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MAKING GOOD ON PRIVATE DUTY

MAKING GOOD ON PRIVATE DUTY

PRACTICAL HINTS TO GRADUATE NURSES

BY

HARRIET CAMP LOUNSBERY, R.N.

PRESIDENT WEST VIRGINIA STATE NURSES' ASSOCIATION SANITARY SCHOOL
INSPECTOR FOR CHARLESTON INDEPENDENT SCHOOL DISTRICT

"Not to be ministered unto, but to minister"




PREFACE


Though technic is constantly changing, methods improving, and the
teaching in our schools grows better and more comprehensive, the
old problems in private work are ever to be faced, and still the
young sister in our nursing world needs to be counselled, guided
and helped. It is for these young private duty nurses that this
book has been written.

For six years I went up and down one of our large cities doing
private nursing, and I can remember, as if it were but yesterday,
the curious little sinking of the heart I used to feel, as I
mounted the steps of a house where there was a new patient needing
my care. "Would I do everything right?" "Could I please the
patient and the friends?" "Would the doctor be satisfied with my
efforts?" "How would I feel when I was leaving?" "Encouraged or
hopeless?" "Happy or sad?" A strange house looks so forbidding,
"would this one ever look friendly?" There is time, while walking
up the steps, for these and many more such thoughts to crowd into
the nurse's mind. Once in the presence of the patient, however,
all this quickly changes, and action puts all wondering and doubt
to flight.

The "hints" here given are the fruit of my own experience and that
of the graduates of the school of which I was the superintendent.
Many long talks we had, when they felt the need of coming back to
their hospital home for advice and comfort. It is an earnest wish
to help the young graduate over the intricate paths that the
inexperienced nurse must often tread that has led me to revise
some early contributions [Footnote: Printed by permission of the
_Trained Nurse_.] to the _Trained Nurse_ and write a few
new ones, which have within the past year appeared in the
_American Journal of Nursing_.

In the chapter "Hints to the Obstetrical Nurse," there is little
or nothing that is commonly taught in the class-room.

All of that is so well done, repetition here would be tiresome.
All the asepsis is familiar to every graduate. She knows how to
sterilize any and every thing, but sometimes she does not know the
best way to wash and dry the baby's little shirts or knitted
shawls. Sometimes she will not realize that if the layette cannot
be purchased at a store, old table linen makes the best diapers
for the newborn baby, and that his pillowcase should not have
embroidery in the center.

I wish in this part to give the nurse such hints that she may be
able to help any woman who wishes to prepare for her confinement.
I have been asked so many times to tell a young expectant mother
just _what_ to get, that I have made for convenience as full
a list as is necessary for any baby or mother, with some hints as
to the washing of the baby. The rest it is expected every nurse
who graduates from a training-school would know. The table for
calculating an expectant confinement was cut from a medical paper
and given me by a physician some years ago. He did not know who
wrote it, nor do I, but he always used it, and I have found it
most accurate.

The recipes I have given are, I know, reliable, having all been
tested many times. Most of the articles of food every nurse has
probably prepared, but exact proportions have a dreadful way of
slipping out of one's memory. Whether it is a pint of milk or a
quart that must be mixed with two eggs for a custard might not
seem much of a problem to a housekeeper, but to a nurse who has
perhaps not made a custard for a year it might carry many
difficulties.

I have tried to help in this most important part of a nurse's
duty, and not only as to the food served the patient, but the
_manner_ of serving it, which last is truly to a sick person
of as much importance as the food itself. The few leaves I have
left blank are for such additional recipes as every nurse will
gather as she goes from house to house. Any cook will be glad to
give some hints as to how she does this or that, and no nurse
should be too proud to learn from the cook, or anybody else. I
shall never forget the fat little Irish woman who taught me to
make clam broth, or how much pride she took in my first success.
To ask the family cook for advice is sometimes good policy; she is
often so ready to resent any extra work caused by the sickness or
the nurse, it pays well to conciliate her, by asking for her aid
or counsel. To feel that she can teach the "Trained Nurse" will
often make a friend of the cook, and this will make things
pleasanter all around. It is with the hope that these homely and
perhaps somewhat old-fashioned hints may be of real service, that
this little book is sent forth to do what good it may to those who
are setting out on their professional careers. It is ever to the
young that we elders look, knowing, as Mrs. Isabel Hampton Robb
has truly said, "Work shall be lifted from our hands and carried
on to loftier ideals and higher aims by the strong young hands,
hearts and brains of future nurses." H. C. L.

Charleston, W. Va.




CONTENTS


CHAPTER

I. THE NURSE AND HER PATIENT

II. THE NURSE AND THE DOCTOR

III. THE NURSE HERSELF

IV. THE NURSE AND HER PATIENT'S FAMILY, FRIENDS AND SERVANTS

V. GENERAL REMARKS ON FOODS AND FEEDING

VI. THE NURSE AS RELATING TO HER TRAINING SCHOOL AND TO HER FELLOW
NURSES

VII. WHY DO NURSES COMPLAIN?

VIII. THE NURSE AS A TEACHER

IX. CONVALESCENCE

X. HOW SHALL A NURSE OCCUPY HER DAYS OF WAITING?

XI. SOME HINTS FOR THE OBSTETRICAL NURSE

XII. AS TO WASHING THE BABY

XIII. THE VALLEY OF THE SHADOW




I

THE NURSE AND HER PATIENT


You may think it unnecessary for me to tell you any more about
"the patient." You will say, perhaps: "Have I had all this
training, and must I yet be told how to treat a patient?" I answer
that you have been taught how to watch the progress of disease,
how to follow intelligently the doctor's orders, also certain
manual arts, your proficiency in which is unquestionably most
necessary, but there is much more comprehended in the meaning of
the term "a good nurse" than this. How often do we hear stories of
nurses who were good--_but_--who were skillful--_but_--
and after the _but_ comes a long list of such faults as do
not show so much in hospital life, where the routine and the many
rules and the constant supervision make them less likely to become
prominent. "She bangs the doors." "She breaks the fine china."
"She wears heavy shoes," or "She talks too much," or "She is
pretty and spends too much time over her front hair"--but why go
on? You have all heard such tales--_ad nauseam_, and if you
are wise, you will set up a sign-post against every one of these
snares into which your sister nurses have fallen, and on this you
will print in large, clear letters: "Danger! Walking on this place
forbidden." So much by way of apology for treating you once more
to a lecture on "the patient."

The relation between nurse and patient should, from the first, be
a more than amicable one. You have come to bestow the priceless
blessing of unwearied, skillful care upon one who should
thankfully receive it, and believe me, if you do not go to your
patient with a feeling of thankfulness to God for allowing you to
assume such a sacred trust as the care of a human life, you are in
no condition to undertake the work. Your nursing should be, in a
way, an exponent of your own spiritual state; looking at it in its
highest aspect, an outward and visible sign of an inward and
spiritual grace.

In the first place, then, you must be in entire sympathy with the
sick one--and here do not mistake me--by sympathy I do not mean
sentimentalism. The two emotions are as far asunder as the poles.
Sympathy, then, you must have, and if you do not intuitively feel
it, let me tell you what to do to rouse your dormant feelings. Try
earnestly to put yourself in the patient's place. Has she had an
operation of some kind, and you have all night been trying to keep
her quiet on her back, and she has been begging you to let her
turn "never so little?" When you go to lie down, and have,
perhaps, a backache, and feel tired, instead of settling yourself
in the most comfortable position you can, lie straight and square
on your back and say to yourself, "Now I can't turn over," and
imagine you have by your side a nurse who will not let you turn.
You will find out in the course of an hour that your patient has
had a good excuse for all her complaints, and the next night you
will know just where to slip your hand in the hollow of the back
or under the shoulders to give a little ease. The patient will
profit by such exercise on the part of the nurse, and your
sympathies will be quickened. Never forget that _the patient is
sick_, and you are _not_. You can, you must be firm in what
you know is for your patient's best good, but you must never
be dictatorial or argumentative. It is hard, I know, to bear with
all the foolish, unreasonable whims of sick people, but if you are
true nurses you will do it. There are, however, several consoling
thoughts which have always helped me, and which I will tell you.
In the first place, always remember, as I said before, that the
sick one _is_ sick, and on that ground you can overlook much.
In the second place, remember that it will not last long. A few
days or weeks will surely bring a change. She cannot, in the
nature of disease, remain for long in the very trying stage,
unless indeed she have some kind of mania, and of course if that
is the case, you need pay no attention to her whims. If she says
white is black, let it go. It does not make it so to have her say
so, but if you argue the point, and bring all your wisdom to bear
upon your demonstration, you may bring her pulse and temperature
up to a point that will do her a real injury.

_Tact_, as you know, is worth everything to you, and by it
you will win your way to all hearts. Try then to feel as the
patient does, and you will know by instinct how to treat her, and
will, perhaps, be often rewarded for some little deed by the
pleased surprise with which she will say, "How did you know I
wanted it done?" You need not tell her how you knew, but you may
be sure she will appreciate you all the more for your prescient
thoughtfulness. Her pillows may be flat and hot, her hair
uncomfortable, her under sheet wrinkled or untucked from the
bottom; all these and a dozen more little things can be arranged
so easily, and they conduce so much to the sick one's comfort when
done, that you must ever have them in your mind.

Be most careful also as to your patient's belongings, her top
drawer, her various boxes, and her linen closet. You must keep all
these things just as she did. You may think it a very foolish
thing for her to have three piles of handkerchiefs, each of a
different age, or degree of fineness, but if that is her way, she
will be better satisfied if she knows you will not lay a fine
handkerchief over a more common one. So keep them as carefully
divided as if they were the two parts of a Seidlitz powder.

Hang her clothes up carefully whenever she goes back to bed, be it
once or oftener during the day. Separate them and hang them up;
don't pick all up together and put them over a chair. Put her
shoes away, lay the stockings on a shelf or put them inside the
shoes. Fold her pretty shawl or kimono and lay it in a drawer. Let
her see that you know a good thing, and know how to take care of
it.

Put away fine china or glass and bric-a-brac, if she is very ill,
and you need space for necessary glasses or other articles. It
will be a pleasant way of beguiling the tedium of some long day in
her convalescence to bring forth and arrange them in their
accustomed places. Be careful of books, table-covers, and all the
articles of luxury and beauty you will find in many of our city
houses. Remember that these things belong to some one else, though
you are for the present custodian, and think how provoked you
would feel if some stranger should come to your home, and, even if
she did nurse you back to health, she left many nicked plates,
broken vases and handleless cups behind her. I think you would not
want her to nurse you again.

I saw recently in an English magazine devoted to nursing, a very
clever article on "Talk." The writer, a nurse, thought subjects
were scarce. She says: "We must not talk to the patient about her
own complaint, that would make her morbid; or about the doctor,
for that would be gossip; or the hospital, for hospitals are full
of horrors; or the other nurses, for that might lead to talking
scandal; or about other patients, for that would be betrayal of
confidence. Now what _are_ you to talk about when a patient
is well enough to talk, and your talking to her will not hurt her
(but on this point be very sure before you air your eloquence)? It
is indeed quite a question, and the nurse must often use all her
ingenuity to keep the patient to the right subjects, for even
patients, though they hold it so reprehensible in a nurse to talk
gossip, do not disdain to serve up their neighbors occasionally to
the nurse, with some very highly seasoned scandal sauce, and here
the honor of the nurse must come into play; let her forget it if
possible, as woe will betide the poor girl if in her next place
she unwittingly lets out any of the secrets she has heard in these
long talks. Try then to steer clear of the neighbors. If your
patient be a cultivated person, and you yourself know anything
about books, you have a never-failing topic. All the latest books,
the famous books, the most entertaining books, and if you can read
aloud and the patient likes to hear you, read to her, and it will
do both good--only be sure not to tire her by reading too much at
one time. Talk of interesting places you have visited and she will
do the same, of pictures you have seen, and last, but not least,
you can talk about clothes. Generally the first serious piece of
business a convalescent concerns herself about is the purchase and
making of some new clothes. She wants something new and fresh, and
if you can give her any new ideas on the subject or tell her of
any pretty materials you have seen in the shop windows, you will
prove as entertaining as if you talked on any of the forbidden
topics, and many times more useful."

I would like, in closing this chapter, to say a word as to reading
the daily papers. If your patient is a woman, she will want to
know just about what you, yourself, would be interested in, and
this is very easy; but if your patient is a man, it is harder to
know what he will want; politics, the money market, etc., which
most women skip over. If then your patient is a man, commence on
the first page and read slowly the headings of the news items,
when one strikes him, as desirable to hear, he will tell you to
read it; when you get through the news you may turn to the
editorial page and do the same there. Unless you know your patient
very well do not attempt to enlighten him as to the stock market
quotations, for it is, I suppose, well nigh impossible for an
ordinary woman to read them so that a man will understand her. He
will probably laugh over your well meant endeavor, and ask you to
"kindly let him look at the paper," when he will in a moment find
out what you have been trying to say.




II

THE NURSE AND THE DOCTOR


I suppose no nurse goes through a training school without being
duly impressed by all the doctors on the staff of lecturers that
they, the doctors, are the generals of the campaign. She and her
fellows are the aids, and that she will be kind enough to remember
this fact, and not make suggestions to him, the doctor, or give
him the fruits of her ripe experience of three years in a
hospital, and more or less time, as may be, since she has
graduated. But though this I think you all know, there are some
points of your connections with the doctor which may not be quite
so clear.

In the first place, then, remember that you are his _aid,_
you are to help him in every way you can, you are never to work
against him, never weaken the patient's confidence in him. If you
do not understand why he does thus and so, ask for an explanation,
if you know him pretty well, and if your questions are reasonable
ones, and intelligently put, he will be glad to answer you, and
explain all you wish explained; but if you do not know the reason
of a certain order, and, moreover, if he will not tell you, do not
assume that he does not know, or that he is cross; it may be some
very uncertain, delicate experiment is being tried, and all he
wants you to do is to tell him, with a free unbiased mind, what
you see. Always, however, be loyal to him with the patient. When
you are asked a thousand questions as to, "Why doesn't the doctor
do this, or why does he do that?" you can always say that he does
it, or does it not, for the patient's best good, of that you are
assured, and they must be also.

You collect the facts and put them in an orderly way before the
doctor; upon your observations and reports he bases his theories
of the disease in many cases. You can see what perfect faith he
must have in you, and how true you must be to him in order to
secure your patient's best good. I have often heard doctors say,
when speaking of a favorite nurse, as if it was the only virtue
worth mentioning: "I am perfectly certain that when I am not
present she will _faithfully_ carry out my orders." Entire
faithfulness takes precedence, I think, and deservedly so. Your
accomplishments may be many, but if you have not this faithfulness,
this obedience to the doctor as a rudder to the ship of your
professional character, no matter how great may be the load
of learning and accomplishments and good intentions, your
self-will and vanity will bring you to the rocks where ruin is
inevitable.

Do not fear losing your own individuality and independence. "He
who obeys well, governs well," is a very old, and a very true
saying, and your responsibilities will never cease. The more
faithful you are to orders, the more trust and confidence will be
reposed in you. You will have not only your patient, but the
entire family looking to you for directions, for, upon your
faithfulness, and the tact with which you administer your
authority, will depend much of your success as nurses.

Be careful not to sever your relations with any patient unless
your doctor knows all about it. Never leave your charge, no matter
how urgent the reason may be, unless you tell him. You may be
sick, or the place may be unsuited to you, or you to the place,
and you may know that it is best for you to go. But speak first to
the doctor, tell him candidly why you wish to go, and take counsel
of him how you should act. If he tells you you may go, and you
know that your place must be filled, do not offer as your
substitute your best friend, or anyone else. If he wishes your
counsel he will ask, and then you may tell him of anyone you think
will suit the position, but do not offer your friend, as he may
have some favorite of his own to put in your place. Of course the
patient or her friends must know about the contemplated change--
that I take for granted. Having consulted the doctor, will make
everything satisfactory to the most careful practitioner. So, as
said before, never go away from your patient, leaving in your
place a nurse whom the doctor does not know. He has, in most
cases, selected you for his patient, and he wants you, you may not
be all he wishes you were, but still such as you are, _there_
you are, he knows what you can and what you cannot do; and it is a
great piece of impertinence for a nurse to go away unknown to the
doctor, leaving a stranger in her place. The consequence, so far
as he is concerned, will most likely be to have her name crossed
off his list as "unreliable"--so be careful.

As to your records, keep them faithfully; the doctor usually looks
them over very carefully, but sometimes you find one who passes
them over in a lofty manner, rather trying when you take such
pains with them. You may conclude that it is not necessary to keep
them accurately in such a case, but this same doctor may ask you
some day how long ago it was that the patient's temperature took
such a sudden rise, or how many days it is since she first had
solid food, and if you have accurately kept and carefully
preserved your records, you can tell without a moment's
hesitation. It is better, more business-like, and every way to be
commended, that the nurse should keep, and be exceedingly
particular about these records. If the doctor will write his
orders on the fresh daily record at his morning visit, it is a
great help to the nurse, but very often he is in a hurry and you
must write them yourself. If you have to do this, take your record
and write as he tells you, _when_ he tells you. If the orders
are at all intricate it is your only way of being absolutely sure
you have everything correct. It is a protection to you also, if
the family are inclined to criticise.

A nice little point for you to remember is always to leave the
doctor _alone_ with the patient for a few moments, if it is
at all possible, at each visit, Wait until he has asked all the
questions he wishes, or until you have told him all that is
necessary to tell before the patient, and then on some errand,
real or imaginary, leave the room. Of course, if the patient is
desperately ill, you cannot do this, nor will it then be
necessary.

It is a good plan to wait for the doctor at the head of the
stairs, or at the foot, if you are likely to be over-heard, and
tell him there all you could not say before the patient as to her
condition, etc. He likewise may have something to say,--some
final instruction to give, some caution he would not wish the
patient to know of. This is also the time to speak about yourself
if you are sick or tired, or unhappy in your position. Perhaps
neither of you have anything to say, and a friendly nod and a
"patient is doing nicely, nurse," will send you back to the sick-
room feeling that your work is appreciated, which always goes a
long way toward making the hard places easy. Your patients may be
very curious as to what you have to say to the doctor, but you can
readily and truly tell them that there are many things you have to
say to him, that would be hard for you to say before them, and
hard for them to hear too, and these are things you arrange
outside.

Always be sure to have on a convenient table, if your doctor be of
a homoeopathic school, a little covered tray, and on it two
glasses, clean, and turned upside down to keep them from dust,
teaspoons and covers for the glasses, also a small pitcher of
fresh water. Many doctors of the old school also use some
medicines in water, so it is best to have glasses always at hand.

Do not sit down when the doctor is making his professional call,
unless he or the patient requests it. He will probably sit at the
side of the bed, your place is at or near the foot. If the doctor
knows the patient well, as a friend, and is inclined to stay a
long time, chatting, you can go quietly to another part of the
room, and take up your work or reading, but be sure the doctor has
finished asking you questions before you go.

Use sparingly technical terms. If your patient's feet are
oedematous, tell the doctor they are much swollen; if he
_ask_ if they are oedematous tell him "yes," but do not
volunteer to name the peculiar kind of swelling. If the abdomen is
tympanitic, tell him it seems much distended; and if he questions
much further, answer the questions fully and intelligently. If
your patient has the symptoms of phlebitis, tell him of the rise
of temperature, the swelling of the leg, the tenderness along the
course of the vein, and he will know that you know and appreciate
the gravity of the disease; but be sure you do not attempt to give
the symptoms a name, that is not your place.

I would have you be very careful as to what instruments you carry;
have them of the best. Let your thermometer be of the very best
make.

There is nothing more trying in a small way than to have your
thermometer doubted, and if you _know_ it is the best the
market affords, if you take it to the instrument maker and have it
tested once in a while, you need not fear, when you find an
unusual temperature, and report it to the doctor, and he quietly
proceeds to test your thermometer by his, which of course is
always correct. Be sure that your hypodermic syringe will work; if
the piston slips loosely after much using of brandy, aromatic
ammonia, etc., take it to be repaired, and see that the needles
are sharp, they become dulled very quickly; keep also the tiny
wires pushed through them. It is just as well to keep this syringe
in the room, its little case is very small and unobtrusive, and if
you keep it near your thermometer in some safe, handy place, you
will have it when some unforeseen emergency arises, and you do not
want to lose time going to your room for it.




III

THE NURSE HERSELF


It is just as necessary for the nurse to be careful of herself as
of the patient, though her care must be manifested in a far
different way. Always remember that to do really good work you
must have really good tools. No man owning, and intelligently
working a valuable machine, would keep it going at its highest
speed all the time. He takes care of it, keeps it clean, renews
defective parts, oils it; and then he expects it to run for so
many hours, and to run well,--to do its work thoroughly. But with
all his keeping it in order he does not make it work night and day
for weeks or months. Such folly is never heard of in an engineer;
but with us human beings, who own and manage a far more wonderful
machine than any steam engine, we hear of it often, and always,
_always_ the tale winds up with the inevitable catastrophe.
The business man develops paresis, the clergyman loses his voice
or his eyes, the nurse contracts some disease that incapacitates
her for work, in every case mother Nature makes the careless or
ignorant owner of the wonderful machine pay the penalty of the
misuse. It does not matter to Nature what the reason is for our
breaking the great laws; we can kill ourselves with philanthropic
work just as surely as with over indulgence. One trouble is, that
it does not always _kill._ A paralytic may live for years, so
does a man with paresis. When the wonderful God-given machine
works badly, or stops entirely, we look on, and sometimes wonder
why it is that those who are so helpful, such fine examples of
courage, of skill, of virtue, so hardly to be spared, are the ones
to be taken away. Do _we_ wonder, we who are nurses? Do we
not know what did it? Ah! yes--we know, we know, that such and
such a nurse was tired out when she went to still another case--
and when we heard she herself was ill we were not slow to say,
"Foolish girl! Did she suppose she was made of wrought iron and
sole leather?" But will _we_ take heed, and not do likewise,
or will we wonder, with the unthinking ones, why it is that the
good, useful people are always taken away? Do not deceive
yourselves; they are not "taken away," they take themselves away,
for God will not reverse His wise laws because we (no matter how
good we are) act in defiance of them.

Please remember I am only speaking now to the good nurses--the
enthusiastic ones,--poor nurses, lazy nurses have no temptation to
overwork themselves. They may die of indigestion, but they will
not die of exhaustion.

It seems to you so natural for others to be sick. You have seen
the sick by scores in the hospital, and have waited on them, felt
sorry for them, sympathized with them; but have you thought that
it was within the bounds of possibility that _you_ could ever
come into such a pitiable condition? You go from house to house in
your private nursing, always you find the sick, and it seems
natural, quite the proper thing. You care for them, they get well,
or die--and on you go to the next--but reflect on what made them
sick, and though you _know_ you are made of like flesh and
blood, do not conduct yourself as if you were not. "Oh, yes" (how
often have I heard it said), "I know she worked too hard, but I am
so strong, you never heard _me_ complain; I can nurse a fever
case for two weeks and never go out of doors for air or exercise."
Is it not foolish? Is it not wrong for any sensible woman to talk
thus?

Now listen to some few practical hints as to how to keep
yourselves in good working order. In the first place, then, never
go to a case unless you are feeling well. It is far wiser, as far
as you are concerned, and better also for the sick one, for you to
say so frankly, if you are not well. Tell the one who comes for
you, that you could not do justice to the case, as indeed you
could not. Sick people are as sensitive as babies to the subtle
influence exerted by the one who is so constantly over them. If
you are in full health and strength, your rubbing will be quieting
and effectual, your very presence, if you are careful and gentle,
will be soothing. On the contrary, if you yourself are suffering
and are using the nervous force you ought to be giving your
patient in hiding your own malady, your presence will not be so
eagerly welcomed; your patient will not know what is the matter,
but she feels rather a relief when you are absent. Going to a case
feeling perfectly well, the next thing is to keep well.

Be careful about your _eating_. Your meals will of necessity
be often irregular, that is unavoidable, but eat only wholesome
things. Do not eat candy; and at dinner, which you will probably
have in the evening after the family are through, avoid patties,
and rich puddings, ice cream, and such like. You will always find
plenty of plain food and fruit in the most luxurious homes; eat
these and let the rest alone. If you want to keep your stomach and
whole digestive apparatus in good order, you must care for it, and
not overtax it. If you have a pretty good stomach it will bear a
good deal of abuse, but in the end it will grumble, and a
dyspeptic nurse is not an attractive object. As to your night
suppers, which you should always have, should your case require
constant watching, I would recommend plenty of coffee, tea, or
cold milk, if you can drink it, bread and butter, cold meat and
fruit. Never eat candied fruits, cake, or pies at night. Have eggs
if you care for them, and pickles if you like. Remember, the
plainest food, the most easily digested, the most nourishing is
what you must have. Believe me, you will be rewarded for the
temperate use you make of all the dainties you see, by a clear
complexion, and good color, which will make you "good to look at,"
especially good for a sick person to look at.

As to the nurse's night toilette, it is quite a problem sometimes
as to just what is best to wear. When the patient is not ill
enough for the uniform to be retained for night duty, the nurse
should be comfortable enough so that she can sleep; yet dressed
enough for any emergency. I think a house gown of pretty material
much neater than the kimono. Be sure this fits about the
shoulders, and never have loose flowing sleeves. A white frill in
the neck looks very trim, and is always becoming. The corset and
all tight clothes should be removed, stockings and underwear kept
on. The hair should be arranged simply, but not allowed to hang in
a loose braid, unless you are _very_ sure you will not see
any but the patient, and even then it may be unwise, as a braid of
hair has an exasperating way of slipping from its proper place
(hanging down the back) and dipping into whatever you are stooping
over. Dressed thus, with night shoes to protect the feet, one can
lie down on a lounge and sleep very comfortably, being freed from
tight clothes, and yet being entirely presentable, no matter what
happens. To undress regularly and put on the diaphanous low-necked
short sleeved night dress of the present mode, and go to bed, when
you are sure you will have to get up one or a dozen times during
the night is not good judgment, I think. You get out of a warm
bed, and if you only put on your shoes and stockings, your patient
must wait while you do it. If anything serious occurs suddenly,
you either run the risk of taking cold from being insufficiently
clad while doing what must be done, or your patient must wait
while you dress--both bad.

Never get into bed with your patient. This seems to most people a
quite unnecessary caution, but it is the commonest experience of
the successful nurse, that a woman, feeble and nervous, should ask
and almost insist that she shall lie down by her, or get into bed
with her. I always wonder that a sick woman can not realize that
she is not a pleasant bed-fellow, but she seldom does. Of course
you are not to tell her that she is not fit to sleep with, but you
_can_ say that she needs and ought to have the whole bed to
herself, and you will sit by her and hold her hand, or if she
insists on it, you can lie down, with your house gown on, on the
_outside_ of the bed, being careful to give her plenty of
space, and when she is asleep, get up quietly and lie down on your
lounge, which should be placed so that you can see her every
movement.

Never let the patient think for a moment that you fear her
disease; if she has diphtheria, do not tell her or the family that
you have a delicate throat or that it is sore, and do not examine
it by the help of a hand-glass where any one can see you. Do not
go to such cases if you really fear them, but if you go, and have
reason to feel that you have contracted the disease, tell the
doctor as soon as you can, and if he thinks you ill, he will send
you home. Never tell a patient you have a weak back or any
weakness. Tell the doctor and he will see to it that you have rest
or medicine, but do not let the patient know it. Never go about a
sick room with a long face; it is enough for the sick one to have
to be sick; the family sympathies are all enlisted for her. You
are there to be a help and a comfort, not an added anxiety. Of
course these remarks do not apply to any of you who are tired from
a long, exhausting case. The family in such instances are ready
and willing enough to let you rest. Keep your cheery manner: all
higher considerations aside, it is money in your pocket to look
cheerful. I have known one or two good, faithful, conscientious
nurses who were dismissed from case after case, merely because
they looked "so doleful." It may seem curious to place a
commercial value on a smile, but in reality it amounts almost to
that.

Be very careful to have your dresses fit you perfectly, and have
them well laundered, especially do not have them too stiff. In
this connection I cannot do better than to relate an incident that
I heard of some time ago. A nurse went to care for a patient whose
first nurse had been called to her own home, and she had not been
in the room an hour before the patient called her and taking her
hand said, "My dear, I can't tell you how thankful I feel that
your dress is not too short in the waist. Miss----'s dress was
frightful!" This was only a nervous woman's whim, but our success
as nurses depends in many cases on just such whims, so it is well
to be careful. When the patient is well enough for you to come to
the family table at meal time, be sure to have on a spotless
apron, and let no sickroom odors announce your presence. It is
worth more to a nurse to have soft, dry, warm, sympathetic hands,
than to have the prettiest face ever seen under a cap, so be
careful of them; after using any antiseptics always have at hand
glycerin and rose water, cold cream, or something soothing to use.
Never put a cold or clammy hand on a patient. If it is cold and
dry it can be laid on a hot, aching head, but never do so if it is
the least damp. If the hand is always damp, pour on it a little
alcohol, or eau de cologne, if that is preferred, or some toilet
water, then put it on the patient's head, and it will be all
right. A simple and very cold lotion is alcohol and water, about
equal parts, and a piece of ice added. Hold your hand in this a
moment and then gently comb the patient's hair (that which grows
on top of the head) with the dripping fingers, taking care not to
let any cold water-drops fall on the face. This is wandering
somewhat from my subject, but I will let it stand and speak of one
more thing that is good to remember. Never lay a warm hand on a
patient's head, or a cold one on the body. If you have to rub your
patient's body, and your hand is warm and damp, shake a little
talcum powder into it, or use a little cold cream, cocoa butter,
or lanolin, and the dampness will not be perceived. Alcohol may
also be used, or bay rum.

Some nurses are much troubled by excessive perspiration,
especially under the arms, any hard work making the dress quite
wet. The ordinary shields are not very good, as they are not
absorbent enough. A piece of flannel basted inside of the shield
is a help, as that is absorbent. The auxiliary space might be
bathed with a solution of alum; alcohol is good or alcohol with
white-oak bark. Many preparations for this trouble are on the
market, most of them are good but some are expensive. A late copy
of the _Journal of Nursing_ gives the following: "Take two
ounces of baking soda, mix with half an ounce of corn starch, and
use as a dusting powder, after the parts have been thoroughly
cleansed and dried. It will check the perspiration and remove
every particle of odor." This is very successful, but I find it
leaves a slight yellow stain on a white dress. Another remedy from
_Journal of Nursing_ is this: "Zinc oxide" applied to axillae
twice a week, after bathing at night, will dissipate the odor. If
the perspiration has a disagreeable odor, no effort should be
spared to free oneself from what is a serious drawback to the
acceptableness of a nurse.

Be very careful not to contract any little annoying habits, such
as frequent clearing of the throat, sniffing, etc. You may have a
catarrh, but use your handkerchief quietly; such noises are very
disgusting, and these habits, I am sorry to say, are not rare, and
seem very hard to conquer.

I suppose that I have better opportunities to hear stories of
nurses and their doings, good and evil, than some have. I
certainly hear some very curious things. The most extraordinary
was of a nurse who always made it a rule, when she went to a
patient's house, to stipulate immediately for her hours "off
duty." She thought she was doing a very clever thing, and making a
most commendable business-like arrangement. It will not be
necessary for me to show you what a lack of tact she exhibited,
and what an antagonistic feeling she aroused.

Never kiss your patient or allow yourself to show any
demonstrative affection, unless you are very sure it will be
welcome, and be careful even then. A kiss for "goodbye" when you
leave the patient is usually quite enough, and many ladies are
repulsed by anything of the kind. If you feel an affectionate
regard for your patient, you can show it by your constant
thoughtfulness and your care. Do not fear that you will lead
lonesome, repressed lives; if you are the nurses you ought to be,
you will have all the affection you want, and often more than you
know what to do with. Never do any sewing or fancy work for
yourself until you are sure there is none you could do for the
patient. Remember that she pays for your time, and govern yourself
accordingly.

Read to her, sew for her, play cards with her, but do not amuse
yourself or regulate your wardrobe at her expense. When I say "sew
for her" I do not mean make her dresses, but do the little odd
things that mothers of families always do, and which must remain
undone if she is sick, unless you do them. Do not write letters
when on duty, and, above all things, do not write with a scratchy
pen. To a nervous person the sound of a scratchy pen traveling
over the paper is torturing, and it can be heard even if you are
in the next room. A fountain pen is, I think, the best to use. See
that it is full before you go to your case, and it will need no
attention for three or four weeks. This pen makes no noise as you
write, and you have it always at hand, and if you have to leave
your letter in haste, you can put the cap on the pen and slip it
in your pocket, and no one is in any danger of finding fault with
the nurse for leaving an open ink-bottle for somebody to tip over.

Remember finally (and I think, from what I read in the daily
papers, you are in no danger of forgetting this), that you are not
domestics, and, while in an emergency I would have you shrink from
nothing that needs doing, I do not think you should do any
washing. Cooking you will very often have to do, but the ordinary
housework does not come at all into your province. If your patient
is a chronic invalid, I would have you make yourself useful in the
house. Do the shopping, order the meals, anything that will show
your patient you are anxious to help make the wheels of domestic
machinery run more smoothly.

You must use all the tact you possess; you will not find two
houses just alike, or two patients with the same tastes. A "lady"
in an emergency does many things she usually leaves to the
servants. So must you. There is sickness, trouble with the
servants, every domestic wheel turning with difficulty, and, if
you have time, if you can leave your patient without doing her an
injury, you can, perhaps, by some little service earn much
gratitude from the family, and help to remove the impression that
trained nurses are "so helpless and need so much waiting on."

In conclusion, let me tell you, with all the earnestness of which
I am capable, that upon each one of you rests not only the
reputation of your school, but, in a measure, the reputation of
the profession. No one needs to be told how much more widely known
is an inconsistent Christian than a faithful one, how much harm
one does and how comparatively little good comes of the others'
faithfulness. And it is just so with you nurses, a careless nurse
makes a far wider reputation than a careful one.

If one physician is unskillful or unprincipled, the whole
profession is not found fault with, but the individual is blamed
and another one found who will do better, but it is not so in most
cases where a nurse proves unsatisfactory. The whole profession
suffers and every nurse sinks more or less if one of her sister
nurses commits an indiscretion, or does any of the thousand things
she ought not to do. I recollect very well, many years ago, a
Brooklyn nurse, of about thirty-five years, married her patient, a
boy nineteen years old. It made a great stir in the city, and, as
I was living there at the time and the superintendent of a
training school, I had to bear my share of the odium cast upon all
nurses. For months after, almost every one I met took pains to
tell me that hereafter they would keep their young sons out of the
clutches of the designing nurse, and I doubt not, such slighting
remarks were borne by every nurse in town, and it was not
pleasant, to say the least of it, for any of us.

Keep your standards high. Let nothing but the very best satisfy
you, as far as you and your work are concerned. Keep your mind
well informed; if it is full of scientific facts, of skillful
methods, of good literature, or fine pictures, there will be no
room in it for the memory of all the disagreeable things every one
must encounter in one's work, and if you do not remember them, you
cannot tell others of them.

Finally, remember (and this lies at the root of it all) to keep
your hearts right,--ever thankful that you are permitted to pursue
this high calling, and ever striving to be more worthy of it, with
many prayers that your life and conduct may show, what is better
_lived_ than talked about, the grace and peace of God, which
verily do pass man's understanding.




IV

THE NURSE AND HER PATIENT'S FAMILY, FRIENDS, AND SERVANTS


Try to realize when you go to a house where there is dangerous
illness, that the family is glad to see you when you come. You
have come to help them, to stay with them, to comfort them by your
presence, by your knowledge, by your experience. They have needed
you, have sent for you, and are to pay you for your time. There is
a general sense of relief when you are once fairly installed in
your place by the bedside, yet you are a stranger. Your friend,
the doctor, has told them what a treasure you are. Mrs. This and
Mr. That have perhaps let them know how invaluable you were when
at their houses; but yet they must look at you a little, they must
note if you make a pleasant impression on the invalid, if you are
as skillful here as you were somewhere else, if you look with
scorn on the plain furniture, or how much you will be displeased
that the bath-room is at the other end of the house. They do not
feel exactly critical: they are too tired or too anxious for that;
but still, unless everyone is too exhausted from watching to do
anything but thankfully surrender everything to you, you will be
pretty closely looked after at first.

You must look for some espionage; and it is only right that you
should be subjected to it. If _your_ mother was lying very
sick, and some stranger, having knowledge and strength superior to
your own, had to come and care for her, would you not feel that
though you were glad to see her, glad she would give your mother
the benefit of her superior skill, yet you would wish to consider
her a little, to note when she did thus and so; or if she did
something you did not understand, could you refrain from asking
her why she did it?

Be patient, therefore, with the suggestions of the family, after
all, though you know the disease and the probable course it will
run, the chances for recovery, and what to do in emergency, etc.,
_they_ know the patient, all her peculiarities, her likes and
dislikes, and if you are wise you will get and keep many little
hints from those who have cared for her before you came. If she
likes milk, will she insist upon tea? Does coffee keep her awake?
Does she hate the sight of gruel, or beef-tea? Does she like much
sugar in her drinks? All these are little matters of individual
taste that you must find out for each patient, and if you have the
necessary tact and forethought, you never need ask the patient one
question; usually the friends are pleased to be consulted on such
small matters, and gladly tell you all you wish to know. To be
sure, they generally tell much more than you asked for; but that
does not matter, it is better to listen patiently for five minutes
to someone's tiresome descriptions than to repulse them, and so
lose just so much kindly feeling from the one who wished to talk
to you.

If the amateur nurse has been doing something actually wrong for
the patient, do not tell her so. She did the best she knew how;
but say, as pleasantly as you can, "I think perhaps _this_
would make our patient more comfortable," or "The doctor thinks
such and such things are not now necessary, and it would be better
to do this way." Then you can do what you know to be right, and
not hurt the feelings of the one who has preceded you, and,
feeling your way carefully, have everything just as it ought to
be, and no one's feelings will be hurt, and no one will feel that
you are looking down upon their ignorance; and here I would say
that in your little confidential talks with the doctor, you could
ask him to say a word to the family if they persist in doing what
you know to be wrong. Ask him to give you orders before some of
them, and that will set _you_ straight in a moment.

With tact, that most invaluable gift, you can get on with
_almost_ every one, and when you find that there is no such
thing as making friends with the family, you can tell the doctor,
and he will let you go; but such places are very rare. Let all see
that you are thoroughly interested in your patient, and do not
hesitate to perform any little kindness that falls in your way for
the rest of the family, and you will win all their hearts without
a struggle.

When you go for your rest, be sure to leave carefully written
directions for the one who is to take your place, just as you do
when in charge of a hospital ward, you leave your orders written
out when you go for your "off duty." Show her how to keep the
sick-room record, and be sure she understands it all before you
leave.

As for the visitors, they are often difficult to manage, and here
again you must have the family help you. Of course _no_
visitors are allowed until the doctor gives permission. So far all
is easy, but when they are admitted you will do well to make a
little plan with the family. Tell them the patient may be seen at
such an hour. Perhaps between eleven and twelve, perhaps between
two and three, just as you consider her brighter in the morning or
afternoon. Ask them who of the first and dearest friends is the
quietest and most discreet, and then say that if they will kindly
arrange for one visitor only to come each day, it would be so much
better for the convalescent. The friends can always do this and
they never object. They tell Mrs. Jones to come on Monday at two,
and stay just fifteen minutes. On Tuesday Mrs. Smith can come, and
so on, until by the end of the week the arrangement ceases to
cause any comment, and soon, if all goes well, and the convalescence
goes on without interruption, _your_ rules and extreme care
can be relaxed to suit the patient's own fancy.

Always carefully note if any visitor tires your patient, and
manage so as not to let her come again until the sick one has more
strength. It is better, I think, to sit in an adjoining room when
your patient has a visitor. This gives you a chance to come into
the room when the person has stayed long enough, and generally
your entrance tells her very plainly that she ought to go, and she
departs without you saying a word. If she does not, you will have
to tell her that the doctor is very particular about not letting
the patient talk too much, etc., etc., and get her out in that
way. Be careful, when the visitor has gone, not to sit down and
talk at length yourself. Give the patient a little nourishment,
turn over her pillows, and if she seems at all wearied make her
comfortable for a nap and let her sleep.

As to the servants they require pretty careful handling. Above all
things, keep on the right side of the _cook_. If you have to
go to the kitchen to do any of the cooking, do not make a
_mess_, or, if you do, don't run off upstairs and leave it.
Gather up your utensils and put them into the sink, and let the
water run over them, and ask for the dishcloth: and if you do it
pleasantly, the cook will probably tell you to "Niver need thim
things," and you will thankfully obey her. If you really cannot
stop to make all tidy after your cooking, you can say, "I'm sorry
to make you extra work with these dishes, but I must hurry back
upstairs." Some such little speech, with a pleasant smile, will
make all things easy for you below stairs, and for the sake of all
the friction it will save you, it is well worth the trouble. Often
the cook will be glad to do the cooking if you tell her how; be
careful to tell her, if it is eaten and enjoyed; and never let her
know if it is rejected. Get rid of it upstairs by some contrivance,
and be sure not to order that dish again. In many cases
of course the cook will know all the little dishes the sick one
will fancy, and you will have very little to do with her. Such
instances are somewhat rare, and very delightful when they occur.

If there is much extra washing, you may have to use much diplomacy
as regards the laundress; and if it is very disgusting washing, it
is well to have a large pail, with a cover, upstairs. Thoroughly
disinfect the clothes before you send them to the washing, as the
odors are often sickening, and the laundress, like other servants,
is very much afraid, usually, of clothing from a sick-bed. Carry
or send the clothes to the washing as soon as possible after
removing them from the bed; never, on any account, allow them to
remain in the room.

The nurse cannot be too careful as to the amount of clothes she
sends to the laundry. She should of course keep herself and the
patient scrupulously clean; but she must reflect that private
families do not have an unlimited store of towels and sheets, and
if she is extravagant in this matter it will seriously detract
from her acceptability.

In concluding, let me remind you that all these hints are intended
for nurses going from one strange place to another, as you would
in nursing fevers, or short surgical cases. Nurses who have
chronic cases need none of these rules. They fall into a routine,
and if they are detained in the family for any length of time,
that shows that their work and methods are right, as far as that
patient and family are concerned. But let them be careful when at
last they leave the case, and go amongst strangers. The ways of
one family are not the ways of another, and they must exercise
much discretion to accommodate themselves to the new environment.




V

GENERAL REMARKS ON FOODS AND FEEDING


Always have all food presented to an invalid as tempting as
possible. Use pretty china and glass, if you are permitted to do
so, yet not the very finest the house affords; that might make the
patient nervous lest some evil befall it. Absolutely clean napkins
and tray cloths, a few green leaves about the plate, a rose on the
tray; the chop or piece of chicken, the bird or the piece of steak
ornamented with sprigs of parsley, the cold things really cold,
and the hot ones _hot_, these are necessities of invalid's
feeding, that mark the nurse who has a proper appreciation of a
sick person's delicate sensibilities. Have all plates, cups and
saucers _hot_, when they are for the reception of hot toast,
coffee, tea, etc. Hot water plates are very convenient, and easily
procured at any large china shop; but if they cannot be found, put
the hot plate containing the chop over a bowl of boiling water,
and cover with a hot saucer, fold a napkin around the baked
potato, and you can carry the tray containing the dinner through
cold halls and up staircases and it will arrive at your patient's
room _hot._ Be careful not to fill the bowl so full of hot
water that it will spill. Never fill a cup so full that it will
spill its contents over into the saucer, it makes a disgusting
looking _mess._ Have all fruit _cold,_ oranges and grapes
especially. Always look over a bunch of grapes and cut off
the soft ones before you hand them to a patient. If you have
foreign or California grapes, hold them for a moment under the
cold water faucet and let the water run through the bunch, and all
the cork dust will then be washed out.

If you peel and quarter an orange for your patient never let her
see you do it, unless you are perfectly sure you will not get your
hands covered with juice. Wash your hands before you bring it to
be eaten.

Be careful not to have any suspicion of grease about the beef tea,
broths, etc. A quick and easy way to remove all grease, is to fill
a cup or bowl _brimming_ full, let it stand a few moments
that the grease may rise to the top, tip the cup a very little to
one side, and the grease, to the last atom, will flow over the
side of the cup; pour your broth carefully into a clean hot cup,
and serve. Beef juice is more palatable with a little very brown
toast.

Remember, that an invalid hardly ever likes any food made sweet.
No matter what the taste may be in health, in sickness, sweet
things are nauseous; for this reason ice cream bought at
confectioners' is often rejected. Salt also must be used with
caution, if the mouth and lips are tender, as is often the case;
use the salt sparingly in all broths, etc.

If your patient cannot take milk, when, as in typhoid fever, the
doctor wishes the diet to be wholly or for the most part of milk,
try at first to remove the thick, bad taste by giving a little
pure water or carbonic acid water after it. If that will not do,
mix the carbonic acid water with it, and have both nice and cold.
If a glass of milk is too much (and it will be in nine cases out
of ten, especially if it is cold), give half a glass; if that is
still too much, give quarter of a glass, or put more water with
it. Never repeat a dose (of food) if it nauseates the patient.
Make some change in quantity or quality, and you will, if you
watch carefully, find out the right proportions.

A person lying flat down in bed cannot, of course, drink from a
glass or cup, and a feeding cup is apt, by pouring too freely, to
cause choking. A bent glass tube is the best arrangement, the
patient can drink easily through this, and can regulate by
sucking, the rapidity with which the food is taken. The tube
should be cleaned immediately after each using, and if any beef
tea or other food cannot be dislodged by letting water run through
it, pass a string with a knot tied in it, through. Make the knot
big enough to touch all sides of the tube, have it thoroughly wet,
and the cleansing will be easily and quickly accomplished. If a
patient prefers drinking from a glass, and can be raised in bed,
always lay a napkin under the chin before you give the drink, and
on no account have the glass or cup more than half full, if you
do, it will surely spill.

In giving medicine that tastes very bitter or unpleasant in any
way, bring, at the _same time_ with the medicine, some water,
milk, or whatever may be preferred, to take after it. Also a
napkin to wipe the lips, especially if the patient be a man.

Always keep milk, beef tea, etc., _covered_ in the
refrigerator, and, if you can, see that this is cleaned every day.
But this might cause the cook to feel aggrieved, so I put it as a
suggestion merely. But if the refrigerator has a _smell,_ and
the cook seems touchy, the milk, etc., better be kept upstairs on
some sheltered window-ledge, and carefully covered.

If you have your own little refrigerator upstairs, see to it that
it is cleaned _every_ day. Never put away anything in tin
pails; always use earthen or china bowls or pitchers.

BEEF TEA.

Beef from the round, finely chopped and free from fat.
Proportions, 1 lb. beef to 1 pint of water, cold. Let the beef
soak in the water, stirring occasionally, for two hours; then put
it on the stove and heat it until the red color disappears; never
boil it. Skim off all grease, salt to taste.

BEEF JUICE.

Round steak cut an inch thick; slightly broil like beefsteak for
the table, cut into squares of an inch, squeeze in a lemon
squeezer, skim carefully and salt. Serve either very cold, or
place the cup containing the juice in a bowl of boiling water,
stir carefully, and as soon as the juice is warm serve. If left a
moment too long it is spoiled, as it curdles. One pound of beef
makes an after dinner coffee cup almost full of juice.

BEEF TEA IN A BOTTLE.

Put into a Mason's preserve jar, tightly corked, one pound of beef
chopped as for ordinary beef tea. Put this into a kettle of cold
water, with a saucer on the bottom, let it come slowly to a boil
and boil for an hour. Take out of the bottle and squeeze the beef.

SCRAPED BEEF.

Take a piece of lean round steak, scrape with the edge of a spoon
until the place scraped has no more meat on the surface, but only
the white fibre, cut this off with a sharp knife, exposing once
more a fresh surface. Season, and spread raw on bread and butter,
or make into little cakes and broil slightly, according to the
doctor's orders, or your patient's taste.

MUTTON BROTH.

Mutton from the neck. Proportions, 1 lb. of mutton to 1 quart of
water, put the mutton and the water (cold) on the back of the
stove, let it come slowly to a boil, boil until the meat is ready
to fall from the bones. After straining out all the meat etc. add
one tablespoonful of rice or barley. Simmer half an hour after
adding rice or barley.

CLAM BROTH. NO. 1.

Take 1 qt. clams. Strain off the juice and chop the clams fine,
return clams to the juice and simmer one hour. Put on to scald as
much milk as juice. Strain out the clams, thicken with a little
corn starch, making about as thick as cream, pour juice into a
bowl and add the milk.

CLAM BROTH. NO. 2.

Same as above, only cut off the hard part of the clams, chop the
soft parts and leave them in the broth. For convalescents.

CLAM BROTH. NO. 3.

Take little neck clams unopened, wash them very clean with a
brush. Place them on the top of the stove in a clean dry pan, and
when the shells open take them off, remove the clams and pour the
juice into a cup. To be served hot. If it is too strong, add a
little boiling water. This is for very sick people; give only a
teaspoonful at a time. It sometimes corrects nausea.

CHICKEN BROTH.

A fowl, not too young, cut in pieces, 1 qt. water to 1 lb. fowl.
Put it on the stove in cold water, let it heat slowly, then boil
gently until the meat is ready to fall from the bones, strain,
skim and add rice, boil once more for 1/2 hour. Salt to taste.
Serve with toast or hot crackers.

OYSTER BROTH.

Equal quantities of juice and milk, put each in separate vessels
on the stove; when the juice comes to the boil, skim and slightly
thicken, pour in the milk boiling hot, add the oysters one by one,
let them remain on the stove about five minutes, or until the
beards begin to curl, and they are no longer slippery. Serve with
crackers heated very hot.

OYSTERS BROILED.

Dry the oysters, large ones are best, in a towel, have a piece of
toast slightly buttered on a hot plate, near, pour over this a
little hot oyster juice, not enough to make the toast wet through.
Arrange the oysters on a fine buttered broiler, cook over a brisk
fire like steak, until the beards curl. Turn them often. It takes
about five minutes. Arrange them on the toast, add a little salt
and a very little butter, serve very hot.

BROILED CHICKEN.

The chicken must be young, split down the back. Lay on the
gridiron and broil evenly, turning frequently. Serve on a piece of
buttered toast, salt and slightly butter the chicken. A little
parsley garnishes the dish prettily.

All birds to be broiled should be split down the back and broiled
evenly, laid on thin toast and served hot.

BEEF STEAK.

Steak must be cut 3/4 inch thick, and evenly broiled, rare, unless
particularly requested to do otherwise. Be careful not to smoke
it; the grease dropping into the fire may make trouble in this
way.

OATMEAL GRUEL.

Take two large iron tablespoonfuls of oatmeal freshly cooked for
breakfast, add one cup of boiling water, slowly stirring all the
time, then add an equal quantity of milk. Let all boil for ten
minutes, and strain through a fine wire sieve. If you have no
cooked oatmeal put 1/2 cup raw oatmeal in a double boiler with two
cups of boiling water and cook for two hours, then proceed as
above. It makes the gruel richer to add all milk, or 1-1/2 cups of
milk and 1 cup of cream. Be sure not to forget the salt. Never put
any sugar in unless requested to do it by the patient.

KOUMYSS.

Dissolve a third of a cake of compressed yeast (Fleischmann's) in
a little warm water (not hot). Take a quart of milk fresh from the
cow, or warmed to blood heat, add to it a tablespoonful of sugar,
and the dissolved yeast. Put the mixture in beer bottles with
patent stoppers, fill to the neck, cork, and let them stand for
twelve hours where the temperature is about 68 degrees or 70 degrees,
then put the bottles on ice, upside down.

MILK PUNCH.

One glass of milk, 1 or 2 tablespoonfuls of brandy, 2 teaspoons of
sugar.

Shake well or beat with an eggbeater. Give cold. Have patient take
slowly.

EGG-NOG.

One egg, half glass of milk, 2 teaspoons of sugar, 2 teaspoons of
sherry or brandy, ice. Beat the yolk of egg in a glass, add the
sugar and beat, then a little milk, continue beating, then four or
five pieces of ice about as big as a hickory nut; add brandy--
regulate to the taste of your patient--add rest of milk; beat
whites of eggs and add all but a teaspoonful with which garnish
the top. It should make a glass brimming full. Have a spoon with
which to eat it.

EGG LEMONADE.

One egg, one-half a lemon, 2 teaspoonfuls of sugar, beat the white
and yolk separately as for egg-nog; add the sugar to the yolk,
then the lemon juice, then the ice, lastly the white beaten to a
stiff froth.

WINE WHEY.

One pint of boiling milk, one-half pint sherry; add sherry to the
milk while scalding hot; stir a moment until the curd gathers;
strain through a fine muslin, sweeten. To be taken cold. This
takes a little practice to gather the curd as it should be done.

POACHED EGGS.

The best way of cooking for an invalid. Slip the egg, previously
broken into a saucer (the fresher the egg the better), carefully
into salted water which is boiling in a frying pan, then
immediately set the pan at the side of the stove so that the water
does not boil, keep it there for about five minutes. Let the water
be about two inches deep in the iron frying pan. Each egg must be
broken separately and slipped carefully into the water. When
cooked so that the white is firm but jelly like, no part being raw
or hard, take it out with a skimmer and slip it on a piece of thin
buttered toast, sprinkle a little salt and pepper on top, serve
immediately. Garnish with parsley.

SCRAMBLED EGGS.

Beat two eggs until thoroughly mixed, add two tablespoonfuls of
milk, salt and pepper. Pour into a very hot frying pan, buttered,
and stir constantly for about two minutes. Pour over buttered
toast.

SHIRRED EGGS.

Heat the shirring cup very hot. Put in a piece of butter as big as
a large pea. Shake it about and break in the egg. Let it remain on
the stove a few moments and serve in the shirring cup. Sprinkle
salt and pepper on it.

OMELETTE.

Beat very stiff two eggs, whites and yolks separately, add two
tablespoonfuls of milk and a little salt. Pour carefully into a
small frying pan, _hot_ and buttered. As soon as the egg is
_set_, slip a knife under one side and fold one side over the
other. Slip on a piece of toast and serve at once. A little finely
minced ham or parsley flavors it very well.

RENNET.

One pint of milk slightly warmed and sweetened and flavored, add
one large teaspoon of liquid rennet. Stir for a moment and set it
in a refrigerator. To be eaten with sugar and cream.

BOILED CUSTARD.

One pint of milk and 2 eggs. Beat the eggs, add the milk heated
almost to the boiling point. Stir in 2 tablespoonfuls of sugar.
Return to the double boiler, and cook for about 3 minutes,
stirring gently all the time. When done it will be about as thick
as cream. Be careful not to let it cook too much as it will
"separate" and be spoiled.

BAKED CUSTARD.

Same ingredients and proportions as for boiled custard, only let
milk be cold. Pour into custard cups. Stand these in a dripping
pan half full of warm water and bake in a pretty hot oven. Watch
carefully, bake 15 minutes.

THIN BREAD AND BUTTER.

Have a loaf of good home-made bread, yesterday's baking, cut off
the crust, then butter the loaf and cut the slice in this way,
buttering first and cutting afterwards. The slice can be made
_very_ thin and dainty, and the thinner it is, the better. A
patient will sometimes relish this when tired of all kinds of
toast or crackers.




VI

THE NURSE AS RELATING TO HER OWN TRAINING SCHOOL AND TO HER FELLOW
NURSES


Always be loyal to your own school and hospital. It may not have
been in every respect perfect; but it is not necessary to tell
strangers of its imperfections: probably those in authority are
just as sensible of its short-comings as you are, and perhaps they
work harder than you do to right its wrong; in any case it does no
good to tell others of the things you disapproved. It may indeed
be that your criticism is one-sided and unfair, that the very
rules you hated and found hard to keep are the wisest ones, and,
if you let strangers see that you disapprove of these wise
regulations, the opinion they will form of your intelligence will
certainly not be flattering to you.

When you meet other nurses in your work, as you are sure to do,
and when you compare your school with the one the other nurse came
from, try to realize that the other school is neither wholly above
nor wholly below your own; each has probably its own merits and
its own drawbacks. You should not tell the other nurse any of your
own school's shortcomings, any sooner than you would tell them to
any other stranger; be loyal everywhere to the place where you
were fitted for your work.

Never tell revolting hospital stories to your patients. Some
people have the most morbid wish to hear dreadful details. I
remember a patient of mine, years ago, asking me in all good faith
to tell her the most horrible thing I had ever seen in all my
hospital experience. I asked her why she wished to hear such
things, and after some reflection she acknowledged that it was a
foolish, morbid curiosity. It is best to keep the dreadful side
entirely out of sight; there are plenty of bright, interesting,
pleasant things always occurring; tell of these. Tell of the
cunning little babies in the lying-in ward, the absurd little
black ones, the fat little German and Swede babies. Tell of the
surly drunken men that come, and how a week of cleanliness in bed,
with a broken leg, or it may be a cracked skull, will change them
into quiet, polite, pleasant patients; and how, later, they will
take their turn at washing dishes, with a docility that would make
their wives stupid with amazement. All such matters (and the more
you try to think of them, the more you will be able to recall)
will amuse and really edify your patient, many of whom think of a
hospital only as a place of terror.

Never gossip about your sister nurses; of the stupidity of one,
the untidiness of another, or the overbearing nature of the third.
It can do no good, and it lowers you in the estimation of every
one who hears you talk.

As for your duties to each other, I would have you always observe
the same punctilious etiquette outside that you do in the
hospital. When you are called to assist another nurse, remember
that _she_ is the head nurse; the case is hers. She gives
directions, and you follow them; be sure you do it faithfully. If
you have some one to assist _you_, be sure you arrange for
her rest and exercise, and that you leave intelligently written
orders when you go for your own rest.

Some very awkward complications may arise where there are two
nurses, and the worst, I think, is for the patient and family to
like the second nurse better than the first one, and to criticise
her and find fault with her to the other nurse. This is hard all
around. The second nurse expects the first one to be preferred,
and usually dislikes to go to such a case, for that very reason;
but if any of you find that under such circumstances you are
preferred, never allow the people to retail to you the faults of
the other nurse, and never gossip about her. She may not suit
them, but she is probably doing the best she can, and such idle
talk can do no good. If they _will_ talk, make all the excuses
for her you can, and never let her suspect from any action
of yours, that you are preferred above her. If, on the other hand,
you are the first nurse and some second one is called in, and
preferred before you, study her well. See how it is that she wins
the patient's confidence, when you did not. Try to find out, in a
quiet way, wherein lies her charm. If it is quietness, exactness,
cheerfulness, or ready tact--it must be something--and if you are
clever you must see how it happens that she is preferred. It will
be a good lesson for you. Perhaps you will never have such another
chance for learning what you have found out by experience you
lack. So do not waste your time by allowing yourself to feel
jealous, but use it as a time of study, and you may reap a rich
reward by winning your next patient's confidence.




VII

WHY DO NURSES COMPLAIN?


It seems to some of us, judging from the prevailing tone of
nurses' conversations, that this is a veritable age of discontent.
We hear that a nurse's life is confining; that it is wearing on
the nerves; it keeps one from enjoying society; it is not
sufficiently remunerative, etc., etc. We all know, without going
into further particulars, what a nurse could complain about, and
though each one's tale of woe may be perfectly true, it seems to
me we are not wise, as nurses, to allow the trials of our
professional life to occupy such a prominent position in our
thoughts.

Let us glance at some of the other professions, and see how the
members of each regard their chosen work. What is the prevailing
theme of the religious newspapers? Is it complaints from the
ministers that they are not appreciated, or that their life wears
on their nerves? Not that surely, but we read of more and more
work to be done; more and more need of the gospel to be preached
and lived, that all may be attracted to it. What do we read in the
medical journals? Not how often Dr. Jones or Dr. Smith has been
called up at night, or how often they have been dismissed or
maligned by ungrateful patients; neither do they talk of such
things. Do they complain that they are kept from the presence of
"Society?" Not so, and why? Their enthusiasm is such that these
matters are accepted as part of the inevitable, and the higher,
nobler aim is so real that the lower and meaner consideration of
personal comfort sinks into insignificance. What is the soldier's
favorite tale? Not that all through the war he had to drink his
coffee without cream, that he did not have sheets on his bed, and
that he ate from a tin plate. Would he ever speak of such things,
except to show that a man can for a noble aim accept inconvenience,
and laugh over it? Yet the soldier has probably been used
to these comforts and many more all of his life in his home;
but viewed in the light of his enthusiasm for the country he
is striving to save, and seen by the side of her peril, such
inconveniences sink into their merited nothingness.

Now the profession we have entered is, we are told, a noble one.
We have been ranked shoulder to shoulder with the doctors, we have
been compared to soldiers, we have been assured that our
opportunities for doing good to souls are second only to those of
the ministers. What more do we want? We want this, and we want it
very much. We want the courage to accept our trials which must
come if we are to have any glory. It is all very fine to be called
a ministering angel, but it is pleasanter to minister to those who
are appreciative. We _can_ be heroic, in an emergency, but if
we are not properly thanked, we do like to growl a little. It is
gratifying to our vanity to be ranked with our masculine
associates, but when it comes to the hard, thankless tasks which
they accept without a murmur, then we proceed to show that we know
what is what, and that our refined tastes cannot be so inconsiderately
treated.

The trouble with these fretful nurses is that they _are_
nurses. If they are not satisfied with the profession they have
chosen, why do they not make a change and enter some other? Do
they not know when they enter the work that it is hard, do they
not hear on every side that it is exacting and confining? They
knew it perfectly well before they began, why then do they
complain? Why not say candidly, "I cannot have such enthusiasm for
my fellow-men that I can forget myself," and then do something
that is easier?

The Superintendent of the training school shows each new aspirant
for the nursing profession that the life is not an easy one, that
patience is one of the most necessary characteristics for the
nurse. She tells her of the trials, the irritations, the unreason,
the tiresomeness of sick people, and still women will come to the
school, and forgetting the warnings, they will complain when some
exasperating incident occurs. If a nurse, from overwork and the
consequent weakening of her nervous energy, has lost her patience,
she will be a wise woman if she drops out of nursing work for a
year or more; this will probably help her, complaining never will.

Do you feel that your patient is cross or unreasonable? That is
most likely, and is to be expected in nine cases out of every ten.
Put yourself in your patient's place for a little while; try to
realize what it is to have a pain, constant and sickening; to have
it every minute of the twenty-four hours; try to imagine the
fatigue of a respiration of forty; the ache and restlessness of a
fever of 103 degrees; the agony of longing to change a position when it
cannot be done; the despair of a hope for recovery growing daily
less, or the realization of absolute weakness that comes with
early convalescence; try to imagine yourself bearing some of these
ills with nerves and brain weakened by disease, and you will not
wonder that your patient is irritable, that he thinks the minutes
of your absence are "hours," that the unevenness of the bed is
"hard lumps," that the food is "slops," and the medicine "no
good." Remember that he is a prisoner, and he has a cruel jailer;
his bed is his prison, his disease is his jailer, and he suffers
whatever torments his jailer chooses to inflict. Now prisoners are
not, as a rule, a happy class of men; so bear with your prisoner
and help him. Complaining about his shortcomings will never make
them any the less. He is sick. Oh! the pathos of that short
sentence, "He is sick;" that says all. You are well, or you ought
to be; therefore bear with him.

You have chosen a hard profession, but we are told it is the
noblest one a woman can follow. Why is it noble? Exactly because
it is hard, and the hardness consists in your forgetting yourself
and giving your strength to others. There are many hard lives that
are not in the least noble, but there is no noble life that is not
hard. A coal miner has, I suppose, a hard life, yet no one calls
it a noble one; why? Because he works solely for his wages, and he
complains and "strikes" when his wages and his hours do not suit
him; but a doctor going from house to house, and in spite of all
discouragements carrying cheer and hope; a city missionary going
to the degraded, the ignorant, and by his own efforts helping his
fellow-men to a better life, to a knowledge of God--these are
noble lives. You can see I am sure the difference, and you will
not gainsay me when I assure you that the doctor and the
missionary, though they may not be satisfied with themselves, or
with their manner of working, are happy men, happy because they
live outside of themselves. The coal miner who is not content with
his wages is miserable, because he himself and his needs loom up
before him so large that every thing else is shut out. It is
because you take a hard task and do it well, that so much praise
is given to nurses. If you undertake a difficult task and fret
over it all the time you are doing it, if you propose to benefit
your fellow creatures and grumble because you have not comforts,
or appreciation, or gratitude, where does the nobility go? Where
is the heroism? If the task is easy, agreeable, delightful, the
idea of heroism, of nobility, of all high aspiration dies
directly. Did any one ever do a grand work and have an easy time
while doing it? Did Florence Nightingale have all the comforts of
life when she did her great work? Was it not by her indomitable
perseverance, her great patience, and her enthusiasm for others
that she won such an honored place for herself? You know almost
before I say it, that there can be no loftiness of purpose, no
enthusiasm, if there are not difficulties to be conquered, and you
all know that complaining about sick people will never alter their
characteristics, and that complaining about the nervousness of the
relatives will never make less unreasoning, when they are fearful
that a loved one is going to die.

Do we want gratitude and appreciation? We get it very often, and
very often we do not; and when this last is the case, we may
reflect that we are in very good company. How did the French
reward Joan of Arc? The warmth of their gratitude led her to the
stake. Galileo, as reward for his discovery, was put into prison
and loaded with chains, as were also Christopher Columbus and Sir
Walter Raleigh, a notable company these, and every one suffered
from the ingratitude of their fellow-men. Many more examples you
must call to mind, of ingratitude more base than any thing we
shall ever be called upon to bear.

The profession of nursing is still one of the most recent that
women have engaged in. The world had until the past few decades
been so used to being nursed by the old-fashioned nurse, who was a
servant, and who never expected any treatment but that of a
servant, that it has taken some years to always remember that we
are not servants, in the usual acceptation of the term; but no one
will be convinced of the fact that we are ladies by our
_telling_ them so. If you are a lady, with a lady's
refinement, every one in the house will know it, will feel it, and
you will never mention the subject; they must feel it, then there
will be no arguing on the subject. It must be demonstrated by your
deftness, your quietness, your cheerfulness, your education, your
intelligence, your quick appreciation of other good qualities. We
must all of us show the world that it is being nursed by its
compeers, that a lady can do even the most revolting service in a
way that robs it of its difficulties; and when the hard part of
the illness is over, when your patient is ready and anxious to be
entertained, you can show that you are not a machine for carrying
out the doctor's orders; that you are capable of something more
than the ability to take temperature, pulse, and respiration.

We must remember that even yet we are, in a way, pioneers of one
part of that great woman movement in the world. It is not enough
to educate one family up to the realization that we are its
equals; the next house we go to, the same work may have to be done
over again; but each time it is done, and done well, the whole
profession has been benefited, which is an aim worth striving for.




VIII

THE NURSE AS A TEACHER


It does not occur to every nurse, when she graduates, that she has
been preparing herself, during all these strenuous years of study
and hospital work, for the life of a teacher. She fondly imagines
that she is a nurse, and only that; but after she has been doing
private duty for a year or more, she realizes that she is
generally a teacher as well as a nurse, and that often she is a
missionary also.

Perhaps no private duty nurse needs to be told what subject she
must teach; the patient or the patient's friends never let her
rest until she has told the "why" of every thing she does, or does
not. There are, however, some important subjects that the nurse-
teacher should try to make very clear to every patient.

We will begin with the baby, as the babies are with us always, and
if doctors and nurses, science and sanitation have their way,
there will some time be no call but that of the baby, for nurse or
doctor either. The ignorance of the young mother is proverbial;
her wish to know about her baby and its care is pathetically
earnest. The new life is so precious, she would take such good
care of it, if she only knew how. Here is a pupil eager for
knowledge, ready to do all that can be intelligently taught to
her. The nurse should have very clearly in her mind all the
mysteries of digestion, all the reasons for regularity in feeding,
the necessity for fresh air, for long and uninterrupted slumber,
for loose clothing, for regular bathing. She should be able to
give the mother the rules for her own living that she may be able
to provide the best milk for the baby, or, if the little one has
to be artificially fed, the methods of preparing the particular
food chosen should be explained, and the indications of
indigestion pointed out. All this is real teaching, real
missionary work, and if well done will help the mother immensely
and probably save the baby many attacks of colic or worse. Washing
the baby is usually regarded by the young mother as a terrible
ordeal. No nurse should leave her young-mother patient until she
is fully able to perform this task. Let the mother watch, a few
mornings, while the nurse does all the work, then let her undress
the baby, when the nurse can take him and finish the operation.
Day by day let her do a little more, as her strength and ambition
permit, until at the end of a week she is fairly used to handling
the child and can, perhaps, keep him until the last finishing
touches are put on. The nurse should always be near, to help, to
advise, to take the child should the mother become exhausted.
Finally, she should go into another room, and, leaving all things
ready, allow the mother to perform the duty by herself, letting
her know that at any time she will be relieved if necessary. In
this way the mother becomes accustomed to the child, and the bath
is always a pleasure to her. How many times have we heard pathetic
stories of a young mother trying for the first time to wash the
baby?--the tears of despair, the nervous blunders, the exhaustion
when the performance was brought to a hasty close. All such
stories mean that the nurse in charge was not a teacher and that
her work when she left the case was not completed.

Suppose that this baby is the third or fourth, the mother knows
what to do for the new little one, but how about the others? She
is still anxious to do what is right, or perhaps she is not
anxious, and her attitude toward the children is not what it
should be. Perhaps she does not realize that she will be called to
account for these souls intrusted to her care, that these bodies
will do their part in life, well or ill, as she treats them wisely
or foolishly. Here is true missionary work. A thoughtful,
intelligent, judicious nurse can show a mother that an adenoid may
be responsible for Johnny's inattention, as it causes dullness of
hearing, how Mary's fretfulness is caused by too little sleep or
by insufficient ventilation of her room at night. She can explain
how irregular eating causes the children to be cross and
irritable. She can show why the first teeth should be removed when
the second begin to push towards the gum. She can teach the mother
that the headaches so often met with, in children who go to
school, are due, perhaps, to eye strain, and can not be corrected
with pills, and should never be soothed with headache powders. She
can show the evils of the gallons of soda water too many young
women swallow, of the injudiciousness of allowing young girls to
congregate in drug stores. These last two evils, "soda water and
the drug store habit," the mother may know nothing about. She is
busy at home with the "little ones," and the fourteen- or sixteen-
year-old girl only too often is allowed to wander off "down town"
with other young girls, and what she does there would astonish
many a mother.

Every nurse should know how to teach her patient to guard herself
and her children from tuberculosis. She should be able to show
what the early symptoms are, what is then necessary to do, what
care should be taken of the sputum, of the patient's food, of his
eating and drinking vessels, his bed and bedding. She should know
how to teach a tuberculosis patient to care for himself, how he
can avoid giving his disease to others, if he stays at home; and
where he will find proper hospital or sanatorium accommodations if
he goes away.

Most mothers are very thankful for practical hints from one who is
supposed to know, and who, during a four to six weeks' stay, makes
herself one of the family, and offers advice in the _right
way_ and _at the right time_.

The great sex question is almost sure to be discussed at such a
time. The advent of a new baby is such a wonderful thing that
nearly always the other little ones want to know (very naturally)
where it came from. Little folks are brimful of curiosity. It is
Nature's way, I suppose, of teaching them. Every new thing fills
them with admiration, with joy, and they must know all about it.
"Oh, mamma, what a lovely new pony! Where did you get it?" "Is it
really mine?" "Oh, papa, what a dandy, new sled! Where did you get
it? Can't I use it right now?" "Oh, have we got a new baby? A real
baby? Is it ours? Where did it come from?" "Can't I hold it?"

All are familiar with these expressions of wonder, of delight, of
joy of possession, but how to satisfy the eager mind aright is a
problem requiring our most careful thought. Books, papers, and
magazines tell us what to say and how to say it. All this should
be talked over, and, if the mother does not know, the nurse should
know what books to tell her to read.

The medical world to-day is much concerned over the question of
prostitution and its effect upon the coming race, through the
transmission of syphilitic taint to an innocent wife, who is
thereafter barren, or who bears syphilitic children. The folly of
the double standard, purity insisted on for the wife, unchasity
condoned in the husband; all these subjects are sure to be brought
up, and the nurse who goes prepared on these and kindred topics
can do an immense amount of good to the women she nurses.

She can show how useful the knowledge of chastity is to a boy-the
strength that comes from self-control, the weakness that follows
self-indulgence, the danger to himself and to those he really
loves when he contaminates himself with prostitutes. A young man
once said to a friend of mine, "Oh! if my mother had only warned
me of the suffering I would cause myself and others, I never would
have polluted my body and shamed my soul." The nurse should know
how to instruct the mother as to the signs of self-abuse in her
little boys, so that she may know what causes the nervous
movements, the pallor, the fitful appetite, the dark circles under
the eyes, the listlessness, the fondness for being alone--any one
of which should call for extreme watchfulness. All these things a
nurse should be sure to know, so that, as far as in her lies, she
should be one more earnest woman striving to make the world better
for her having lived and worked in it. A wise man has given this
quaint description of a perfectly educated man: "When a man knows
what he knows, when he knows what he does not know, when he knows
where to go for what he should know, I call that a perfectly
educated man." So with the nurse. When she finds a social problem
with which she is not familiar, let her turn to this list of
books, magazine articles, and pamphlets upon the subject: Chapman,
Rose R., The Moral Problems of Children; Dock, Lavinia L., Hygiene
and Morality; Hall, Winfield Scott, Reproduction and Sexual
Hygiene; Henderson, Charles W., Education with Reference to Sex;
Lyttelton, E., Training of the Young in the Laws of Sex; Morley,
Margaret W., The Renewal of Life; Morrow, Dr. P. A., Social
Diseases and Marriage; Saleeby, Caleb W., Parenthood and Race
Culture; Wilson, Dr. Robert N., The American Boy and the Social
Evil, The Nobility of Boyhood, 50 cents (contained in "The
American Boy and the Social Evil"); Hall, Stanley, Educational
Problems, Chapter on the Pedagogy of Sex, Adolescence, Youth;
Northcoate, H., Christianity and Sex Problems; Janney, Dr. Edward
O., The White Slave Traffic in America; Report of the 3 8th
Conference of Charities and Corrections, in Boston, June, 1911,
Sex-Hygiene Section; Kauffman, Reginald Wright, The House of
Bondage; Summary of the Chicago Vice Commission, in the May number
of _Vigilance_; Education with Reference to Sex in the August
number of _Vigilance_ (published monthly at 156 Fifth Ave.,
New York City, at five cents per copy); The Cause of Decency,
Theodore Roosevelt, _Outlook_, July 15, 1911; articles on The
Causes of Prostitution in _Collier's Weekly_, from time to
time, since April 1, by Reginald Wright Kauffman; articles on the
Necessity for Teaching Sex Hygiene, in _Good Housekeeping_,
beginning with the September number; Dr. Dale's articles on Moral
Prophylaxis, in the JOURNAL OF NURSING since the July number;
Instructing Children in the Origin of Life, Elisabeth Robinson
Scovil, in October JOURNAL OF NURSING; Leaflets and pamphlets
published by American Motherhood, 188 Main Street, Cooperstown,
New York; Publications of the American Association of Sanitary and
Moral Prophylaxis, New York City, JOURNAL OF NURSING, February,
1912.

One last word and I have finished. Be careful, oh so careful, that
your instructions are acceptable, that your pupil is anxious to be
taught. Most mothers are anxious on these subjects; if one is
encountered who does not care, first try to make her care (and
this is a task, indeed), and then teach her what to do and how to
do it.




IX

CONVALESCENCE


One frequently hears the private duty nurse deplore the necessity
of her remaining with a patient during convalescence. "I wish,"
such a one would say, "that I never need stay with a patient after
the temperature has been normal for ten days," or, "I do not mind
the first two weeks of an obstetric case, then there is something
to do, but after that I am ready to leave," or again, "When my
patient is ready to go out driving, I always wish she would drive
me home; half-sick people are not to my taste." I have often
wondered if this feeling is not caused by the atmosphere of the
hospital which has, during training, been the nurse's home,--the
hospital, where the patient leaves at the earliest possible moment
of recovery, to make room for someone else. The pupil nurse gets
used to the excitement of critical illness, used to the hard work
of constant watching and fighting for the patients' lives, and
that, and only that, it seems to her, is nursing. So when she goes
to her private cases, and her patient has a long period of
convalescence, she feels out of place, she does not seem to be
doing what she was trained to do, and she frets over it, until
some happy day when the doctor releases her, and she is at liberty
to go once more to some one who is at death's door.

Nurses seem to feel that caring for a convalescent is not
"nursing," but there they are mistaken. After a serious illness it
takes a long time to restore the patient to perfect health, some
function may need the close watching which only trained eyes can
give, and it is not beneath the dignity of the nurse to remain,
and keep watch until every part is once more in perfect working
order. Many nurses feel that it is not nursing to amuse a patient,
but it is nursing to help him on to the healthy plane from which
he has fallen, to play games with an invalid and to watch him, to
read with him, and to watch, to walk or ride or travel with him,
and to watch, always to watch, that the dreaded symptom does not
appear, that the one part which still needs care gets it.

A surgeon does not spend all day, every day, with his gloves on,
and his scalpel in his hand; he is not _always_ operating, or
even arranging for operations; he can find time to see patients,
to sit and talk with them, to advise them, to cheer them, even to
tell funny stories to them, but all the time he is watching them.
A lawyer is not always pleading in the court room, a clergyman is
not forever in the pulpit. The lawyer when talking to his client
is just as truly a lawyer; the clergyman, when visiting his
congregation, is just as truly a clergyman,--the sermon on Sunday
is the climax, if I may so express it, of his week's work. The
lawyer's speech to the jury is the point to which all his efforts
tend after, perhaps, weeks of preparation. So the convalescence of
a patient is the post climax of the nurse's undertaking. She
begins with the climax, severe illness, operation, or obstetric
case, whatever it may be, gradually the stress lessens, the whole
atmosphere of the house becomes natural as the patient progresses
toward recovery; but the process is not complete, and the nurse's
work is not done until the doctor pronounces her trained care no
longer necessary; then she may go, and feel that her work has been
thoroughly done-no small comfort surely.

I wish I could show my young sister nurses how good _for
them_ this period of the patient's convalescence might be. The
delightful rest of regular sleep, and regular meals comfortably
eaten at a table instead of in solitude from a tray, the
opportunity for regular exercise--these things come as a real
luxury when one has been nursing a critically-ill patient, and
anxiety has been with one, night and day. This is the period when
the nurse's nerves, strained to their utmost, can regain their
tone, where the responsibility borne by the doctor and shared by
the nurse is not so great a weight, and the knowledge of one more
victory over death, one more human life saved, gives a joyousness
to the day that is good to experience.

The satisfaction of knowing that by your help the patient has
come, perhaps, from the gates of death; the pleasure of noting day
by day the return of healthful sensations, the gradual ever-
growing desire to once more take his accustomed place in the life
work that has been interrupted--all these are missed by the nurse
who flies from convalescents.

May it not be that the change in occupation has something to do
with this unwillingness to remain with a patient when he is
convalescing? When a temperature has to be taken but once a day,
or when the doctor only makes visits twice a week, when all the
routine of the sick-room gives way to a more natural atmosphere,
many nurses do not feel at ease, they do not read aloud
pleasantly, they do not care for books, and, if the patient asks
for this amusement, the reading is a torment to the nurse, and I
imagine it does not afford much pleasure to the listener. A nurse
once gave me a graphic description of her efforts to read "Romola"
to a convalescent typhoid patient. The poor nurse knew nothing of
Florence or of the Italian language, and her struggles over the
foreign words in that book must have been funny enough. Her
patient was not much edified--of that I am certain. If a nurse
does not read aloud understandingly, she should make every effort
to learn. She thereby increases her usefulness, and makes herself
more acceptable to her patients. She adds to her own value. She is
worth more. No nurse can tell when this method of passing the
weary hours will be required of her, as it is almost certain that
a patient of intelligence will ask for some mental refreshment.

Another pleasant way to pass the long hours of convalescence, is
by playing games with your patient. I am sure no training school
for nurses has added the study of cribbage, pinochle, bezique,
chess, checkers, backgammon, or dominos to its curriculum. All
these are two-handed games, the playing of which will help the
convalescent to forget himself and his past illness and present
weakness. The nurse, if she knows only one game that is unfamiliar
to the patient, gives him new thoughts while she teaches him, and
it is quite astonishing how much pleasure such simple things can
give both to teacher and pupil. I would suggest that nurses in
their club houses or homes could profitably fill some vacant
evenings practising these two-handed games. I am sure they would
never regret the time so spent.

If the convalescent is a woman, the means of amusing her are more
varied and more congenial perhaps. In addition to reading aloud
and playing games, there is the vast realm of "fancy work," where
most women feel at home. It is a pity, so few women nowadays know
anything about knitting, crochetting or tatting,--many do not even
know which is which. A lady asked me very innocently, not long
ago, how I could tell the difference between knitting and
crochetting! Since Irish crochet has returned to favor, however,
many have once more taken up their crochet needles. The nurse who
can deftly turn her hand to these dainty arts, and can teach them
to her patients, or any of the patient's family, has the means of
making herself a very acceptable companion, apart from her nursing
skill. Embroidery is very fascinating, and appeals to every woman.
A dainty little garment for your patient, embroidered while you
watch her return to health, will be long treasured by her. For a
nurse, what art, what accomplishment can she have that will not
help some poor invalid, that will not shorten the weary hours for
some sick body, or bring consolation to a weary soul? A perfect
nurse is one who brings comfort to her patient. It is because
trained nurses bring more comfort that they have replaced the old
style nurse; the more comfort the nurse brings, the more
successful she is. The ability to talk well, when talk is needed,
to read well, to amuse understandingly, to wisely meet each need
of the invalid as it presents itself, this is to be the ideal
nurse.




X

HOW SHALL A NURSE OCCUPY HER DAYS OF WAITING?


To many nurses the time between cases is dreaded as a period when
money is being spent for necessary maintenance, and none is coming
in; a nervous time, as the ring of the telephone which may mean a
call is wished for or dreaded, perhaps both; an anxious time, as
no one knows how long she may have to wait; a dreary time, as the
days drag on and still no call comes. It _is_ a trying time,
but much can be done in these days of waiting that is delightful
in the doing, and that will prove a source of pleasure to all
future patients, and no little profit to the nurse also.

Let me preface my few hints by saying that all patients and
patients' friends expect the nurse to know all about the diseases
and their cures, the care and management of the sick,--that is
common, ordinary nurses' business,--but there too many nurses
stop; they often can go no further; and when one comes to a family
and adds to this a broad culture, and an intelligent interest in
the topics of the day, the respect and admiration of the patient
and family are unbounded, and their surprise genuine.

I would like, if possible, to impress upon the nurse graduate that
really there is much to learn after she has left the training
school. All the technic of hospital and operating room is fresh in
mind, but there is so much that lies necessarily outside the walls
of a hospital, and this knowledge that comes with experience is a
great part of what makes a successful nurse.

I will not touch here upon what every nurse knows so well,
relating to the "preparedness" of clothes, satchel, and
instruments. We take it for granted that all this is ready. The
case before has been a hard one, we will imagine, and several days
have been given to the luxury of whole nights in bed, and whole
days of resting; this is all done, and the next case is awaited.

The best thing to do first is for the nurse to examine a little
her mental equipment, see what she has stored away in her mind
that can help the next patient, or that can assist in fighting the
battle of hygienic cleanliness versus disease-bearing dirt. Let
her consider whether she reads aloud acceptably, understandingly.
Has she a good list of books which most women would enjoy? Does
she know what books to suggest for the children? Can she tell what
would interest the boys, or what a man would like to listen to?
Does she know humorous books, interesting histories, or
biographies? Here, then, is occupation for many idle days.

To go to a public library is always a pleasure, to make friends
with the librarian is an added pleasure, as is also the making
one's self familiar with some good books that can always be
procured, and that will give pleasure and profit to patient after
patient. This search for good literature will give happiness in
the quest, and happiness in the reading. Librarians are usually
glad to direct one to the books needed, and many delightful hours
may be spent in the library, and all the while the comfortable
feeling experienced that the pleasure felt will be transferred
later to future patients.

The subject of hygiene is taught in most training schools, and
indeed in many day schools as well; but this is a branch of
knowledge that is growing so rapidly that, unless the very latest
discoveries are learned, the nurse may find herself of use merely
when the infection has done its work.

I wonder how many nurses have made use of the bulletins issued by
the U. S. Department of Agriculture in Washington. These are
called Farmers' Bulletins, but many of them are of use to all
mankind, be they farmers or not. They are free to any who ask for
them, and up to the present time about five hundred have been
issued. They are upon all sorts of subjects--Flies, Malaria, The
Destruction of Rats, Care of Food in the House, Fruit as a Food,
Cereal Breakfast Foods, etc., etc., subjects _ad infinitum._
Here, then, is a mine of information open to anyone who asks; all
one has to do is to write to the Secretary of Agriculture and ask
to have sent a list of the Farmers' Bulletins published by his
department, and from the list any bulletins may be selected, and
they will be sent. Ask for what is needed; it is all meant for the
education of the public. The information is absolutely reliable,
and represents the best thought of the country--expert advice by
the foremost scientists.

I have often thought that a nurse who made the nursing of children
a specialty, or even those who nursed children occasionally, would
be much profited by a course in a Kindergarten Training School.
The private duty nurse, however, having but a few days at her
disposal, cannot do anything as extensive as that; but a very good
substitute is at hand, in the kindergarten department of any of
our public schools. It is most interesting to go to a public
school, ask to see the Principal, and let the nurse explain her
visit, and show her how helpful it would be to future little sick
folks, if she might be allowed to study some of the kindergarten
methods, and permission will readily be given. When the nurse
reaches the room of the "littlest ones," let her sit down, and
quietly watch what is done for them, and how they are managed. The
kindergartner will be glad to tell where she finds the charming
stories she relates; she will give models of the wonderful things
her pupils cut out of paper, the canoes, the men to sit in them,
the wigwams, the sleds, automobiles, swings, stoves, trees,
apples, etc., etc., articles well-nigh innumerable, and all so
simple and so deftly made. A small convalescent could be amused
for weeks with the things one could learn in a few hours in one of
our city kindergartens. I speak of the things I know, for I have
tried it, and I never yet found a Principal who was not glad to
have her kindergarten studied, nor a kindergartner who was not
pleased to know that she could assist in the work of nursing sick
children, even in this seemingly roundabout way.

In all of our large cities are fine art galleries, and in many
there are fine loan collections on exhibition every summer. There
are, besides pictures in these loan collections, many things; some
curious, some beautiful, and all of them interesting. Some days
spent in these galleries will bring much knowledge and beauty into
one's life. Time must be taken for these visits; no one can
appreciate the patience and skill of oriental handiwork in a
hurry. If unacquainted with the exhibits, a catalogue should be
purchased, and each one studied until one knows why it is there,
and what is its beauty. I remember seeing, one day, in a
collection, a cup of jade, with a very finely wrought handle; I
thought it fine, but did not appreciate it until the Custodian
told me that it took the artist twenty years to carve that one
cup, jade is such a hard stone. This cup was so valuable that the
Kensington Museum, in England, had paid an immense sum of money
for it, as a nearly perfect specimen. This information was my
reward for close study of an exhibit. In these exhibitions one
could spend many vacant days with much pleasure and profit.

In whatever town a nurse lives she should familiarize herself with
the philanthropic efforts of the place. In the largest cities it
is not possible to know them all, but she should know about some
of the settlement work, the day nurseries, the babies' hospitals,
the rescue work, the homes for aged. Of course she will know about
the hospitals and dispensaries, but what is done for the poor, the
ignorant, the sinful, and the stranger--these she should learn.
Many times she could do much to help these institutions, by
relating, simply and truthfully, when occasion offers, what she
has seen, of the great needs of such efforts, and the heroic work
of those who go down and live amongst the needy and try to uplift
them. Many a rich, idle patient might become interested and give
money, if not time, to help in these good works; and my experience
shows that they generally need all the help they can get. So the
nurse should know about the anti-tuberculosis work, the night
schools, the playgrounds on the roofs of the school-houses, all
the philanthropic work of her town, and she cannot know about it
unless she takes some of her vacant days, her days of waiting, and
turns them into days of learning, and the expansion of both her
mind and her heart.

Another pleasant way to spend some days of waiting is to study the
trolley system of the town where you live. Learn how far it can
go, to how many other towns. If a river is near, become familiar
with its steamboats. Excursions on boat or trolley will be
delightful, and will teach the best routes, the best terminal
stations, and the best restaurants, and some day when a patient is
well enough to take an excursion, some part of his own immediate
neighborhood may be shown him which he has never seen before.
Believe me, all this will be appreciated. Space fails me to tell
of music to be heard, theatres to be enjoyed, and all to be used
hereafter for the benefit of those to whom you will be called to
minister. The information constantly gathered in the "days of
waiting," rightly used, intelligently imparted to the patient or
her friends, will make of the nurse such a broad-minded,
sympathetic woman that everyone who employs her will appreciate
the fact that she has a wide culture, and brings to her patient
something besides mere technical skill.




XI

SOME HINTS FOR THE OBSTETRICAL NURSE

THE BABY'S WARDROBE.


When a nurse goes to see a woman who wishes to engage her, some
months hence, to care for her baby and herself, it is very nice to
be able to give her, should she ask, a list of all the things she
will need, both for her own comfort and the baby's.

The following is a good sensible wardrobe, and will be found
ample, though many articles more or less fanciful will, most
probably, be added by friends. The things enumerated below should
last the baby until he is put into short clothes:

Slips, 10. Dresses, 8 to 10. Pinning blankets, 4. Flannel skirts,
4. White skirts, 5. Shirts, 4. Bands, plain flannel, 4. Bands,
Jersey made, 4. Diapers first size, 17 inches square, 20. Diapers
second size, 20 inches square, 30. Diapers third size, 26 inches
square, 30. Knitted blankets, plain white, 2; if with any color, 4
to 6. Knitted sacques, 4 (two sizes). Little pillow (hair), 6
cases. Crib sheets, 6. Crib blankets, 2.

FOR BASKET.

Two small gold safety pins. Large safety pins, I box. Small safety
pins, i box. Powder box and puff. Coudreay's powder. Small box of
equal parts borax and powdered sugar. Old damask towels. One cake
old white castile soap, or Colgate's nursery soap. One bottle
unscented vaseline. As many sachets as you can get. Some few yards
of the narrowest ribbon, pink and blue. Two old handkerchiefs. One
lap protector. Brush and comb. Absorbent cotton.

FOR THE MOTHER.

All the old sheets in the house. Rubber sheet, double width. A
square of rubber sheeting single width. An old comforter.
[Footnote: When the Kelly pad is used for the delivery, the
old comfortable, the blankets and the single width rubber
sheet need not be provided.]Two or three old blankets. Fountain
syringe. Paper basin. Towels ad libitum. Six or seven night
dresses, three of them old. Undershirts, if worn in bed, 4
(large). Bandages, 6. Cheese cloth, 10 yards. Absorbent cotton, 2
lbs. A large flannel sacque, or a nightingale. Soft unbleached
muslin, 2 or 3 yards. Colgate's fumigating wafers, I box. Bedpan,
I.

Layettes can be purchased at any good department store, but many
expectant mothers prefer to make all the clothes for the little
one. These lists are for the benefit of these mothers.

These look, perhaps, like two very formidable lists, but a second
glance will convince any one that all these articles are
absolutely necessary, and none of them are expensive.

The slips should be made very plainly. The material may be as fine
as can be bought, but beyond a few tucks about the yoke, and a
little lace or fine embroidery about neck and sleeves, should be
perfectly plain. The dresses, of course, are somewhat more
elaborate, but the fashion now decrees that infant's clothing
shall be perfectly plain, and a most sensible fashion it is.
Pinning blankets are open all down the front, and are usually made
in the shops with a broad band of stiff white muslin, which shows
that the people who made them never tried to dress a baby. The
band should be of flannel or coarse linen many times washed so
that it may be soft, and the pins will go through many folds of
it. Flannel skirts are usually made of two breadths of flannel,
and are more or less embroidered. These are not left open, except
just enough to make the dressing easy. Shirts are made so well in
stores that few people care to knit them. They should always be
high in the neck and long sleeved, and it is better to get two
sizes, as, if the baby is small, it never can be comfortable in a
large shirt that does not fit.

The four flannel bands should be 6 inches wide by 17 or 18 long,
torn the length way of the flannel and left just as torn. Not
hemmed or ornamented in any way. No hemming or stitching can be so
fine that it will not mark the baby's flesh. Besides this, if you
have these plain bands and find they are several inches too big,
nothing is easier than tearing off a strip and making them fit. If
the child has a very large, round abdomen, they can be made to fit
over it nicely by taking two little tucks on the lower edge, about
half an inch from the middle of the band, and letting the tucks
run up about an inch or a little more, tapering it off gradually.
When these are discarded and the Jersey made bands are put on,
always put them on the baby feet first, as it is hard to get them
over the shoulders.

The very best material for the first small diapers is old, soft
table damask. The better the quality, the softer it will be; be
sure they are exactly square. Nothing is more trying, in a small
way, than to get a diaper that cannot be folded true. These should
be made double and the edges turned in and sewed around. By the
time the baby has outgrown them they will be fit only for the rag-
bag, and may be thrown aside. The second size diaper, also the
third should be many times washed to make them soft enough for
use. These may be used at first folded eight times and put under
the baby next the damask diaper, between that and the pinning
blanket, and will often save the nurse the trouble of changing the
baby's clothing, because it is wet through. In this way they will
get more washings and be softer when you have to use them next the
baby's skin.

Cotton flannel, with a good nap and not a very close web, is very
good also and can be used instead of the damask where that cannot
be procured. Put it on with the nap next the skin. It is an
excellent absorbent.

The baby should have at least one little (rather flat) hair
pillow, covered on one side with blue or pink silk, on the other
with plain white over the ticking. The prettiest pillow cases I
ever saw were made of broad hemmed pocket handkerchiefs. Two sewed
neatly together round three edges, and on the fourth button holes
for mother-of-pearl studs. The handkerchiefs may be fine or not,
embroidered or plain, and may have lace sewed on the edge, but
they can't help being pretty, and the embroidery will never be in
the middle. I shall never forget my pity for one poor little mite
I saw once, who, on waking from his sleep, was discovered to have
the print of an embroidered S on his cheek. It had been worked in
the centre of the little pillow case by some loving but ignorant
hands. When the baby uses the pillow, let him sleep on the white
side; at other times turn up the colored side and the pink or blue
will show very prettily through the linen. If you let the child
sleep on the colored side he may, most likely will, vomit some
sour milk on it, sooner or later, and the beauty of your pillow
will be gone.

If the regular little crib blankets are thought too expensive, a
very good substitute may be made from white eiderdown cloth, which
is warm, soft, and not at all costly.

The gold safety pins are intended for the final pinning of the
dress in the front and in the back. Of course any little
ornamental baby pin answers the purpose just as well, and, indeed,
an ordinary safety pin will do should no other be at hand.

The little box of equal parts of borax and sugar should not be
forgotten. Mix the two very thoroughly, and if any little white
aphthous spots appear on baby's lips, tongue or cheeks, apply a
little of this mixture several times a day, and they will probably
all be gone by night. Put it on very carefully with the tip of
your finger slightly moistened so that some of the powder will
adhere. Examine the baby's mouth every day for these spots. They
are likely to appear any time after ten days or two weeks, and are
more often seen in weak children, or those who are fed by a
bottle. If the spots appear on a child who is taking the breast,
the nipples are very apt to be sore. Much care, therefore, must be
exercised in this matter.

Sachets are a real luxury in the drawers of the baby's bureau.
Atkinson's sachets are the best, though Colgate's violet is very
delicate and pleasant. Put one or two amongst the little shirts,
and some among the knitted blankets, but mostly have them in the
dresses, and be sure when you take out a clean dress, or slip, to
take the sachet and slide it into the neck of the slip that will
be worn tomorrow. Nothing can be more attractive than a clean,
sweetly smelling baby, and, _per contra_, nothing is more
disgusting than a wet, sour, cold, crying baby. If he be wet and
sour he will surely have cold feet and hands, and as surely will
he cry. Poor little thing! It is his only way of expressing his
opinion of the state of his toilette.

It is very pretty, when the baby is fresh and clean, and has on a
fine slip with lace edging the sleeves, to tie around the wrist,
outside of the sleeve, a piece of pink or blue ribbon. Make a nice
little bow and let the lace fall over the fat little hands, like a
frill. Be careful not to tie the ribbon too tight, and keep it
clean. If it becomes soiled or wet, take it off directly.

A lap protector is made by covering a piece of rubber cloth about
14 inches square with several thicknesses of old blanket. To cover
this have some slips like pillow cases, of linen or cotton, plain
or fancy, as the lady may have time or money. Slip the "protector"
in its case, and lay it on your own, or any one else's, lap who
wishes to hold the baby, and it perfectly protects from all
wetting.

TABLE FOR ESTIMATING THE PROBABLE DURATION OF PREGNANCY

Two hundred and eighty days, forty weeks, ten lunar months, or
nine calendar months are here estimated as the usual duration of
pregnancy (the actual computed average being 276-2/3 days). The
exact day of conception (_not_ the fertile coition), can
never be accurately determined; the only date from which
conception can be dated, and the probable confinement day
predicted with some chance of certainty, is the first day of the
last menstrual flow, adding to this one week (seven days) for the
average duration of the flow (with a few days lee-way). We count
nine calendar months forward, and have the approximate date of the
expected confinement. The most ready method is to add seven days
to the first day of the last menstrual flow, count back three
months, and add one year, when we have the future date when, or
about when, delivery may be expected.

An _exact_ estimate is but guess work; errors of one or two
weeks either way may be made by the most experienced, as in cases
where conception occurred shortly before the next menstrual
period, which did not then appear.

The present table is constructed on the above principle, the
second column representing the day of quickening, nineteen weeks
after the beginning of the last menstruation, with seven days
added; and the third column still twenty weeks later. The date of
quickening is still more variable than that of delivery, from one
to four weeks.

Intermediate dates may be fixed by adding the necessary number of
days to each column. Thus, for Jan. 11th, the second column should
read 31st of May, and the third column, October 18th, and so on.

Beginning
of last
Quickening.       Confinement.       Menstruation.


Jan.  1st.........May   20th.........Oct.  8th.
Feb.  1st.........June  20th.........Nov.  8th.
March 1st.........July  18th.........Dec.  4th.
April 1st.........Aug.  18th.........Jan.  6th.
May   1st.........Sept. 17th.........Feb.  5th.
June  1st.........Oct.   8th.........March 8th.
July  1st.........Nov.  17th.........April 7th.
Aug.  1st.........Dec.  18th.........May   8th.
Sept. 1st.........Jan.  18th.........June  6th.
Oct.  1st.........Feb.  17th.........July  8th.
Nov.  1st.........March 20th.........Aug.  8th.
Dec.  1st.........April 19th.........Sept. 7th.




ARTICLES FOR THE MOTHER'S USE.


Perhaps it is not necessary to say why it is better to use old
sheets for the bed of a parturient woman, but I will repeat that
old ones are to be preferred, and really new ones, that is, only
once washed, never used. New towels are of course objectionable,
as being too harsh. If the patient likes a rough towel, use a
regular bath towel, if you can get it. Be careful, never to let
loose and wet ends of the wash cloth drag along exposed parts of
the body. It is a good plan to sew your wash cloth into a bag, and
to slip your hand inside, and work with it put on like a mitten. A
rubber or fibre sponge is to be preferred. Keep one for the face,
neck, arms, and hands, and another for the feet and legs. The
vulva is bathed best by means of a fountain syringe used as an
irrigator, and a little sterilized gauze twisted around your
dressing forceps. The gauze can be changed as often as necessary,
and is much more satisfactory than anything else, especially if
there has been a laceration.

The square of rubber sheeting, single width, is most useful. For
the confinement the bed should be made by first spreading over the
mattress the wide rubber sheet, over this put an old blanket, then
the under sheet; upon the right side of the bed, where most likely
the woman will lie, place the square of rubber, over that the old
comfortable, four double, and hold all in place with a sheet
folded like a hospital "draw-sheet." This must be firmly tucked in
at the sides under the mattress. It will seldom be found necessary
to change the under sheet, if the bed is made this way, and the
rubber square is drawn carefully away, with the comfortable and
draw sheet, when it is time to make the patient clean and dry
after the birth. It is a good plan now to tear this square in two,
and keep one piece directly under the clean draw sheet for the
first few days. This saves much washing.

An old blanket and a small one will be found invaluable for all
sorts of things--for example, to spread over the shoulders and
chest when the bandage is being pinned; to warm and wrap up the
feet and legs, if they show any signs of being cold; to cover one
knee and part of the body when using the irrigator, which when
there has been _any_ laceration, is a delicate piece of
business, as every nurse knows. Always fold up this invaluable and
constant friend, and put it in some handy but inconspicuous place;
it _is_ a friend, and a good one; but it is not a beautiful
object to look upon, and others not knowing its virtues would
think you untidy if it was in a noticeable place. The fountain
syringe is absolutely indispensable; and, though it may seem
unnecessarily large, yet I think a four-quart bag better than any
of the smaller sizes. To be sure, you never might need four quarts
in the bag, but it is so much easier managed, so much less liable
to spill over, if you have a large bag and put it only half or
three-quarters full. Then, too, you get so much more force if you
have more water in the bag, you need not use it all. A Davidson
syringe is very nice for some things that a fountain syringe could
not be used for. Oil enemas, for instance, also nutritive enemas.
After an oil enema be sure to wash your syringe _thoroughly_
with a strong solution of washing soda or ammonia, else you will
find the rubber of the bulb and tubing becoming pasty, and your
syringe will be utterly spoiled. The paper basin is very light and
easily handled and much to be preferred to a large china affair,
which may easily slide from warm, wet, slippery hands.

I often wonder that the women of our day, who are so sensible in
many things, should have abandoned the fashion of short night
gowns, which our grandmothers always provided for themselves at
these times. I remember asking one lady, when talking over what
she would need for her first baby, and for herself, at the time of
its birth, if she had not something short and plain that she could
wear. She looked very thoughtful for a moment and then said that
she thought she did have _one_ night-dress that did not have
a ruffle or embroidery around the bottom. She could wear that. It
certainly is not from motives of economy that our wealthy patients
do not have these most sensible of garments. I think they know
nothing about them, and they should have their virtues explained
to them. A pocket could be added to this garment, I think, and it
would be a real comfort to a woman. I know it would be to a nurse,
who usually has to hunt up the ever missing pocket handkerchief a
dozen times a day. Men always have pockets in their night-shirts,
and they are not sick half as much as the women. I wonder why
women do not imitate this most sensible custom. If your patient
will not let you cut off any of her old night-dresses, you must
use the long ones, of course, and change them as often as
necessary.

Bandages should always be made of soft unbleached muslin; double
is best, though I have used them of the single fold, and hemmed,
but they are firmer if double. They should be wide enough to come
down to the great trochanters, and up to a place two inches above
the umbilicus; long enough to fit the woman before she became
pregnant. She has likely some measure, or could get it from her
dress-maker. Women vary so much, it is hard to give an exact
measure in inches, but you might begin with a bandage fifty inches
long, and if the ends are too long, cut them off, and turn in the
edges of the cloth and overhand it neatly.

Obstetrical binders, or bandages are now seldom put on a
parturient woman, but in case they are to be used, I give the best
kind I know of. They are sometimes made to order, but I never knew
one of these to fit, or wash well.

The method of their application is of course taught in the
schools. The nurse should always know from the doctor, or the
prospective patient, if binders are to be worn, and instructions
given as to how to make them. Four or six will be enough.

Two or three yards of soft, unbleached muslin for breast-bandages
should be provided in case they are needed. A six-tailed bandage
is, I think, the best for this purpose. Tear down the first two
"tails" to within three inches of the others, and these passing
over the shoulders, and fastening to others, which are adjusted
over the breasts, keep the whole bandage in place.

It is not necessary to speak of the napkins or pads; these are
universally used, and readily bought, sterilized, and ready for
use. All sterilization is so thoroughly taught in the schools, I
have taken proficiency in this particular for granted.

There should always be a disinfectant or antiseptic of some sort
on hand.

Carbolic I-30, Platt's chlorides, permanganate of potash, or
something that will answer the purpose; bichloride of mercury,
etc. You must find out from the physician which he prefers, and of
what strength.

I must not forget to say that when you go to see you prospective
patient, and she shows you the room she expects to occupy, it
would be well to cast your eyes about for some rug, that you can,
if necessary, turn wrong side out and spread at the side of the
bed. Some doctors are very neat about their work, but some are--
well, perhaps I better not say it; we must not criticise the
doctors.

But sometimes it is best to have protection for the floor, it
gives the nurse a comfortable feeling quite beyond description to
know, that, no matter what may happen, the carpet will not be
ruined.




XII

AS TO WASHING THE BABY


In the first place get together everything you will need for the
bath and subsequent dressing. Have the clothes all laid in order
over a chair-back before an open fireplace, or over a radiator, or
if no better expedient suggest itself, fill bottles with hot
water, or get a hot water bag and fill that, and lay it
_over_ the clothes arranged in the order you will need them,
beginning the pile with the dress and having the band the last.
Have _two_ large, soft towels and keep them warm. If possible,
have an apron made of rubber cloth to tie about your waist.
At your side, on the floor, have a small blanket ready to
lay over the rubber apron when needed. Put your baby basket where
you can reach it, be sure that it contains all the things you will
need--sponge, soap, powder, pins, vaseline, etc., and an extra
diaper or two. Now get the tub (tin) and pour in the water until
it is about four inches deep. Have the water no warmer than 100 degrees
F. Bath thermometers are made that are quite cheap, and a great
convenience; one should always be at hand, as no nurse should ever
trust her feelings as to whether the water is hot enough or not.
Always test any water to be used for the sick or the delicate with
a thermometer. Another point a nurse should be most careful about,
is to be careful that her hands are warm before she takes the
baby, as her cold hands on his warm flesh will surely make him
scream.

All being now ready, take the baby and sit down with him,
spreading the blanket over your knees as you do so, and having the
tub just in front of you on another chair. The sponge is best to
use for the washing, but a piece of old table damask is very good.
Wash the eyes very carefully first, then the face, and dry on the
towel. Now hold the baby's head over the tub and give that a good
washing with soap on your bare hand, and rinse it well with plenty
of water, always holding the left hand under the head and neck.
Bring him back on your lap and thoroughly dry his head, then wash
and dry the ears carefully.

When you get this far you may undress the baby completely, being
most careful yet not taking any unnecessary time. When he is quite
ready for the tub, grasp him firmly with the right hand, letting
the buttocks rest in the palm of the hand, the fingers being
outspread, and the thumb coming up almost to the pubic bone. With
the left hand hold the head and shoulders. Lower him _very_
gently into the water. Any sudden movement is most injurious, as a
baby must never cry when the band is off, if it can be avoided. He
will often put out both hands as if trying to catch hold of
something. If he seems frightened at the same time, and cries
violently, let the buttocks rest on the bottom of the tub, and
with the right hand hold both of his, and he will be comforted.

I think it well to wash the whole body with your bare hand, well
soaped. Be careful to wash under the arms, in the bend of the
elbows, the groins, and under the knees, rinse him with the wash
cloth or sponge, and now lay one warm towel on your lap, and take
up the baby just as you put him in, slowly, and without shock, and
lay him in the warm towel. Lay the second one over him, and draw
over all the blanket, wrapping him up warm and snug. Put your hand
inside the blanket and dry him. This can be easily and quickly
done without at all uncovering the child. Pass the hand with a
slight squeezing movement over each arm and leg, and over the
front of the body. When this is done, you must undo the blanket,
and take the upper towel and dry most carefully all the creases,
and powder everywhere, especially if he is very fat. Get down to
the very bottom of every crease, and be sure it is dry and
powdered. Lay over the navel a compress of absorbent cotton,
unless the child is over four weeks old, and over this the band,
which should be unhemmed, and wide enough to extend from the hip
to the armpit. Lay the palm of your right hand firmly over band
and pad and turn the child carefully, holding your right hand
still under him, and with the left, clear away all damp towels,
and then straighten out the band that is wrinkled under one side.
Keep your knees close together. Now take away the right hand, and
see that the baby's knees are on the right side of your knee, and
the elbows well over the other side of your lap. Now you have the
baby where he can kick, but he can't wriggle or spring off your
lap. See that the back is dry, rub it a little with your hand, and
powder. Look carefully in the deep dimple just at the coccyx and
see if it is clean. Now pin the band snugly, but not too tight.
Use the smallest safety pins, and never pin directly over the
spine. Sometimes the abdomen is very large and it will be
necessary to make two little tucks in the lower edge of the band
in front to make it fit snugly.

While the baby is still on his stomach, lay in place the diaper,
and next the shirt, which should be open in the front, and the
pinning blanket. Lay all of these just as they should be, as
regards the back, and turn him, being careful to hold all the
clothes in place. If he is liable to chafe, or the movements of
the bowels are in any way irritating, use vaseline about the
buttocks. Now put the arms in the shirt sleeves and tie or button
it up, and then pin the petticoat or pinning blanket. Lay an extra
diaper folded many times under him, and fold the pinning blanket
just in three, bring the hem up to the waist and pin in place.

The dress goes on feet first. Slip it on over the pinning blanket,
and pass the right hand up under the buttocks, and with the left,
pull the dress into place, put the little hands in the sleeves,
and get it perfectly straight and smooth over the chest. Now pass
the fore-finger of the left hand down inside of all the clothes,
beginning at the neck, until you find the band (the first
garment), take a small safety pin or any small ornamental pin, and
pin thoroughly through everything. This last pin I consider most
necessary, as it keeps the dress, shirt, band and all in place.
Turn the baby over once more and put a similar pin in the back of
the dress, being very careful to get at the band. While the baby
is in this position put the blanket he wears during the day over
him, and a final turn brings him around, and he is washed and
dressed all but his mouth, which must be carefully washed with
clean, warm water or borax and water. This should be also done
many times each day, if the mouth is sore, and always a sharp
watch kept for white patches on lips, cheeks and tongue. If the
baby has hair to brush, it is well to brush it. It makes him look
very cunning, but if he is tired or sleepy, do not trouble him.
This washing and dressing should not occupy more than twenty
minutes, I have done it in fifteen where the baby was very well
behaved.

Be sure that the room is warm and that the windows and doors are
kept closed. Do not allow admiring relatives to come and go,
opening and shutting the doors as they do so. If they want to see
the operation, let them come and stay. A baby should never be
bathed in a tub until the stump of the cord is off and the navel
well and strong. If there is any inclination to pouting of the
navel, wash the child on your lap and do not take off the band
until the rest of the baby is all washed, dried, and powdered.
Then take off band and compress, and put on fresh ones as quickly
as possible, turn the child and pin as before directed.

In taking the clothing off, it is not necessary to turn the child
at all, the band being the only thing pinned in the back.

N. B.--This method of bathing is for a normally healthy child,
from the time it is one week old, until it is six months or more.

Until the stump of the cord has sloughed off, a baby should never
be put into the tub. If after the stump has sloughed there seems
to be any protrusion, or indeed any ulcerated look about the
naval, it is best to bathe the child on your lap. In all such
cases undress the baby as previously directed, until you come to
the band (flannel belly band). Wash, rinse, wipe and powder him,
being careful to make every part absolutely clean and dry. If the
band is soiled or wrinkled, or out of shape in any way, remove it
and put on a fresh one--looking every day, after three days, to
see if the stump has come off--and if it is still adherent, being
most careful not to disturb it in any way. Apply the fresh band
immediately. Turn the baby on its stomach, and when the back is
exposed, wash and rub the back gently with your warm hand. If the
band does not need changing, unpin it, rub the back, pin it up
again, and proceed in dressing as before. When the cord is once
fairly off, and the navel smooth and clean, you can put the baby
into the tub, very gently, slowly, and cautiously, remembering
that a sudden movement on your part may, in fact, always will make
him scream, and screaming with no band or compress on is for a
baby a very frequent cause of umbilical hernia. If the cord is
small when the child is born, there will be less danger of hernia,
but if it be a large one, then beware! It will not always be your
fault if the baby's navel is not small and flat when you are
leaving your case, but you will always be blamed for it, if it is
not. Notice carefully every morning when you bathe the child if
there is any umbilical protrusion, and report it without delay to
your doctor, if there is any, no matter how slight. This is not,
however, the place to treat of umbilical hernia, and we will go on
with the washing, If the child's skin is very tender, chafing
easily, wash with castile soap suds, rinse and dry carefully,
after every time he urinates, as well as when you bathe him.
Powder with talcum powder. Sometimes no powder will do it any
good, then try vaseline. If that will not do, ask the doctor if
you can try oxide of zinc ointment. Ordinarily, extreme care in
washing, drying and powdering will be sufficient, but it must be
done every time the diaper is changed. In this, as in other
things, eternal vigilance is absolutely necessary.

When the baby is about two or three weeks old, it is a good plan
to put some alcohol into the water in which he is bathed--two or
three ounces to the amount of water used in bathing. Have a small
bowl of cooler water, 70 degrees to 80 degrees, for the face, and
after that is washed, add a tablespoonful of alcohol to that also,
for the head. It helps to toughen the skin, and prevents the baby
from taking cold so easily.

If the baby seems much frightened by being put into the tub,
spread a bath towel or small thin blanket over it and have someone
hold his hands, so that he will not clutch so wildly at
everything, then lower him into the water, towel and all, and he
will not notice it so much.

I know of no place where deftness of handling shows to such
advantage as with a baby. He knows well enough if he is handled
properly or not, and his fretful cry, or violent screams, will
tell you without delay if he is not comfortable.

Once more, let me impress upon the minds of all who read this, the
necessity of having everything used about the tub and subsequent
dressing, warm. Anything cold will make the little one scream, and
I think all nurses will agree with me, that there is no more
nervous work than washing and dressing a baby who is crying (and
once he begins, he is only too apt to keep it up during the entire
time). This is especially true if a weak, ignorant mother is made
nervous by the noise, or a doting grandmother hovers about, making
remarks about "new fashioned ways," and wondering why this child
should cry when his mother was always so good, as a baby, in her
bath.

Now, as to the time of washing a baby. The morning is
unquestionably the time, but if the baby be very young (less than
two weeks) and has been wakeful during the night, I would let him
have his nap, even if it did delay you and interfere with your
plan of work. If he sleeps he is comfortable, and, unless for some
more serious reason than the bath, he ought not to be disturbed.
This, for babies in private practice. Hospital babies cannot be so
tenderly cared for. When there are ten or eleven to be washed in
one morning, choose, of course, the ones that are awake, as far as
you can, but there will always be one or two sleepy, warm little
ones about whom you will have some twinges of conscience as you
begin to wash their faces, but the work presses so, it must be
done.

A baby should not be bathed just after nursing, or when he is
hungry. Yet, most little babies go to sleep at the breast, and
very often do not waken until they are once more ready for eating.
This seems like stating a difficult problem, and I know it is not
always easy to select just the proper time, but the best way, I
think, is this.

If the baby is nursing from the breast, tell the mother, after
this nursing you wish to wash the child, and not to let him go off
for sound sleep. She can prevent it, and keep him for the twenty
minutes or half an hour it is necessary to wait after his meal,
meantime you have time to get everything in readiness for the
bath. It is a great mistake to attempt to bathe a baby when he is
hungry. He will scream for his food from the beginning to the end
of the performance, hesitating occasionally when something warm
touches his mouth, and he eagerly seeks his meal, only to redouble
his cries when not satisfied. Nothing is so persevering in its
endeavors, as a hungry baby. Satisfy its appetite first and wait a
reasonable length of time, wash him deftly and quickly, and he
will be so sleepy by the time you are through, you can lay him in
his bed and he will be asleep in a moment, when you can pick up
all the soiled clothing and the general "mess" of the bathing
operation, and leave the room once more tidy.

And just here, let me say a little about the washing of the baby's
clothes. Of course the dresses or slips, skirts, and the diapers
go to the laundress. Begin every morning on an entirely new, that
is newly-washed, set of diapers. Gather up all that have been used
the past twenty-four hours and have them washed. Perhaps they may
not be ironed, but washed they should be, every twenty-four hours,
even if you have to do it yourself, and I do not think a nurse
should ever be called upon to do this. Still, I would rather do it
than use a diaper over and over again.

But it is of the little shirts I particularly wish to speak. I
think the nurse should wash these, also the socks when they need
it, and the knitted shawls most babies wear. It takes very little
time to do this, and if you know how, you will do it much better
than any laundress. The best way to wash these things is in cool
borax water, and if there is any one place the baby has vomited
on, put a little dry powdered borax on (the place being wet), and
rub it in. Then wash by plunging it in the water and squeezing it
out. Do this again and again until the garment is clean. Rinse in
clear cool water, and wring as dry as possible in a towel; then
pull in shape and lay it on a clean towel to dry. It is a good
plan to lay it on a folded towel over a half shut register and
place a single fold of towel over. It will dry very soon. If you
are washing a baby's knitted shawl, be very careful about the
wringing. Lay a large towel (bath towel is the best) out flat,
and, having squeezed the most of the water from the blanket, lay
it carefully on the towel and roll both together, and wring very
tightly. If this towel gets wet take a second. When you are
satisfied that it is as dry as you can make it, lay it out on a
folded sheet on the floor, in some room not much used, and pull
and arrange it into its original shape and size.

Anything made of Germantown wool stretches terribly, but you can
arrange it as it ought to be. It will look ruffly here and there
and ridgy all over, but when it is dry it will shrink down all
right. Only do not hang it up, and when it is dry you will be
surprised to find it looks as good as new. If you are ever
consulted beforehand as to what would be nice for the baby, use
all your eloquence against _any_ color being put into these
knitted shawls. Germantown wool is the best to use, and plain
knitting or brioche stitch is the best to wear and wash, and these
things must be washed with the most careful handling. On the
nicest baby they will become dirty, and the delicate blues and
pinks become the dismalest wrecks when washed. Therefore, tell
your patient not to put any color in these first plain little
comfortable shawls. They should be a yard long by about three-
quarters wide. Two or three will be all you will need, and do not
use any of the fancy blankets sent in by friends. Lay these all
away, with a sachet bag or two, in some convenient drawer, and
never take them out unless the baby is required to look very fine
for a brief display to some friend. These delicate, fancy trifles
when once wet through or vomited on are ruined, and it should be
your aim to leave everything as good as you found it when you go
from the house. There will be plenty of time after you have left,
for the fond mamma to spoil all the pretty things, and as she does
so she will appreciate more and more your care of them.




XIII

THE VALLEY OF THE SHADOW


I suppose that no nurse deliberately chooses to go to an incurable
case, yet most of us who have done private nursing have found
ourselves at some time caring for one who slowly, and painfully,
creeps nearer day by day to the great End. We have gone perhaps to
stay a few weeks, for some acute disease, but symptoms have
changed, and instead of recovery, a long, slow decline is to be
faced, the nurse feeling she is needed, decides to stay and do
what she can for the poor failing body, and so the weeks drag on
in the dreadful monotony of that one sick room, until we feel that
we have been left out of the real nursing world, that we are
stranded with our patient upon an island of pain, that there is no
outlook but the one dread Valley, no moving object but the river
of Death, and no hope for the life we are guarding. Each week we
grow more and more rusty as to our hardly-won surgical technic,
more out of touch with those who come and go to one patient after
the other, and who not unnaturally count upon so and so many
victories over the very enemy who we know will overcome the life
we are fighting to save. Yet we realize that all our care will
never bring victory, all our skill can but help to smooth the
rugged pathway, down which the feet must tread alone. The endless
repetition of the same symptoms is wearying, the only possible
variation being some new pain, which indicates another stage in
the development of the disease. An improvement hardly cheers us,
as we know it is but temporary, and maybe followed by an
exacerbation of the trouble.

Often the actual nursing calls but for a portion of the day, but
that portion is so necessary that the nurse's presence is
imperatively demanded. The remainder of the time little is to be
done, except perhaps a guard maintained over the failing strength,
a watch kept for untoward accidents that might snap the frail
thread that binds the spirit still to earth. Probably the bedroom
must be kept tidy, and the patient's clothing cared for, and the
nurse feels she has degenerated into a servant.

One who has gone through with an experience like this, and who has
courageously remained with her patient to the end, has passed
through a training more severe than any she has had in her
hospital life, and she has earned a new diploma.

There are some things which the nurse may do to lighten these dark
days, some things which may help both herself and her patient, and
these I will try to show.

_Firstly_, it is well to study your case from a pathological
view point. Find out the heredity, the manner of the daily life,
the first manifestation of the disease, what circumstances led to
it, how it was treated, what success the treatment seemed to have,
what symptoms can now be noted, what complications have shown
themselves, and their influence on the original disease. A careful
history could be written embracing all of these points, and as new
symptoms appear they should be observed and noted. All this should
be valuable and should help some future day to show some one who
has but started on the dreaded pathway, how to avoid what will
surely be a fatal disease. Many a valuable paper could be written
in the long hours when the nurse feels she is losing her time, if
she would intelligently study her case, and write the story of the
disease, what led to it, and how it is being combated.

Perhaps, if it could be arranged, the nurse might be spared part
of a day once or twice a week, and she could go to her hospital
out patient department, or to some dispensary and do some work
that carries a little feeling of success with it; work in a babies
milk station, or almost any of the numerous charitable activities,
would rest and refresh one who has for months been with the same
patient.

_Secondly_, as a psychological study. We all know we must
die, we feel that we talk to people every day who perhaps will not
be alive a twelvemonth hence; but we are not actually certain that
ourselves or any of our friends will so soon be dead, and we
habitually act and speak as if we all were to live on indefinitely.
So to be closely associated with some one who we know is
drawing closer and closer to the life beyond the grave, is a
very solemn thing; whether the sick one knows it or not, the
nurse knows it, and such an one must be viewed with peculiar
interest.

She is so near to knowing the great Mystery. She will so soon see
those who have gone before. The present helplessness will so
marvelously become Life Everlasting. It seems, as the end comes
nearer, and yet more near, as if, perhaps, one could send a
message to some of our own loved ones gone on before, "If you see
some of my dear ones, on that other shore, bear them a loving
greeting from me, tell them I am trying to live as they would have
me live." Such a thought trembles on the tongue, so near does the
unseen seem to come to us.

In the face of these things, how small do the thoughts of our own
dignity seem. It is all _service_, and service is what we
were made for.

"I pass this way but once, if, therefore, there is _any_
service I can perform for my fellow man let me do it now, for I
shall not pass this way again." This quotation is familiar to all,
and especially does it come to mind when we minister to those who
are to die. When they are gone there will be no bringing them back
to explain duties slighted or left undone. "We pass this way but
once."

_Thirdly_, from a religious point of view. It is quite
impossible to say, what exactly is the nurse's duty as regards the
religious side of her ministration, though the wish to help must
be often in the mind of every thoughtful nurse who has charge of
an incurable case.

The patient may not know her condition, and the doctor may not
wish her to be told, then, of course, the nurse's lips must be
sealed, as to any allusion to the dread truth. The religious views
of the patient and her friends may be different from anything that
the nurse knows, or perhaps the family pastor comes frequently,
and instructs and comforts the sick one, and the family.

A patient will sometimes _ask_ for the reading of some
portion of the Bible, and unless the part is specified the nurse
may be at a loss just where to turn. Some parts of the Scriptures
are so generally known and accepted, that they can hardly fail to
give hope and comfort, no matter what the religious teaching may
have been heretofore.

I will suggest then _in case_ readings are asked for. The
Psalms are full of beautiful comforting thoughts and prayers. The
23d has helped many a poor soul about to take its last journey,
the 37th, which begins "Fret not thyself," shows that those are
truly blessed who trust in the Lord, the 51st, "Have mercy upon
me, O God," teaches repentance, the 42d, "As the hart pants after
the water-brooks, so longeth my soul for Thee, O God," shows the
desire of the soul for God.

In the New Testament, the 14th chapter of St. John's gospel is a
universal favorite, on account of its comforting thoughts "In my
Father's house are many mansions." In St. Luke's gospel chapter
15th, verse 11, we have the parable of the Prodigal Son, to show
how complete and perfect is God's love, and His forgiveness, when
sin is forsaken. In 1st Corinthians, 15th chapter, verse 20, we
have a masterly argument for the resurrection from the dead, and a
life beyond the grave. In Revelations, 14th chapter, 13th verse,
is a very comforting thought for those who have led a strenuous
life and are in much suffering.

These few references will help, I hope, if any nurse is called
upon to read the Bible, and she feels a little nonplussed as to
exactly where to turn.

There are of course innumerable passages besides these, that could
be found by the aid of a concordance, and which it would be wise
to note on a slip of paper, ready for any call. Sometimes a
patient will ask for a prayer, and it is not often that a nurse
would feel competent to kneel down by the bedside and make an
acceptable extemporaneous prayer, so I would suggest buying a
volume of "Prayers for the Sick."

Very tiny, dainty little books can be purchased at the church book
stores, full of these prayers.

In the Episcopal Book of Common Prayer are many helpful prayers.

The sentence, the collect, and the whole of the Easter service in
this book are radiant with the truths of the Resurrection, and the
Easter hymns are tuned to the same inspiring theme.

This last thought I leave with you. What more helpful
consideration can come to a weary nurse, than that the sick one to
whom she has ministered for so many weeks or months should at
last, on entering in to the life Eternal, lay before the Lord of
Glory, the name of the one who was with her, who helped her, who
cared for her, and who was faithful to her trust to the end?