Chapter XIII: The Valley of the Shadow (2)

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.