all the covers from an unoccupied bed and leave the bed to air. Open a bed to receive a patient.

II. Show how you would:

Change all the linen and remake an occupied bed. (How long did it take you?) Turn a patient from his back to his side, and the reverse. Remove, shake, and readjust a patient's pillows. Move a patient from one bed to another. Prepare a weak patient to sit up in a chair, and assist him from the bed to the chair. Assist a weak patient from the chair to the bed. Arrange pillows and back rest for a patient to sit up in bed; and also how you would remove the pillows and back rest.

III. Show how you would:

Lift a patient who has slipped down toward the foot of the bed, and show what you would do to prevent him from slipping down. Prevent bed covers from resting upon a sensitive foot, leg, abdomen, or arm. Describe and demonstrate every device you would use and every thing you would do to prevent pressure sores. Arrange pillows to support the arms of a person sitting up in bed. Arrange a table or a substitute for a table to support the book or work of a patient sitting up in bed. Arrange the light for a patient who is allowed to read in bed.

IV.

Assemble all the articles you would use in giving a bed bath. (How long did it take you?) Show how to give a complete bed bath. (How long did it take you? Did you have to stop the bath to fetch anything you had forgotten?) What special care would you give to the mouth and teeth? to the finger and toe nails? to the hair? to badly tangled hair? How would you cleanse the mouth of a helpless patient? Show how to shampoo the hair of a bed patient. Show how you would give a bath to a baby. Show everything that you would do to prepare a patient for the night.

V.

Show how to take the temperature, pulse, and respiration. Show how to cleanse a clinical thermometer. Show how to give a foot bath (a) to a patient out of bed, (b) to a patient in bed. Show how you would give a cool sponge bath to a feverish patient. Show how to give, remove, and cleanse a bed-pan. Show how to fill and apply a hot water bag; an ice bag. Show how to prepare and apply a mustard paste; a mustard leaf; a flaxseed poultice; hot fomentations; cold compresses. Show how to measure and administer a fluid medicine; pills or tablets. Show how to prepare and administer a salt and water enema to a grown person; to a baby. Show how to prepare steam inhalations. Show how to apply an ointment; a liniment.

VI.

Show how you would feed a helpless patient who is lying down. Show how you would feed a patient who is able to sit up but unable to use his hands. Prepare a liquid nourishment tray. Set a tray for light diet; for full diet. Show how to place a tray for a patient unable to sit up but able to feed himself; for a patient sitting up in bed. What personal care should be given a patient just before meals? just after meals? How would you modify the diet of a patient inclined to constipation? to diarrhœa?

VII.

Describe effective household methods for removing dust. Demonstrate the cleaning of a refrigerator. Show how to ventilate a sick room while protecting the patient from direct draughts. Show how to clean a sick room with a minimum of disturbance to the patient. Explain how a patient with communicable disease should be isolated. Demonstrate the daily care of a room occupied by a patient with communicable disease. Explain methods of concurrent disinfection. Explain methods of terminal disinfection. Tell how the following should be disinfected: discharges from the nose, throat, eyes, ears, bowels, bladder, wounds, and sores; bed and personal linen; blankets; mattresses; dishes; utensils, especially bedpans and urinals; clothing and person of the attendant, especially the hands; furniture, rugs, and woodwork.

VIII.

Name some of the most obvious symptoms of sickness. Name some symptoms that would lead you to take a patient to a doctor; to send for a doctor; to send for a doctor in haste. Name some symptoms that are dangerous to neglect even though the patient feels fairly well. What are some of the symptoms of physical defects in children? Name some conditions that are frequently caused by unremedied defects. Name some diseases commonly ushered in by symptoms resembling those of a cold in the head. What symptoms would lead you to isolate a patient? Give as many illustrations as you can of the part played by good and bad habits in determining health and sickness.

IX.

How would you dress a cut? a burn? a sprain? What would you do for a person suffering from colic? nausea? diarrhœa? chill? What are the symptoms of shock? heat stroke? heat prostration? What treatment would you give in each case? What would you do for a fainting person? for a person suffering from nose bleed? from earache? from a cinder in the eye? What course of action would you advise for a person troubled with sleeplessness? frequent headaches? excessive irritability? unusual depression of spirits? unfounded suspicions of other persons' motives? a tendency to have the feelings hurt easily? inability to control the emotions?

X.

Why is it better to prevent sickness than to cure it? Name the essentials of good hygienic conditions for babies, for children, for grown people, for the aged. How much of the sickness in the United States is preventable? If part of the sickness is preventable, why is it not prevented? What constitutes adequate care of the sick? What proportion of the young men in your community who were drafted have been rejected for physical disability? How many were rejected for disabilities that might have been prevented?

XI. (Answers to the following questions can generally be obtained from local health officers.)

What are the duties and powers of your local board of health? How much did your city or town spend per person last year on health protection? How does this amount compare with the amount spent per person for police protection? for fire protection? Who inspects the water supply in your town? the milk supply? the food supply? In your city, what was the number of deaths per 100,000 of the population from tuberculosis each year for the last five years? from typhoid fever? Is there a tuberculosis sanitarium in your city or county? Are nurses employed to supervise tuberculosis patients who remain at home? What provision does your community make for patients suffering from other communicable diseases? What measures are taken in your community to instruct school children in matters of health? to instruct grown persons? How does your community provide medical and nursing care for persons unable to pay part or all of the cost of such service?

XII. Explain why the following common beliefs are erroneous or unfounded:

That a damp cellar causes diphtheria. That night air is harmful. That one should "stuff a cold" and "starve a fever." That almost everyone needs a tonic in the spring. That the health of one's family would be endangered if a tuberculosis hospital were placed on the next block. That clearing up the back yard will protect the children of a family from infantile paralysis. That odorless and tasteless water is necessarily free from harmful germs. That all children should have the children's diseases, and have them as early as possible. That boils are a benefit to the system by removing impurities from the blood. That tomatoes cause cancer. That consumption is inherited. That dirt breeds disease. That diseases come up drains. That if a teaspoonful of medicine does you good, a tablespoonful will do you more good. That instinct teaches a mother how to care for her baby. That low heeled shoes, though suitable for boys and men, cause broken arches in women and girls. That in one's own case, the rule that everyone needs regular meals, regular hours of sleep, and daily exercise out of doors, may be safely violated.

APPENDIX

The New York City Department of Health has kindly permitted us to include the following circulars of information issued by the Division of Child Hygiene.

DEPARTMENT OF HEALTH
THE CITY OF NEW YORK
Instructions to Parents Regarding the Care of the Mouth and Teeth.

The physical examination of school children shows that in many instances the teeth are in a decayed and unhealthy condition.

Decayed teeth cause an unclean mouth. Toothache and disease of the gums may result.

Neglect of the first teeth is a frequent cause of decay of the second teeth.

If a child has decayed teeth, it cannot properly chew its food. Improperly chewed food and an unclean mouth cause bad digestion, and consequently poor general health.

If a child is not in good health, it cannot keep up with its studies in school. It is more likely to contract any contagious disease, and it has not the proper chance to grow into a robust, healthy adult.

If the child's teeth are decayed, it should be taken to a dentist at once.

The teeth should be brushed after each meal, using a tooth brush and tooth powder.

The following tooth powder

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