A Study of Thirty Cases of Antral Empyema

FREDERIC C. COBB
1898 Boston Medical and Surgical Journal  
finement and the calls of the physician, there can be no question which she should choose. For almost all the skilled nursing she needs can be given her on such calls, and for her care during the rest of the time she can safely depend upon her sister or daughter or friendly neighbors. Indeed it is in the instruction of these helpers that the district-visiting nurse has almost her greatest opportunity for good. They can be taught how to make the gruel and broth, how to dress and undress the
more » ... nd undress the baby, and how to do the thousand and one services needed in the lying-in room. The especial service of the trained nurse in confinement cases lies in precaution-taking, in the prevention of troubles. But for this it is not necessary that she shall be on constaut duty at the case. It is enough, for instance, in the proper care of the nipples and breasts if she teaches the patient how to bathe and anoint the nipples, and if at the proper time she bandages the heavy breasts. And so iu tbe care of the bladder. If eight or teu hours after the labor the nurse visits the patient and helps her to empty her bladder, the danger of retention and catherization is much diminished. The same is true iu the care of the rectum. And indeed, over the whole range of the lying-in period, most of the usual suffering and trouble can be prevented by proper nursing and most of this advantage can be had where only district-nursing visits can be afforded. To the very poor woman who otherwise could not have any nursing and at most only the occasional help of a kindly neighbor, the district nurse comes as an angel from heaven. During her labor she need not suffer the inquisition of the neighborhood, aud during the following days she can at least rest in bed. But, after all, it is not ouly to the very poor mothers and babies that district-visiting nursing comes as a blessing. It is neither for the submerged tenth, who cannot bave either the luxuries or the necessaries of life, nor for the sublimated tenth of the population who can have everything except conteutment, that there is the greatest need for planning improvements. Our chief responsibility is rather to the great middle class of self-respecting families of moderate means who pay for everything they have and yet can afford but few luxuries. To such families the maternity service of district nursing is indeed a boon. Instead of the cheap, untrained nurse, who fails both as nurse and house servant simply because she tries to serve in that dual rôle, a perfectly trained nurse can be had for the labor and for the few hours on following days, that is, for ouly such time as trained nursing service is needed. By paying full price to the district nurse by the hour ; and by paying servant's wages to a servant, the total cost is less than for the service of even the cheapest kind of nurse who undertakes to do everything. Inasmuch as in district-visiting nursing there is such grand opportunity for acquiring experience, which after all is the professional nurse's real capital, nurses are very willing to work in it for far less money return than they rightly expect when half their time is spent in waiting and much of the remainder in unnur8e-like work or idleness in wealthy homes. Wherever introduced, this sort of nursing will surely take deep root, because (1) Nurses themselves recognize the opportunities so afforded for advancing in their profession. (2) Physicians once accustomed to the assistance of such nursing in their midwifery practice will never be long without it. (3) Families soon learn so to depend upon visitingnursing service that the demand for it becomes steady and strong. -»-The object of this paper is to study a series of cases of antral disease as to cause and treatment. The etiology is, of course, of the greatest interest since upon it hinges the prospect of cure. The antrum has always been considered a most intractable cavity, and we find in cases cited during the last ten years that surgeons have made wide openings in it, and even removed the bony walls in order to bring the mucous membrane of the two sides in apposition to each other, and thus stop suppuration. From my experience iu these cases,
doi:10.1056/nejm189812011392202 fatcat:xn2vzmxmlrd4fe7kcgyjfokcmi