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 s.e.x 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 prost.i.tution 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 chast.i.ty 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 prost.i.tutes. 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 appet.i.te, 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 s.e.xual Hygiene; Henderson, Charles W., Education with Reference to s.e.x; Lyttelton, E., Training of the Young in the Laws of s.e.x; 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 n.o.bility of Boyhood, 50 cents (contained in "The American Boy and the Social Evil"); Hall, Stanley, Educational Problems, Chapter on the Pedagogy of s.e.x, Adolescence, Youth; Northcoate, H., Christianity and s.e.x 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, s.e.x-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 s.e.x 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 Prost.i.tution in _Collier's Weekly_, from time to time, since April 1, by Reginald Wright Kauffman; articles on the Necessity for Teaching s.e.x 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 a.s.sociation 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 p.r.o.nounces 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 amus.e.m.e.nt, 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 pa.s.sing 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 pa.s.s 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 a.s.sist 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 subst.i.tute 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 Princ.i.p.al, 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 Princ.i.p.al who was not glad to have her kindergarten studied, nor a kindergartner who was not pleased to know that she could a.s.sist 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 inst.i.tutions, 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. s.p.a.ce 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.