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 SCHOOLINSPECTOR FOR CHARLESTON INDEPENDENT SCHOOL DISTRICT

"Not to be ministered unto, but to minister"

PREFACE

Though technic is constantly changing, methods improving, and theteaching in our schools grows better and more comprehensive, theold problems in private work are ever to be faced, and still theyoung sister in our nursing world needs to be counselled, guidedand helped. It is for these young private duty nurses that thisbook has been written. 

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

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

In the chapter "Hints to the Obstetrical Nurse, " there is littleor 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 tosterilize any and every thing, but sometimes she does not know thebest way to wash and dry the baby's little shirts or knittedshawls. Sometimes she will not realize that if the layette cannotbe purchased at a store, old table linen makes the best diapersfor the newborn baby, and that his pillowcase should not haveembroidery in the center. 

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

The recipes I have given are, I know, reliable, having all beentested many times. Most of the articles of food every nurse hasprobably prepared, but exact proportions have a dreadful way ofslipping out of one's memory. Whether it is a pint of milk or aquart that must be mixed with two eggs for a custard might notseem much of a problem to a housekeeper, but to a nurse who hasperhaps not made a custard for a year it might carry manydifficulties. 

I have tried to help in this most important part of a nurse'sduty, and not only as to the food served the patient, but the_manner_ of serving it, which last is truly to a sick personof as much importance as the food itself. The few leaves I haveleft blank are for such additional recipes as every nurse willgather as she goes from house to house. Any cook will be glad togive some hints as to how she does this or that, and no nurseshould be too proud to learn from the cook, or anybody else. Ishall never forget the fat little Irish woman who taught me tomake clam broth, or how much pride she took in my first success. To ask the family cook for advice is sometimes good policy; she isoften so ready to resent any extra work caused by the sickness orthe nurse, it pays well to conciliate her, by asking for her aidor counsel. To feel that she can teach the "Trained Nurse" willoften make a friend of the cook, and this will make thingspleasanter all around. It is with the hope that these homely andperhaps somewhat old-fashioned hints may be of real service, thatthis little book is sent forth to do what good it may to those whoare setting out on their professional careers. It is ever to theyoung that we elders look, knowing, as Mrs. Isabel Hampton Robbhas truly said, "Work shall be lifted from our hands and carriedon 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 FELLOWNURSES

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 thistraining, and must I yet be told how to treat a patient?" I answerthat you have been taught how to watch the progress of disease, how to follow intelligently the doctor's orders, also certainmanual arts, your proficiency in which is unquestionably mostnecessary, but there is much more comprehended in the meaning ofthe term "a good nurse" than this. How often do we hear stories ofnurses who were good--_but_--who were skillful--_but_--and after the _but_ comes a long list of such faults as donot show so much in hospital life, where the routine and the manyrules and the constant supervision make them less likely to becomeprominent. "She bangs the doors. " "She breaks the fine china. ""She wears heavy shoes, " or "She talks too much, " or "She ispretty and spends too much time over her front hair"--but why goon? You have all heard such tales--_ad nauseam_, and if youare wise, you will set up a sign-post against every one of thesesnares into which your sister nurses have fallen, and on this youwill print in large, clear letters: "Danger! Walking on this placeforbidden. " So much by way of apology for treating you once moreto a lecture on "the patient. "

The relation between nurse and patient should, from the first, bea more than amicable one. You have come to bestow the pricelessblessing of unwearied, skillful care upon one who shouldthankfully receive it, and believe me, if you do not go to yourpatient with a feeling of thankfulness to God for allowing you toassume such a sacred trust as the care of a human life, you are inno condition to undertake the work. Your nursing should be, in away, an exponent of your own spiritual state; looking at it in itshighest aspect, an outward and visible sign of an inward andspiritual grace. 

In the first place, then, you must be in entire sympathy with thesick one--and here do not mistake me--by sympathy I do not meansentimentalism. The two emotions are as far asunder as the poles. Sympathy, then, you must have, and if you do not intuitively feelit, let me tell you what to do to rouse your dormant feelings. Tryearnestly to put yourself in the patient's place. Has she had anoperation of some kind, and you have all night been trying to keepher quiet on her back, and she has been begging you to let herturn "never so little?" When you go to lie down, and have, perhaps, a backache, and feel tired, instead of settling yourselfin the most comfortable position you can, lie straight and squareon your back and say to yourself, "Now I can't turn over, " andimagine 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 hashad a good excuse for all her complaints, and the next night youwill know just where to slip your hand in the hollow of the backor under the shoulders to give a little ease. The patient willprofit by such exercise on the part of the nurse, and yoursympathies will be quickened. Never forget that _the patient issick_, and you are _not_. You can, you must be firm in whatyou know is for your patient's best good, but you must neverbe dictatorial or argumentative. It is hard, I know, to bear withall the foolish, unreasonable whims of sick people, but if you aretrue nurses you will do it. There are, however, several consolingthoughts which have always helped me, and which I will tell you. In the first place, always remember, as I said before, that thesick one _is_ sick, and on that ground you can overlook much. In the second place, remember that it will not last long. A fewdays or weeks will surely bring a change. She cannot, in thenature of disease, remain for long in the very trying stage, unless indeed she have some kind of mania, and of course if thatis the case, you need pay no attention to her whims. If she sayswhite is black, let it go. It does not make it so to have her sayso, but if you argue the point, and bring all your wisdom to bearupon your demonstration, you may bring her pulse and temperatureup to a point that will do her a real injury. 

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

Be most careful also as to your patient's belongings, her topdrawer, her various boxes, and her linen closet. You must keep allthese things just as she did. You may think it a very foolishthing for her to have three piles of handkerchiefs, each of adifferent age, or degree of fineness, but if that is her way, shewill be better satisfied if she knows you will not lay a finehandkerchief over a more common one. So keep them as carefullydivided as if they were the two parts of a Seidlitz powder. 

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

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. Itwill be a pleasant way of beguiling the tedium of some long day inher convalescence to bring forth and arrange them in theiraccustomed places. Be careful of books, table-covers, and all thearticles of luxury and beauty you will find in many of our cityhouses. Remember that these things belong to some one else, thoughyou are for the present custodian, and think how provoked youwould feel if some stranger should come to your home, and, even ifshe did nurse you back to health, she left many nicked plates, broken vases and handleless cups behind her. I think you would notwant her to nurse you again. 

I saw recently in an English magazine devoted to nursing, a veryclever article on "Talk. " The writer, a nurse, thought subjectswere scarce. She says: "We must not talk to the patient about herown complaint, that would make her morbid; or about the doctor, for that would be gossip; or the hospital, for hospitals are fullof horrors; or the other nurses, for that might lead to talkingscandal; or about other patients, for that would be betrayal ofconfidence. Now what _are_ you to talk about when a patientis 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)? Itis indeed quite a question, and the nurse must often use all heringenuity to keep the patient to the right subjects, for evenpatients, though they hold it so reprehensible in a nurse to talkgossip, do not disdain to serve up their neighbors occasionally tothe nurse, with some very highly seasoned scandal sauce, and herethe honor of the nurse must come into play; let her forget it ifpossible, as woe will betide the poor girl if in her next placeshe unwittingly lets out any of the secrets she has heard in theselong talks. Try then to steer clear of the neighbors. If yourpatient be a cultivated person, and you yourself know anythingabout books, you have a never-failing topic. All the latest books, the famous books, the most entertaining books, and if you can readaloud and the patient likes to hear you, read to her, and it willdo both good--only be sure not to tire her by reading too much atone time. Talk of interesting places you have visited and she willdo the same, of pictures you have seen, and last, but not least, you can talk about clothes. Generally the first serious piece ofbusiness a convalescent concerns herself about is the purchase andmaking of some new clothes. She wants something new and fresh, andif you can give her any new ideas on the subject or tell her ofany pretty materials you have seen in the shop windows, you willprove as entertaining as if you talked on any of the forbiddentopics, and many times more useful. "

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

II

THE NURSE AND THE DOCTOR

I suppose no nurse goes through a training school without beingduly impressed by all the doctors on the staff of lecturers thatthey, the doctors, are the generals of the campaign. She and herfellows are the aids, and that she will be kind enough to rememberthis fact, and not make suggestions to him, the doctor, or givehim the fruits of her ripe experience of three years in ahospital, and more or less time, as may be, since she hasgraduated. But though this I think you all know, there are somepoints of your connections with the doctor which may not be quiteso 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 workagainst him, never weaken the patient's confidence in him. If youdo not understand why he does thus and so, ask for an explanation, if you know him pretty well, and if your questions are reasonableones, and intelligently put, he will be glad to answer you, andexplain all you wish explained; but if you do not know the reasonof a certain order, and, moreover, if he will not tell you, do notassume that he does not know, or that he is cross; it may be somevery uncertain, delicate experiment is being tried, and all hewants you to do is to tell him, with a free unbiased mind, whatyou see. Always, however, be loyal to him with the patient. Whenyou are asked a thousand questions as to, "Why doesn't the doctordo this, or why does he do that?" you can always say that he doesit, or does it not, for the patient's best good, of that you areassured, and they must be also. 

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

Do not fear losing your own individuality and independence. "Hewho obeys well, governs well, " is a very old, and a very truesaying, and your responsibilities will never cease. The morefaithful you are to orders, the more trust and confidence will bereposed in you. You will have not only your patient, but theentire family looking to you for directions, for, upon yourfaithfulness, and the tact with which you administer yourauthority, will depend much of your success as nurses. 

Be careful not to sever your relations with any patient unlessyour doctor knows all about it. Never leave your charge, no matterhow urgent the reason may be, unless you tell him. You may besick, 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 tothe doctor, tell him candidly why you wish to go, and take counselof him how you should act. If he tells you you may go, and youknow that your place must be filled, do not offer as yoursubstitute your best friend, or anyone else. If he wishes yourcounsel he will ask, and then you may tell him of anyone you thinkwill suit the position, but do not offer your friend, as he mayhave some favorite of his own to put in your place. Of course thepatient or her friends must know about the contemplated change--that I take for granted. Having consulted the doctor, will makeeverything satisfactory to the most careful practitioner. So, assaid before, never go away from your patient, leaving in yourplace a nurse whom the doctor does not know. He has, in mostcases, selected you for his patient, and he wants you, you may notbe 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 agreat piece of impertinence for a nurse to go away unknown to thedoctor, leaving a stranger in her place. The consequence, so faras he is concerned, will most likely be to have her name crossedoff his list as "unreliable"--so be careful. 

As to your records, keep them faithfully; the doctor usually looksthem over very carefully, but sometimes you find one who passesthem over in a lofty manner, rather trying when you take suchpains with them. You may conclude that it is not necessary to keepthem accurately in such a case, but this same doctor may ask yousome day how long ago it was that the patient's temperature tooksuch a sudden rise, or how many days it is since she first hadsolid food, and if you have accurately kept and carefullypreserved your records, you can tell without a moment'shesitation. It is better, more business-like, and every way to becommended, that the nurse should keep, and be exceedinglyparticular about these records. If the doctor will write hisorders on the fresh daily record at his morning visit, it is agreat help to the nurse, but very often he is in a hurry and youmust write them yourself. If you have to do this, take your recordand write as he tells you, _when_ he tells you. If the ordersare at all intricate it is your only way of being absolutely sureyou have everything correct. It is a protection to you also, ifthe family are inclined to criticise. 

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

It is a good plan to wait for the doctor at the head of thestairs, or at the foot, if you are likely to be over-heard, andtell him there all you could not say before the patient as to hercondition, etc. He likewise may have something to say, --somefinal instruction to give, some caution he would not wish thepatient to know of. This is also the time to speak about yourselfif you are sick or tired, or unhappy in your position. Perhapsneither 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 along way toward making the hard places easy. Your patients may bevery curious as to what you have to say to the doctor, but you canreadily and truly tell them that there are many things you have tosay to him, that would be hard for you to say before them, andhard for them to hear too, and these are things you arrangeoutside. 

Always be sure to have on a convenient table, if your doctor be ofa homoeopathic school, a little covered tray, and on it twoglasses, clean, and turned upside down to keep them from dust, teaspoons and covers for the glasses, also a small pitcher offresh water. Many doctors of the old school also use somemedicines 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 theside of the bed, your place is at or near the foot. If the doctorknows the patient well, as a friend, and is inclined to stay along time, chatting, you can go quietly to another part of theroom, and take up your work or reading, but be sure the doctor hasfinished asking you questions before you go. 

Use sparingly technical terms. If your patient's feet areoedematous, tell the doctor they are much swollen; if he_ask_ if they are oedematous tell him "yes, " but do notvolunteer to name the peculiar kind of swelling. If the abdomen istympanitic, tell him it seems much distended; and if he questionsmuch further, answer the questions fully and intelligently. Ifyour patient has the symptoms of phlebitis, tell him of the riseof temperature, the swelling of the leg, the tenderness along thecourse of the vein, and he will know that you know and appreciatethe gravity of the disease; but be sure you do not attempt to givethe 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 bestmake. 

There is nothing more trying in a small way than to have yourthermometer doubted, and if you _know_ it is the best themarket affords, if you take it to the instrument maker and have ittested once in a while, you need not fear, when you find anunusual temperature, and report it to the doctor, and he quietlyproceeds to test your thermometer by his, which of course isalways correct. Be sure that your hypodermic syringe will work; ifthe piston slips loosely after much using of brandy, aromaticammonia, etc. , take it to be repaired, and see that the needlesare sharp, they become dulled very quickly; keep also the tinywires pushed through them. It is just as well to keep this syringein the room, its little case is very small and unobtrusive, and ifyou keep it near your thermometer in some safe, handy place, youwill have it when some unforeseen emergency arises, and you do notwant 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 asof the patient, though her care must be manifested in a fardifferent way. Always remember that to do really good work youmust have really good tools. No man owning, and intelligentlyworking a valuable machine, would keep it going at its highestspeed all the time. He takes care of it, keeps it clean, renewsdefective parts, oils it; and then he expects it to run for somany hours, and to run well, --to do its work thoroughly. But withall his keeping it in order he does not make it work night and dayfor weeks or months. Such folly is never heard of in an engineer;but with us human beings, who own and manage a far more wonderfulmachine 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 voiceor his eyes, the nurse contracts some disease that incapacitatesher for work, in every case mother Nature makes the careless orignorant owner of the wonderful machine pay the penalty of themisuse. It does not matter to Nature what the reason is for ourbreaking the great laws; we can kill ourselves with philanthropicwork just as surely as with over indulgence. One trouble is, thatit does not always _kill. _ A paralytic may live for years, sodoes a man with paresis. When the wonderful God-given machineworks badly, or stops entirely, we look on, and sometimes wonderwhy it is that those who are so helpful, such fine examples ofcourage, of skill, of virtue, so hardly to be spared, are the onesto be taken away. Do _we_ wonder, we who are nurses? Do wenot know what did it? Ah! yes--we know, we know, that such andsuch 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 andsole leather?" But will _we_ take heed, and not do likewise, or will we wonder, with the unthinking ones, why it is that thegood, useful people are always taken away? Do not deceiveyourselves; they are not "taken away, " they take themselves away, for God will not reverse His wise laws because we (no matter howgood we are) act in defiance of them. 

Please remember I am only speaking now to the good nurses--theenthusiastic ones, --poor nurses, lazy nurses have no temptation tooverwork themselves. They may die of indigestion, but they willnot die of exhaustion. 

It seems to you so natural for others to be sick. You have seenthe sick by scores in the hospital, and have waited on them, feltsorry for them, sympathized with them; but have you thought thatit was within the bounds of possibility that _you_ could evercome into such a pitiable condition? You go from house to house inyour private nursing, always you find the sick, and it seemsnatural, 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 themsick, and though you _know_ you are made of like flesh andblood, do not conduct yourself as if you were not. "Oh, yes" (howoften have I heard it said), "I know she worked too hard, but I amso strong, you never heard _me_ complain; I can nurse a fevercase 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 talkthus?

Now listen to some few practical hints as to how to keepyourselves in good working order. In the first place, then, nevergo to a case unless you are feeling well. It is far wiser, as faras you are concerned, and better also for the sick one, for you tosay so frankly, if you are not well. Tell the one who comes foryou, that you could not do justice to the case, as indeed youcould not. Sick people are as sensitive as babies to the subtleinfluence exerted by the one who is so constantly over them. Ifyou are in full health and strength, your rubbing will be quietingand effectual, your very presence, if you are careful and gentle, will be soothing. On the contrary, if you yourself are sufferingand are using the nervous force you ought to be giving yourpatient in hiding your own malady, your presence will not be soeagerly welcomed; your patient will not know what is the matter, but she feels rather a relief when you are absent. Going to a casefeeling perfectly well, the next thing is to keep well. 

Be careful about your _eating_. Your meals will of necessitybe often irregular, that is unavoidable, but eat only wholesomethings. Do not eat candy; and at dinner, which you will probablyhave in the evening after the family are through, avoid patties, and rich puddings, ice cream, and such like. You will always findplenty of plain food and fruit in the most luxurious homes; eatthese and let the rest alone. If you want to keep your stomach andwhole digestive apparatus in good order, you must care for it, andnot overtax it. If you have a pretty good stomach it will bear agood deal of abuse, but in the end it will grumble, and adyspeptic nurse is not an attractive object. As to your nightsuppers, which you should always have, should your case requireconstant watching, I would recommend plenty of coffee, tea, orcold milk, if you can drink it, bread and butter, cold meat andfruit. Never eat candied fruits, cake, or pies at night. Have eggsif you care for them, and pickles if you like. Remember, theplainest food, the most easily digested, the most nourishing iswhat you must have. Believe me, you will be rewarded for thetemperate use you make of all the dainties you see, by a clearcomplexion, 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 sometimesas to just what is best to wear. When the patient is not illenough for the uniform to be retained for night duty, the nurseshould be comfortable enough so that she can sleep; yet dressedenough for any emergency. I think a house gown of pretty materialmuch neater than the kimono. Be sure this fits about theshoulders, and never have loose flowing sleeves. A white frill inthe neck looks very trim, and is always becoming. The corset andall tight clothes should be removed, stockings and underwear kepton. The hair should be arranged simply, but not allowed to hang ina loose braid, unless you are _very_ sure you will not seeany but the patient, and even then it may be unwise, as a braid ofhair has an exasperating way of slipping from its proper place(hanging down the back) and dipping into whatever you are stoopingover. Dressed thus, with night shoes to protect the feet, one canlie down on a lounge and sleep very comfortably, being freed fromtight clothes, and yet being entirely presentable, no matter whathappens. To undress regularly and put on the diaphanous low-neckedshort sleeved night dress of the present mode, and go to bed, whenyou are sure you will have to get up one or a dozen times duringthe night is not good judgment, I think. You get out of a warmbed, and if you only put on your shoes and stockings, your patientmust wait while you do it. If anything serious occurs suddenly, you either run the risk of taking cold from being insufficientlyclad while doing what must be done, or your patient must waitwhile you dress--both bad. 

Never get into bed with your patient. This seems to most people aquite unnecessary caution, but it is the commonest experience ofthe successful nurse, that a woman, feeble and nervous, should askand almost insist that she shall lie down by her, or get into bedwith her. I always wonder that a sick woman can not realize thatshe is not a pleasant bed-fellow, but she seldom does. Of courseyou 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 toherself, and you will sit by her and hold her hand, or if sheinsists on it, you can lie down, with your house gown on, on the_outside_ of the bed, being careful to give her plenty ofspace, and when she is asleep, get up quietly and lie down on yourlounge, which should be placed so that you can see her everymovement. 

Never let the patient think for a moment that you fear herdisease; if she has diphtheria, do not tell her or the family thatyou have a delicate throat or that it is sore, and do not examineit by the help of a hand-glass where any one can see you. Do notgo to such cases if you really fear them, but if you go, and havereason to feel that you have contracted the disease, tell thedoctor as soon as you can, and if he thinks you ill, he will sendyou home. Never tell a patient you have a weak back or anyweakness. Tell the doctor and he will see to it that you have restor medicine, but do not let the patient know it. Never go about asick room with a long face; it is enough for the sick one to haveto be sick; the family sympathies are all enlisted for her. Youare there to be a help and a comfort, not an added anxiety. Ofcourse these remarks do not apply to any of you who are tired froma long, exhausting case. The family in such instances are readyand willing enough to let you rest. Keep your cheery manner: allhigher considerations aside, it is money in your pocket to lookcheerful. I have known one or two good, faithful, conscientiousnurses who were dismissed from case after case, merely becausethey looked "so doleful. " It may seem curious to place acommercial value on a smile, but in reality it amounts almost tothat. 

Be very careful to have your dresses fit you perfectly, and havethem well laundered, especially do not have them too stiff. Inthis connection I cannot do better than to relate an incident thatI heard of some time ago. A nurse went to care for a patient whosefirst nurse had been called to her own home, and she had not beenin the room an hour before the patient called her and taking herhand said, "My dear, I can't tell you how thankful I feel thatyour dress is not too short in the waist. Miss----'s dress wasfrightful!" This was only a nervous woman's whim, but our successas nurses depends in many cases on just such whims, so it is wellto be careful. When the patient is well enough for you to come tothe family table at meal time, be sure to have on a spotlessapron, and let no sickroom odors announce your presence. It isworth more to a nurse to have soft, dry, warm, sympathetic hands, than to have the prettiest face ever seen under a cap, so becareful of them; after using any antiseptics always have at handglycerin and rose water, cold cream, or something soothing to use. Never put a cold or clammy hand on a patient. If it is cold anddry it can be laid on a hot, aching head, but never do so if it isthe least damp. If the hand is always damp, pour on it a littlealcohol, or eau de cologne, if that is preferred, or some toiletwater, then put it on the patient's head, and it will be allright. A simple and very cold lotion is alcohol and water, aboutequal parts, and a piece of ice added. Hold your hand in this amoment and then gently comb the patient's hair (that which growson top of the head) with the dripping fingers, taking care not tolet any cold water-drops fall on the face. This is wanderingsomewhat from my subject, but I will let it stand and speak of onemore thing that is good to remember. Never lay a warm hand on apatient's head, or a cold one on the body. If you have to rub yourpatient's body, and your hand is warm and damp, shake a littletalcum powder into it, or use a little cold cream, cocoa butter, or lanolin, and the dampness will not be perceived. Alcohol mayalso be used, or bay rum. 

Some nurses are much troubled by excessive perspiration, especially under the arms, any hard work making the dress quitewet. The ordinary shields are not very good, as they are notabsorbent enough. A piece of flannel basted inside of the shieldis a help, as that is absorbent. The auxiliary space might bebathed with a solution of alum; alcohol is good or alcohol withwhite-oak bark. Many preparations for this trouble are on themarket, most of them are good but some are expensive. A late copyof the _Journal of Nursing_ gives the following: "Take twoounces of baking soda, mix with half an ounce of corn starch, anduse as a dusting powder, after the parts have been thoroughlycleansed and dried. It will check the perspiration and removeevery particle of odor. " This is very successful, but I find itleaves a slight yellow stain on a white dress. Another remedy from_Journal of Nursing_ is this: "Zinc oxide" applied to axillaetwice a week, after bathing at night, will dissipate the odor. Ifthe perspiration has a disagreeable odor, no effort should bespared to free oneself from what is a serious drawback to theacceptableness of a nurse. 

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

I suppose that I have better opportunities to hear stories ofnurses and their doings, good and evil, than some have. Icertainly hear some very curious things. The most extraordinarywas of a nurse who always made it a rule, when she went to apatient's house, to stipulate immediately for her hours "offduty. " She thought she was doing a very clever thing, and making amost commendable business-like arrangement. It will not benecessary 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 anydemonstrative affection, unless you are very sure it will bewelcome, and be careful even then. A kiss for "goodbye" when youleave the patient is usually quite enough, and many ladies arerepulsed by anything of the kind. If you feel an affectionateregard for your patient, you can show it by your constantthoughtfulness and your care. Do not fear that you will leadlonesome, repressed lives; if you are the nurses you ought to be, you will have all the affection you want, and often more than youknow what to do with. Never do any sewing or fancy work foryourself until you are sure there is none you could do for thepatient. Remember that she pays for your time, and govern yourselfaccordingly. 

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

Remember finally (and I think, from what I read in the dailypapers, you are in no danger of forgetting this), that you are notdomestics, and, while in an emergency I would have you shrink fromnothing that needs doing, I do not think you should do anywashing. Cooking you will very often have to do, but the ordinaryhousework does not come at all into your province. If your patientis a chronic invalid, I would have you make yourself useful in thehouse. Do the shopping, order the meals, anything that will showyour patient you are anxious to help make the wheels of domesticmachinery run more smoothly. 

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

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

If one physician is unskillful or unprincipled, the wholeprofession is not found fault with, but the individual is blamedand another one found who will do better, but it is not so in mostcases where a nurse proves unsatisfactory. The whole professionsuffers and every nurse sinks more or less if one of her sisternurses commits an indiscretion, or does any of the thousand thingsshe ought not to do. I recollect very well, many years ago, aBrooklyn nurse, of about thirty-five years, married her patient, aboy nineteen years old. It made a great stir in the city, and, asI was living there at the time and the superintendent of atraining school, I had to bear my share of the odium cast upon allnurses. For months after, almost every one I met took pains totell me that hereafter they would keep their young sons out of theclutches of the designing nurse, and I doubt not, such slightingremarks were borne by every nurse in town, and it was notpleasant, to say the least of it, for any of us. 

Keep your standards high. Let nothing but the very best satisfyyou, as far as you and your work are concerned. Keep your mindwell informed; if it is full of scientific facts, of skillfulmethods, of good literature, or fine pictures, there will be noroom in it for the memory of all the disagreeable things every onemust encounter in one's work, and if you do not remember them, youcannot tell others of them. 

Finally, remember (and this lies at the root of it all) to keepyour hearts right, --ever thankful that you are permitted to pursuethis high calling, and ever striving to be more worthy of it, withmany prayers that your life and conduct may show, what is better_lived_ than talked about, the grace and peace of God, whichverily 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 dangerousillness, that the family is glad to see you when you come. Youhave come to help them, to stay with them, to comfort them by yourpresence, by your knowledge, by your experience. They have neededyou, have sent for you, and are to pay you for your time. There isa general sense of relief when you are once fairly installed inyour place by the bedside, yet you are a stranger. Your friend, the doctor, has told them what a treasure you are. Mrs. This andMr. That have perhaps let them know how invaluable you were whenat their houses; but yet they must look at you a little, they mustnote if you make a pleasant impression on the invalid, if you areas skillful here as you were somewhere else, if you look withscorn on the plain furniture, or how much you will be displeasedthat the bath-room is at the other end of the house. They do notfeel exactly critical: they are too tired or too anxious for that;but still, unless everyone is too exhausted from watching to doanything but thankfully surrender everything to you, you will bepretty closely looked after at first. 

You must look for some espionage; and it is only right that youshould be subjected to it. If _your_ mother was lying verysick, and some stranger, having knowledge and strength superior toyour own, had to come and care for her, would you not feel thatthough you were glad to see her, glad she would give your motherthe benefit of her superior skill, yet you would wish to considerher a little, to note when she did thus and so; or if she didsomething you did not understand, could you refrain from askingher why she did it?

Be patient, therefore, with the suggestions of the family, afterall, though you know the disease and the probable course it willrun, the chances for recovery, and what to do in emergency, etc. , _they_ know the patient, all her peculiarities, her likes anddislikes, and if you are wise you will get and keep many littlehints from those who have cared for her before you came. If shelikes milk, will she insist upon tea? Does coffee keep her awake?Does she hate the sight of gruel, or beef-tea? Does she like muchsugar in her drinks? All these are little matters of individualtaste that you must find out for each patient, and if you have thenecessary tact and forethought, you never need ask the patient onequestion; usually the friends are pleased to be consulted on suchsmall matters, and gladly tell you all you wish to know. To besure, they generally tell much more than you asked for; but thatdoes not matter, it is better to listen patiently for five minutesto someone's tiresome descriptions than to repulse them, and solose just so much kindly feeling from the one who wished to talkto you. 

If the amateur nurse has been doing something actually wrong forthe 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 thinkssuch and such things are not now necessary, and it would be betterto do this way. " Then you can do what you know to be right, andnot hurt the feelings of the one who has preceded you, and, feeling your way carefully, have everything just as it ought tobe, and no one's feelings will be hurt, and no one will feel thatyou are looking down upon their ignorance; and here I would saythat in your little confidential talks with the doctor, you couldask him to say a word to the family if they persist in doing whatyou know to be wrong. Ask him to give you orders before some ofthem, 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 suchthing 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 seethat you are thoroughly interested in your patient, and do nothesitate to perform any little kindness that falls in your way forthe rest of the family, and you will win all their hearts withouta struggle. 

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

As for the visitors, they are often difficult to manage, and hereagain you must have the family help you. Of course _no_visitors are allowed until the doctor gives permission. So far allis easy, but when they are admitted you will do well to make alittle plan with the family. Tell them the patient may be seen atsuch an hour. Perhaps between eleven and twelve, perhaps betweentwo and three, just as you consider her brighter in the morning orafternoon. Ask them who of the first and dearest friends is thequietest and most discreet, and then say that if they will kindlyarrange for one visitor only to come each day, it would be so muchbetter for the convalescent. The friends can always do this andthey never object. They tell Mrs. Jones to come on Monday at two, and stay just fifteen minutes. On Tuesday Mrs. Smith can come, andso on, until by the end of the week the arrangement ceases tocause any comment, and soon, if all goes well, and the convalescencegoes on without interruption, _your_ rules and extreme carecan be relaxed to suit the patient's own fancy. 

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

As to the servants they require pretty careful handling. Above allthings, keep on the right side of the _cook_. If you have togo 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 thewater run over them, and ask for the dishcloth: and if you do itpleasantly, the cook will probably tell you to "Niver need thimthings, " and you will thankfully obey her. If you really cannotstop to make all tidy after your cooking, you can say, "I'm sorryto make you extra work with these dishes, but I must hurry backupstairs. " Some such little speech, with a pleasant smile, willmake all things easy for you below stairs, and for the sake of allthe friction it will save you, it is well worth the trouble. Oftenthe cook will be glad to do the cooking if you tell her how; becareful to tell her, if it is eaten and enjoyed; and never let herknow if it is rejected. Get rid of it upstairs by some contrivance, and be sure not to order that dish again. In many casesof course the cook will know all the little dishes the sick onewill fancy, and you will have very little to do with her. Suchinstances are somewhat rare, and very delightful when they occur. 

If there is much extra washing, you may have to use much diplomacyas regards the laundress; and if it is very disgusting washing, itis well to have a large pail, with a cover, upstairs. Thoroughlydisinfect the clothes before you send them to the washing, as theodors are often sickening, and the laundress, like other servants, is very much afraid, usually, of clothing from a sick-bed. Carryor send the clothes to the washing as soon as possible afterremoving them from the bed; never, on any account, allow them toremain in the room. 

The nurse cannot be too careful as to the amount of clothes shesends to the laundry. She should of course keep herself and thepatient scrupulously clean; but she must reflect that privatefamilies do not have an unlimited store of towels and sheets, andif she is extravagant in this matter it will seriously detractfrom her acceptability. 

In concluding, let me remind you that all these hints are intendedfor nurses going from one strange place to another, as you wouldin nursing fevers, or short surgical cases. Nurses who havechronic 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 thatpatient and family are concerned. But let them be careful when atlast they leave the case, and go amongst strangers. The ways ofone family are not the ways of another, and they must exercisemuch 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 aspossible. Use pretty china and glass, if you are permitted to doso, yet not the very finest the house affords; that might make thepatient nervous lest some evil befall it. Absolutely clean napkinsand tray cloths, a few green leaves about the plate, a rose on thetray; the chop or piece of chicken, the bird or the piece of steakornamented with sprigs of parsley, the cold things really cold, and the hot ones _hot_, these are necessities of invalid'sfeeding, that mark the nurse who has a proper appreciation of asick person's delicate sensibilities. Have all plates, cups andsaucers _hot_, when they are for the reception of hot toast, coffee, tea, etc. Hot water plates are very convenient, and easilyprocured at any large china shop; but if they cannot be found, putthe hot plate containing the chop over a bowl of boiling water, and cover with a hot saucer, fold a napkin around the bakedpotato, and you can carry the tray containing the dinner throughcold halls and up staircases and it will arrive at your patient'sroom _hot. _ Be careful not to fill the bowl so full of hotwater that it will spill. Never fill a cup so full that it willspill its contents over into the saucer, it makes a disgustinglooking _mess. _ Have all fruit _cold, _ oranges and grapesespecially. Always look over a bunch of grapes and cut offthe soft ones before you hand them to a patient. If you haveforeign or California grapes, hold them for a moment under thecold water faucet and let the water run through the bunch, and allthe cork dust will then be washed out. 

If you peel and quarter an orange for your patient never let hersee you do it, unless you are perfectly sure you will not get yourhands covered with juice. Wash your hands before you bring it tobe 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 filla cup or bowl _brimming_ full, let it stand a few momentsthat the grease may rise to the top, tip the cup a very little toone side, and the grease, to the last atom, will flow over theside of the cup; pour your broth carefully into a clean hot cup, and serve. Beef juice is more palatable with a little very browntoast. 

Remember, that an invalid hardly ever likes any food made sweet. No matter what the taste may be in health, in sickness, sweetthings are nauseous; for this reason ice cream bought atconfectioners' is often rejected. Salt also must be used withcaution, 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, thedoctor 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 littlepure 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 outof ten, especially if it is cold), give half a glass; if that isstill too much, give quarter of a glass, or put more water withit. Never repeat a dose (of food) if it nauseates the patient. Make some change in quantity or quality, and you will, if youwatch carefully, find out the right proportions. 

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

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

Always keep milk, beef tea, etc. , _covered_ in therefrigerator, 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 asuggestion merely. But if the refrigerator has a _smell, _ andthe cook seems touchy, the milk, etc. , better be kept upstairs onsome sheltered window-ledge, and carefully covered. 

If you have your own little refrigerator upstairs, see to it thatit is cleaned _every_ day. Never put away anything in tinpails; 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 beefsoak in the water, stirring occasionally, for two hours; then putit on the stove and heat it until the red color disappears; neverboil it. Skim off all grease, salt to taste. 

BEEF JUICE. 

Round steak cut an inch thick; slightly broil like beefsteak forthe table, cut into squares of an inch, squeeze in a lemonsqueezer, skim carefully and salt. Serve either very cold, orplace the cup containing the juice in a bowl of boiling water, stir carefully, and as soon as the juice is warm serve. If left amoment too long it is spoiled, as it curdles. One pound of beefmakes 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 beefchopped as for ordinary beef tea. Put this into a kettle of coldwater, with a saucer on the bottom, let it come slowly to a boiland 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 spoonuntil the place scraped has no more meat on the surface, but onlythe white fibre, cut this off with a sharp knife, exposing oncemore a fresh surface. Season, and spread raw on bread and butter, or make into little cakes and broil slightly, according to thedoctor's orders, or your patient's taste. 

MUTTON BROTH. 

Mutton from the neck. Proportions, 1 lb. Of mutton to 1 quart ofwater, put the mutton and the water (cold) on the back of thestove, let it come slowly to a boil, boil until the meat is readyto fall from the bones. After straining out all the meat etc. Addone tablespoonful of rice or barley. Simmer half an hour afteradding 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 asmuch milk as juice. Strain out the clams, thicken with a littlecorn starch, making about as thick as cream, pour juice into abowl and add the milk. 

CLAM BROTH. NO. 2. 

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

CLAM BROTH. NO. 3. 

Take little neck clams unopened, wash them very clean with abrush. Place them on the top of the stove in a clean dry pan, andwhen the shells open take them off, remove the clams and pour thejuice into a cup. To be served hot. If it is too strong, add alittle boiling water. This is for very sick people; give only ateaspoonful 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 boilgently 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 vesselson the stove; when the juice comes to the boil, skim and slightlythicken, pour in the milk boiling hot, add the oysters one by one, let them remain on the stove about five minutes, or until thebeards begin to curl, and they are no longer slippery. Serve withcrackers heated very hot. 

OYSTERS BROILED. 

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

BROILED CHICKEN. 

The chicken must be young, split down the back. Lay on thegridiron and broil evenly, turning frequently. Serve on a piece ofbuttered toast, salt and slightly butter the chicken. A littleparsley garnishes the dish prettily. 

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

BEEF STEAK. 

Steak must be cut 3/4 inch thick, and evenly broiled, rare, unlessparticularly requested to do otherwise. Be careful not to smokeit; the grease dropping into the fire may make trouble in thisway. 

OATMEAL GRUEL. 

Take two large iron tablespoonfuls of oatmeal freshly cooked forbreakfast, add one cup of boiling water, slowly stirring all thetime, then add an equal quantity of milk. Let all boil for tenminutes, and strain through a fine wire sieve. If you have nocooked oatmeal put 1/2 cup raw oatmeal in a double boiler with twocups of boiling water and cook for two hours, then proceed asabove. It makes the gruel richer to add all milk, or 1-1/2 cups ofmilk and 1 cup of cream. Be sure not to forget the salt. Never putany sugar in unless requested to do it by the patient. 

KOUMYSS. 

Dissolve a third of a cake of compressed yeast (Fleischmann's) ina little warm water (not hot). Take a quart of milk fresh from thecow, or warmed to blood heat, add to it a tablespoonful of sugar, and the dissolved yeast. Put the mixture in beer bottles withpatent stoppers, fill to the neck, cork, and let them stand fortwelve 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 ofsugar. 

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

EGG-NOG. 

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

EGG LEMONADE. 

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

WINE WHEY. 

One pint of boiling milk, one-half pint sherry; add sherry to themilk while scalding hot; stir a moment until the curd gathers;strain through a fine muslin, sweeten. To be taken cold. Thistakes 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, previouslybroken into a saucer (the fresher the egg the better), carefullyinto salted water which is boiling in a frying pan, thenimmediately set the pan at the side of the stove so that the waterdoes not boil, keep it there for about five minutes. Let the waterbe about two inches deep in the iron frying pan. Each egg must bebroken separately and slipped carefully into the water. Whencooked so that the white is firm but jelly like, no part being rawor hard, take it out with a skimmer and slip it on a piece of thinbuttered toast, sprinkle a little salt and pepper on top, serveimmediately. Garnish with parsley. 

SCRAMBLED EGGS. 

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

SHIRRED EGGS. 

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

OMELETTE. 

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

RENNET. 

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

BOILED CUSTARD. 

One pint of milk and 2 eggs. Beat the eggs, add the milk heatedalmost 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 thickas 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 letmilk be cold. Pour into custard cups. Stand these in a drippingpan half full of warm water and bake in a pretty hot oven. Watchcarefully, bake 15 minutes. 

THIN BREAD AND BUTTER. 

Have a loaf of good home-made bread, yesterday's baking, cut offthe 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. Apatient will sometimes relish this when tired of all kinds oftoast or crackers. 

VI

THE NURSE AS RELATING TO HER OWN TRAINING SCHOOL AND TO HER FELLOWNURSES

Always be loyal to your own school and hospital. It may not havebeen in every respect perfect; but it is not necessary to tellstrangers of its imperfections: probably those in authority arejust as sensible of its short-comings as you are, and perhaps theywork harder than you do to right its wrong; in any case it does nogood to tell others of the things you disapproved. It may indeedbe that your criticism is one-sided and unfair, that the veryrules you hated and found hard to keep are the wisest ones, and, if you let strangers see that you disapprove of these wiseregulations, the opinion they will form of your intelligence willcertainly 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 camefrom, try to realize that the other school is neither wholly abovenor wholly below your own; each has probably its own merits andits own drawbacks. You should not tell the other nurse any of yourown school's shortcomings, any sooner than you would tell them toany other stranger; be loyal everywhere to the place where youwere fitted for your work. 

Never tell revolting hospital stories to your patients. Somepeople have the most morbid wish to hear dreadful details. Iremember a patient of mine, years ago, asking me in all good faithto tell her the most horrible thing I had ever seen in all myhospital experience. I asked her why she wished to hear suchthings, and after some reflection she acknowledged that it was afoolish, morbid curiosity. It is best to keep the dreadful sideentirely out of sight; there are plenty of bright, interesting, pleasant things always occurring; tell of these. Tell of thecunning little babies in the lying-in ward, the absurd littleblack ones, the fat little German and Swede babies. Tell of thesurly 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 theminto quiet, polite, pleasant patients; and how, later, they willtake their turn at washing dishes, with a docility that would maketheir wives stupid with amazement. All such matters (and the moreyou 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 ahospital 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 everyone who hears you talk. 

As for your duties to each other, I would have you always observethe same punctilious etiquette outside that you do in thehospital. When you are called to assist another nurse, rememberthat _she_ is the head nurse; the case is hers. She givesdirections, and you follow them; be sure you do it faithfully. Ifyou have some one to assist _you_, be sure you arrange forher rest and exercise, and that you leave intelligently writtenorders when you go for your own rest. 

Some very awkward complications may arise where there are twonurses, and the worst, I think, is for the patient and family tolike the second nurse better than the first one, and to criticiseher and find fault with her to the other nurse. This is hard allaround. 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 arepreferred, never allow the people to retail to you the faults ofthe other nurse, and never gossip about her. She may not suitthem, but she is probably doing the best she can, and such idletalk can do no good. If they _will_ talk, make all the excusesfor her you can, and never let her suspect from any actionof yours, that you are preferred above her. If, on the other hand, you are the first nurse and some second one is called in, andpreferred before you, study her well. See how it is that she winsthe patient's confidence, when you did not. Try to find out, in aquiet way, wherein lies her charm. If it is quietness, exactness, cheerfulness, or ready tact--it must be something--and if you areclever you must see how it happens that she is preferred. It willbe a good lesson for you. Perhaps you will never have such anotherchance for learning what you have found out by experience youlack. So do not waste your time by allowing yourself to feeljealous, but use it as a time of study, and you may reap a richreward by winning your next patient's confidence. 

VII

WHY DO NURSES COMPLAIN?

It seems to some of us, judging from the prevailing tone ofnurses' conversations, that this is a veritable age of discontent. We hear that a nurse's life is confining; that it is wearing onthe nerves; it keeps one from enjoying society; it is notsufficiently remunerative, etc. , etc. We all know, without goinginto further particulars, what a nurse could complain about, andthough each one's tale of woe may be perfectly true, it seems tome we are not wise, as nurses, to allow the trials of ourprofessional life to occupy such a prominent position in ourthoughts. 

Let us glance at some of the other professions, and see how themembers of each regard their chosen work. What is the prevailingtheme of the religious newspapers? Is it complaints from theministers that they are not appreciated, or that their life wearson their nerves? Not that surely, but we read of more and morework to be done; more and more need of the gospel to be preachedand lived, that all may be attracted to it. What do we read in themedical journals? Not how often Dr. Jones or Dr. Smith has beencalled up at night, or how often they have been dismissed ormaligned by ungrateful patients; neither do they talk of suchthings. Do they complain that they are kept from the presence of"Society?" Not so, and why? Their enthusiasm is such that thesematters are accepted as part of the inevitable, and the higher, nobler aim is so real that the lower and meaner consideration ofpersonal comfort sinks into insignificance. What is the soldier'sfavorite tale? Not that all through the war he had to drink hiscoffee without cream, that he did not have sheets on his bed, andthat 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 usedto these comforts and many more all of his life in his home;but viewed in the light of his enthusiasm for the country heis striving to save, and seen by the side of her peril, suchinconveniences 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 havebeen compared to soldiers, we have been assured that ouropportunities for doing good to souls are second only to those ofthe ministers. What more do we want? We want this, and we want itvery much. We want the courage to accept our trials which mustcome if we are to have any glory. It is all very fine to be calleda ministering angel, but it is pleasanter to minister to those whoare appreciative. We _can_ be heroic, in an emergency, but ifwe are not properly thanked, we do like to growl a little. It isgratifying to our vanity to be ranked with our masculineassociates, but when it comes to the hard, thankless tasks whichthey accept without a murmur, then we proceed to show that we knowwhat is what, and that our refined tastes cannot be so inconsideratelytreated. 

The trouble with these fretful nurses is that they _are_nurses. If they are not satisfied with the profession they havechosen, why do they not make a change and enter some other? Dothey not know when they enter the work that it is hard, do theynot hear on every side that it is exacting and confining? Theyknew it perfectly well before they began, why then do theycomplain? Why not say candidly, "I cannot have such enthusiasm formy fellow-men that I can forget myself, " and then do somethingthat is easier?

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

Do you feel that your patient is cross or unreasonable? That ismost 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 torealize what it is to have a pain, constant and sickening; to haveit every minute of the twenty-four hours; try to imagine thefatigue of a respiration of forty; the ache and restlessness of afever of 103 degrees; the agony of longing to change a position when itcannot be done; the despair of a hope for recovery growing dailyless, or the realization of absolute weakness that comes withearly convalescence; try to imagine yourself bearing some of theseills with nerves and brain weakened by disease, and you will notwonder that your patient is irritable, that he thinks the minutesof your absence are "hours, " that the unevenness of the bed is"hard lumps, " that the food is "slops, " and the medicine "nogood. " Remember that he is a prisoner, and he has a cruel jailer;his bed is his prison, his disease is his jailer, and he sufferswhatever torments his jailer chooses to inflict. Now prisoners arenot, as a rule, a happy class of men; so bear with your prisonerand help him. Complaining about his shortcomings will never makethem any the less. He is sick. Oh! the pathos of that shortsentence, "He is sick;" that says all. You are well, or you oughtto be; therefore bear with him. 

You have chosen a hard profession, but we are told it is thenoblest one a woman can follow. Why is it noble? Exactly becauseit is hard, and the hardness consists in your forgetting yourselfand giving your strength to others. There are many hard lives thatare not in the least noble, but there is no noble life that is nothard. A coal miner has, I suppose, a hard life, yet no one callsit a noble one; why? Because he works solely for his wages, and hecomplains and "strikes" when his wages and his hours do not suithim; but a doctor going from house to house, and in spite of alldiscouragements carrying cheer and hope; a city missionary goingto the degraded, the ignorant, and by his own efforts helping hisfellow-men to a better life, to a knowledge of God--these arenoble lives. You can see I am sure the difference, and you willnot gainsay me when I assure you that the doctor and themissionary, though they may not be satisfied with themselves, orwith their manner of working, are happy men, happy because theylive outside of themselves. The coal miner who is not content withhis wages is miserable, because he himself and his needs loom upbefore him so large that every thing else is shut out. It isbecause you take a hard task and do it well, that so much praiseis given to nurses. If you undertake a difficult task and fretover it all the time you are doing it, if you propose to benefityour fellow creatures and grumble because you have not comforts, or appreciation, or gratitude, where does the nobility go? Whereis the heroism? If the task is easy, agreeable, delightful, theidea of heroism, of nobility, of all high aspiration diesdirectly. Did any one ever do a grand work and have an easy timewhile doing it? Did Florence Nightingale have all the comforts oflife when she did her great work? Was it not by her indomitableperseverance, her great patience, and her enthusiasm for othersthat she won such an honored place for herself? You know almostbefore I say it, that there can be no loftiness of purpose, noenthusiasm, if there are not difficulties to be conquered, and youall know that complaining about sick people will never alter theircharacteristics, and that complaining about the nervousness of therelatives will never make less unreasoning, when they are fearfulthat a loved one is going to die. 

Do we want gratitude and appreciation? We get it very often, andvery often we do not; and when this last is the case, we mayreflect that we are in very good company. How did the Frenchreward Joan of Arc? The warmth of their gratitude led her to thestake. Galileo, as reward for his discovery, was put into prisonand loaded with chains, as were also Christopher Columbus and SirWalter Raleigh, a notable company these, and every one sufferedfrom the ingratitude of their fellow-men. Many more examples youmust call to mind, of ingratitude more base than any thing weshall ever be called upon to bear. 

The profession of nursing is still one of the most recent thatwomen have engaged in. The world had until the past few decadesbeen so used to being nursed by the old-fashioned nurse, who was aservant, and who never expected any treatment but that of aservant, that it has taken some years to always remember that weare not servants, in the usual acceptation of the term; but no onewill be convinced of the fact that we are ladies by our_telling_ them so. If you are a lady, with a lady'srefinement, every one in the house will know it, will feel it, andyou will never mention the subject; they must feel it, then therewill be no arguing on the subject. It must be demonstrated by yourdeftness, your quietness, your cheerfulness, your education, yourintelligence, your quick appreciation of other good qualities. Wemust all of us show the world that it is being nursed by itscompeers, that a lady can do even the most revolting service in away that robs it of its difficulties; and when the hard part ofthe illness is over, when your patient is ready and anxious to beentertained, you can show that you are not a machine for carryingout the doctor's orders; that you are capable of something morethan the ability to take temperature, pulse, and respiration. 

We must remember that even yet we are, in a way, pioneers of onepart of that great woman movement in the world. It is not enoughto educate one family up to the realization that we are itsequals; the next house we go to, the same work may have to be doneover again; but each time it is done, and done well, the wholeprofession 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 hasbeen preparing herself, during all these strenuous years of studyand hospital work, for the life of a teacher. She fondly imaginesthat she is a nurse, and only that; but after she has been doingprivate duty for a year or more, she realizes that she isgenerally a teacher as well as a nurse, and that often she is amissionary also. 

Perhaps no private duty nurse needs to be told what subject shemust teach; the patient or the patient's friends never let herrest until she has told the "why" of every thing she does, or doesnot. 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, andif doctors and nurses, science and sanitation have their way, there will some time be no call but that of the baby, for nurse ordoctor either. The ignorance of the young mother is proverbial;her wish to know about her baby and its care is patheticallyearnest. The new life is so precious, she would take such goodcare of it, if she only knew how. Here is a pupil eager forknowledge, ready to do all that can be intelligently taught toher. The nurse should have very clearly in her mind all themysteries 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 togive the mother the rules for her own living that she may be ableto provide the best milk for the baby, or, if the little one hasto be artificially fed, the methods of preparing the particularfood chosen should be explained, and the indications ofindigestion pointed out. All this is real teaching, realmissionary work, and if well done will help the mother immenselyand probably save the baby many attacks of colic or worse. Washingthe baby is usually regarded by the young mother as a terribleordeal. No nurse should leave her young-mother patient until sheis fully able to perform this task. Let the mother watch, a fewmornings, while the nurse does all the work, then let her undressthe baby, when the nurse can take him and finish the operation. Day by day let her do a little more, as her strength and ambitionpermit, until at the end of a week she is fairly used to handlingthe child and can, perhaps, keep him until the last finishingtouches are put on. The nurse should always be near, to help, toadvise, to take the child should the mother become exhausted. Finally, she should go into another room, and, leaving all thingsready, allow the mother to perform the duty by herself, lettingher know that at any time she will be relieved if necessary. Inthis way the mother becomes accustomed to the child, and the bathis always a pleasure to her. How many times have we heard patheticstories of a young mother trying for the first time to wash thebaby?--the tears of despair, the nervous blunders, the exhaustionwhen the performance was brought to a hasty close. All suchstories mean that the nurse in charge was not a teacher and thather work when she left the case was not completed. 

Suppose that this baby is the third or fourth, the mother knowswhat to do for the new little one, but how about the others? Sheis still anxious to do what is right, or perhaps she is notanxious, and her attitude toward the children is not what itshould be. Perhaps she does not realize that she will be called toaccount for these souls intrusted to her care, that these bodieswill do their part in life, well or ill, as she treats them wiselyor foolishly. Here is true missionary work. A thoughtful, intelligent, judicious nurse can show a mother that an adenoid maybe responsible for Johnny's inattention, as it causes dullness ofhearing, how Mary's fretfulness is caused by too little sleep orby insufficient ventilation of her room at night. She can explainhow irregular eating causes the children to be cross andirritable. She can show why the first teeth should be removed whenthe second begin to push towards the gum. She can teach the motherthat the headaches so often met with, in children who go toschool, are due, perhaps, to eye strain, and can not be correctedwith pills, and should never be soothed with headache powders. Shecan show the evils of the gallons of soda water too many youngwomen swallow, of the injudiciousness of allowing young girls tocongregate in drug stores. These last two evils, "soda water andthe drug store habit, " the mother may know nothing about. She isbusy 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 astonishmany a mother. 

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

Most mothers are very thankful for practical hints from one who issupposed to know, and who, during a four to six weeks' stay, makesherself one of the family, and offers advice in the _rightway_ and _at the right time_. 

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

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

The medical world to-day is much concerned over the question ofprostitution and its effect upon the coming race, through thetransmission of syphilitic taint to an innocent wife, who isthereafter barren, or who bears syphilitic children. The folly ofthe double standard, purity insisted on for the wife, unchasitycondoned in the husband; all these subjects are sure to be broughtup, and the nurse who goes prepared on these and kindred topicscan do an immense amount of good to the women she nurses. 

She can show how useful the knowledge of chastity is to a boy-thestrength that comes from self-control, the weakness that followsself-indulgence, the danger to himself and to those he reallyloves when he contaminates himself with prostitutes. A young manonce said to a friend of mine, "Oh! if my mother had only warnedme of the suffering I would cause myself and others, I never wouldhave polluted my body and shamed my soul. " The nurse should knowhow to instruct the mother as to the signs of self-abuse in herlittle boys, so that she may know what causes the nervousmovements, the pallor, the fitful appetite, the dark circles underthe eyes, the listlessness, the fondness for being alone--any oneof which should call for extreme watchfulness. All these things anurse should be sure to know, so that, as far as in her lies, sheshould be one more earnest woman striving to make the world betterfor her having lived and worked in it. A wise man has given thisquaint description of a perfectly educated man: "When a man knowswhat he knows, when he knows what he does not know, when he knowswhere to go for what he should know, I call that a perfectlyeducated man. " So with the nurse. When she finds a social problemwith which she is not familiar, let her turn to this list ofbooks, magazine articles, and pamphlets upon the subject: Chapman, Rose R. , The Moral Problems of Children; Dock, Lavinia L. , Hygieneand Morality; Hall, Winfield Scott, Reproduction and SexualHygiene; 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. , SocialDiseases and Marriage; Saleeby, Caleb W. , Parenthood and RaceCulture; Wilson, Dr. Robert N. , The American Boy and the SocialEvil, The Nobility of Boyhood, 50 cents (contained in "TheAmerican Boy and the Social Evil"); Hall, Stanley, EducationalProblems, Chapter on the Pedagogy of Sex, Adolescence, Youth;Northcoate, H. , Christianity and Sex Problems; Janney, Dr. EdwardO. , The White Slave Traffic in America; Report of the 3 8thConference of Charities and Corrections, in Boston, June, 1911, Sex-Hygiene Section; Kauffman, Reginald Wright, The House ofBondage; Summary of the Chicago Vice Commission, in the May numberof _Vigilance_; Education with Reference to Sex in the Augustnumber 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 TheCauses of Prostitution in _Collier's Weekly_, from time totime, since April 1, by Reginald Wright Kauffman; articles on theNecessity for Teaching Sex Hygiene, in _Good Housekeeping_, beginning with the September number; Dr. Dale's articles on MoralProphylaxis, in the JOURNAL OF NURSING since the July number;Instructing Children in the Origin of Life, Elisabeth RobinsonScovil, in October JOURNAL OF NURSING; Leaflets and pamphletspublished by American Motherhood, 188 Main Street, Cooperstown, New York; Publications of the American Association of Sanitary andMoral Prophylaxis, New York City, JOURNAL OF NURSING, February, 1912. 

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

IX

CONVALESCENCE

One frequently hears the private duty nurse deplore the necessityof her remaining with a patient during convalescence. "I wish, "such a one would say, "that I never need stay with a patient afterthe temperature has been normal for ten days, " or, "I do not mindthe first two weeks of an obstetric case, then there is somethingto do, but after that I am ready to leave, " or again, "When mypatient is ready to go out driving, I always wish she would driveme home; half-sick people are not to my taste. " I have oftenwondered if this feeling is not caused by the atmosphere of thehospital which has, during training, been the nurse's home, --thehospital, where the patient leaves at the earliest possible momentof recovery, to make room for someone else. The pupil nurse getsused to the excitement of critical illness, used to the hard workof constant watching and fighting for the patients' lives, andthat, and only that, it seems to her, is nursing. So when she goesto her private cases, and her patient has a long period ofconvalescence, she feels out of place, she does not seem to bedoing what she was trained to do, and she frets over it, untilsome happy day when the doctor releases her, and she is at libertyto 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 ittakes a long time to restore the patient to perfect health, somefunction may need the close watching which only trained eyes cangive, and it is not beneath the dignity of the nurse to remain, and keep watch until every part is once more in perfect workingorder. 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 whichhe has fallen, to play games with an invalid and to watch him, toread with him, and to watch, to walk or ride or travel with him, and to watch, always to watch, that the dreaded symptom does notappear, 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, oreven arranging for operations; he can find time to see patients, to sit and talk with them, to advise them, to cheer them, even totell funny stories to them, but all the time he is watching them. A lawyer is not always pleading in the court room, a clergyman isnot forever in the pulpit. The lawyer when talking to his clientis just as truly a lawyer; the clergyman, when visiting hiscongregation, is just as truly a clergyman, --the sermon on Sundayis the climax, if I may so express it, of his week's work. Thelawyer's speech to the jury is the point to which all his effortstend after, perhaps, weeks of preparation. So the convalescence ofa patient is the post climax of the nurse's undertaking. Shebegins with the climax, severe illness, operation, or obstetriccase, whatever it may be, gradually the stress lessens, the wholeatmosphere of the house becomes natural as the patient progressestoward recovery; but the process is not complete, and the nurse'swork is not done until the doctor pronounces her trained care nolonger necessary; then she may go, and feel that her work has beenthoroughly done-no small comfort surely. 

I wish I could show my young sister nurses how good _forthem_ this period of the patient's convalescence might be. Thedelightful rest of regular sleep, and regular meals comfortablyeaten at a table instead of in solitude from a tray, theopportunity for regular exercise--these things come as a realluxury when one has been nursing a critically-ill patient, andanxiety has been with one, night and day. This is the period whenthe nurse's nerves, strained to their utmost, can regain theirtone, where the responsibility borne by the doctor and shared bythe nurse is not so great a weight, and the knowledge of one morevictory over death, one more human life saved, gives a joyousnessto the day that is good to experience. 

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

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

Another pleasant way to pass the long hours of convalescence, isby playing games with your patient. I am sure no training schoolfor nurses has added the study of cribbage, pinochle, bezique, chess, checkers, backgammon, or dominos to its curriculum. Allthese are two-handed games, the playing of which will help theconvalescent to forget himself and his past illness and presentweakness. The nurse, if she knows only one game that is unfamiliarto the patient, gives him new thoughts while she teaches him, andit is quite astonishing how much pleasure such simple things cangive both to teacher and pupil. I would suggest that nurses intheir club houses or homes could profitably fill some vacantevenings practising these two-handed games. I am sure they wouldnever regret the time so spent. 

If the convalescent is a woman, the means of amusing her are morevaried and more congenial perhaps. In addition to reading aloudand playing games, there is the vast realm of "fancy work, " wheremost women feel at home. It is a pity, so few women nowadays knowanything about knitting, crochetting or tatting, --many do not evenknow which is which. A lady asked me very innocently, not longago, how I could tell the difference between knitting andcrochetting! Since Irish crochet has returned to favor, however, many have once more taken up their crochet needles. The nurse whocan deftly turn her hand to these dainty arts, and can teach themto her patients, or any of the patient's family, has the means ofmaking herself a very acceptable companion, apart from her nursingskill. Embroidery is very fascinating, and appeals to every woman. A dainty little garment for your patient, embroidered while youwatch her return to health, will be long treasured by her. For anurse, what art, what accomplishment can she have that will nothelp some poor invalid, that will not shorten the weary hours forsome sick body, or bring consolation to a weary soul? A perfectnurse is one who brings comfort to her patient. It is becausetrained nurses bring more comfort that they have replaced the oldstyle nurse; the more comfort the nurse brings, the moresuccessful she is. The ability to talk well, when talk is needed, to read well, to amuse understandingly, to wisely meet each needof the invalid as it presents itself, this is to be the idealnurse. 

X

HOW SHALL A NURSE OCCUPY HER DAYS OF WAITING?

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

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

I would like, if possible, to impress upon the nurse graduate thatreally there is much to learn after she has left the trainingschool. All the technic of hospital and operating room is fresh inmind, but there is so much that lies necessarily outside the wallsof a hospital, and this knowledge that comes with experience is agreat 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, andinstruments. We take it for granted that all this is ready. Thecase before has been a hard one, we will imagine, and several dayshave been given to the luxury of whole nights in bed, and wholedays 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 littleher mental equipment, see what she has stored away in her mindthat can help the next patient, or that can assist in fighting thebattle of hygienic cleanliness versus disease-bearing dirt. Lether consider whether she reads aloud acceptably, understandingly. Has she a good list of books which most women would enjoy? Doesshe know what books to suggest for the children? Can she tell whatwould interest the boys, or what a man would like to listen to?Does she know humorous books, interesting histories, orbiographies? Here, then, is occupation for many idle days. 

To go to a public library is always a pleasure, to make friendswith the librarian is an added pleasure, as is also the makingone's self familiar with some good books that can always beprocured, and that will give pleasure and profit to patient afterpatient. This search for good literature will give happiness inthe quest, and happiness in the reading. Librarians are usuallyglad to direct one to the books needed, and many delightful hoursmay be spent in the library, and all the while the comfortablefeeling experienced that the pleasure felt will be transferredlater to future patients. 

The subject of hygiene is taught in most training schools, andindeed in many day schools as well; but this is a branch ofknowledge that is growing so rapidly that, unless the very latestdiscoveries are learned, the nurse may find herself of use merelywhen the infection has done its work. 

I wonder how many nurses have made use of the bulletins issued bythe U. S. Department of Agriculture in Washington. These arecalled Farmers' Bulletins, but many of them are of use to allmankind, be they farmers or not. They are free to any who ask forthem, and up to the present time about five hundred have beenissued. They are upon all sorts of subjects--Flies, Malaria, TheDestruction 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; allone has to do is to write to the Secretary of Agriculture and askto have sent a list of the Farmers' Bulletins published by hisdepartment, and from the list any bulletins may be selected, andthey will be sent. Ask for what is needed; it is all meant for theeducation of the public. The information is absolutely reliable, and represents the best thought of the country--expert advice bythe foremost scientists. 

I have often thought that a nurse who made the nursing of childrena specialty, or even those who nursed children occasionally, wouldbe much profited by a course in a Kindergarten Training School. The private duty nurse, however, having but a few days at herdisposal, cannot do anything as extensive as that; but a very goodsubstitute is at hand, in the kindergarten department of any ofour public schools. It is most interesting to go to a publicschool, ask to see the Principal, and let the nurse explain hervisit, and show her how helpful it would be to future little sickfolks, if she might be allowed to study some of the kindergartenmethods, and permission will readily be given. When the nursereaches the room of the "littlest ones, " let her sit down, andquietly watch what is done for them, and how they are managed. Thekindergartner will be glad to tell where she finds the charmingstories she relates; she will give models of the wonderful thingsher 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 sosimple and so deftly made. A small convalescent could be amusedfor weeks with the things one could learn in a few hours in one ofour city kindergartens. I speak of the things I know, for I havetried it, and I never yet found a Principal who was not glad tohave her kindergarten studied, nor a kindergartner who was notpleased to know that she could assist in the work of nursing sickchildren, even in this seemingly roundabout way. 

In all of our large cities are fine art galleries, and in manythere are fine loan collections on exhibition every summer. Thereare, besides pictures in these loan collections, many things; somecurious, some beautiful, and all of them interesting. Some daysspent in these galleries will bring much knowledge and beauty intoone's life. Time must be taken for these visits; no one canappreciate the patience and skill of oriental handiwork in ahurry. If unacquainted with the exhibits, a catalogue should bepurchased, and each one studied until one knows why it is there, and what is its beauty. I remember seeing, one day, in acollection, a cup of jade, with a very finely wrought handle; Ithought it fine, but did not appreciate it until the Custodiantold me that it took the artist twenty years to carve that onecup, jade is such a hard stone. This cup was so valuable that theKensington Museum, in England, had paid an immense sum of moneyfor it, as a nearly perfect specimen. This information was myreward for close study of an exhibit. In these exhibitions onecould spend many vacant days with much pleasure and profit. 

In whatever town a nurse lives she should familiarize herself withthe philanthropic efforts of the place. In the largest cities itis not possible to know them all, but she should know about someof the settlement work, the day nurseries, the babies' hospitals, the rescue work, the homes for aged. Of course she will know aboutthe hospitals and dispensaries, but what is done for the poor, theignorant, the sinful, and the stranger--these she should learn. Many times she could do much to help these institutions, byrelating, simply and truthfully, when occasion offers, what shehas seen, of the great needs of such efforts, and the heroic workof those who go down and live amongst the needy and try to upliftthem. Many a rich, idle patient might become interested and givemoney, if not time, to help in these good works; and my experienceshows that they generally need all the help they can get. So thenurse should know about the anti-tuberculosis work, the nightschools, the playgrounds on the roofs of the school-houses, allthe philanthropic work of her town, and she cannot know about itunless she takes some of her vacant days, her days of waiting, andturns them into days of learning, and the expansion of both hermind and her heart. 

Another pleasant way to spend some days of waiting is to study thetrolley system of the town where you live. Learn how far it cango, to how many other towns. If a river is near, become familiarwith its steamboats. Excursions on boat or trolley will bedelightful, and will teach the best routes, the best terminalstations, and the best restaurants, and some day when a patient iswell enough to take an excursion, some part of his own immediateneighborhood may be shown him which he has never seen before. Believe me, all this will be appreciated. Space fails me to tellof music to be heard, theatres to be enjoyed, and all to be usedhereafter for the benefit of those to whom you will be called tominister. The information constantly gathered in the "days ofwaiting, " rightly used, intelligently imparted to the patient orher friends, will make of the nurse such a broad-minded, sympathetic woman that everyone who employs her will appreciatethe fact that she has a wide culture, and brings to her patientsomething 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, somemonths hence, to care for her baby and herself, it is very nice tobe able to give her, should she ask, a list of all the things shewill need, both for her own comfort and the baby's. 

The following is a good sensible wardrobe, and will be foundample, though many articles more or less fanciful will, mostprobably, be added by friends. The things enumerated below shouldlast 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. Diaperssecond size, 20 inches square, 30. Diapers third size, 26 inchessquare, 30. Knitted blankets, plain white, 2; if with any color, 4to 6. Knitted sacques, 4 (two sizes). Little pillow (hair), 6cases. Crib sheets, 6. Crib blankets, 2. 

FOR BASKET. 

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

FOR THE MOTHER. 

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

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

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

The slips should be made very plainly. The material may be as fineas can be bought, but beyond a few tucks about the yoke, and alittle lace or fine embroidery about neck and sleeves, should beperfectly plain. The dresses, of course, are somewhat moreelaborate, but the fashion now decrees that infant's clothingshall be perfectly plain, and a most sensible fashion it is. Pinning blankets are open all down the front, and are usually madein the shops with a broad band of stiff white muslin, which showsthat the people who made them never tried to dress a baby. Theband should be of flannel or coarse linen many times washed sothat it may be soft, and the pins will go through many folds ofit. Flannel skirts are usually made of two breadths of flannel, and are more or less embroidered. These are not left open, exceptjust enough to make the dressing easy. Shirts are made so well instores that few people care to knit them. They should always behigh in the neck and long sleeved, and it is better to get twosizes, as, if the baby is small, it never can be comfortable in alarge 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. Nothemmed or ornamented in any way. No hemming or stitching can be sofine that it will not mark the baby's flesh. Besides this, if youhave these plain bands and find they are several inches too big, nothing is easier than tearing off a strip and making them fit. Ifthe child has a very large, round abdomen, they can be made to fitover it nicely by taking two little tucks on the lower edge, abouthalf an inch from the middle of the band, and letting the tucksrun 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 themover the shoulders. 

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

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

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

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

The gold safety pins are intended for the final pinning of thedress in the front and in the back. Of course any littleornamental 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 beforgotten. Mix the two very thoroughly, and if any little whiteaphthous spots appear on baby's lips, tongue or cheeks, apply alittle of this mixture several times a day, and they will probablyall be gone by night. Put it on very carefully with the tip ofyour finger slightly moistened so that some of the powder willadhere. Examine the baby's mouth every day for these spots. Theyare likely to appear any time after ten days or two weeks, and aremore often seen in weak children, or those who are fed by abottle. If the spots appear on a child who is taking the breast, the nipples are very apt to be sore. Much care, therefore, must beexercised 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 verydelicate and pleasant. Put one or two amongst the little shirts, and some among the knitted blankets, but mostly have them in thedresses, and be sure when you take out a clean dress, or slip, totake the sachet and slide it into the neck of the slip that willbe worn tomorrow. Nothing can be more attractive than a clean, sweetly smelling baby, and, _per contra_, nothing is moredisgusting than a wet, sour, cold, crying baby. If he be wet andsour he will surely have cold feet and hands, and as surely willhe cry. Poor little thing! It is his only way of expressing hisopinion of the state of his toilette. 

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

A lap protector is made by covering a piece of rubber cloth about14 inches square with several thicknesses of old blanket. To coverthis have some slips like pillow cases, of linen or cotton, plainor 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 whowishes to hold the baby, and it perfectly protects from allwetting. 

TABLE FOR ESTIMATING THE PROBABLE DURATION OF PREGNANCY

Two hundred and eighty days, forty weeks, ten lunar months, ornine calendar months are here estimated as the usual duration ofpregnancy (the actual computed average being 276-2/3 days). Theexact day of conception (_not_ the fertile coition), cannever be accurately determined; the only date from whichconception can be dated, and the probable confinement daypredicted with some chance of certainty, is the first day of thelast menstrual flow, adding to this one week (seven days) for theaverage duration of the flow (with a few days lee-way). We countnine calendar months forward, and have the approximate date of theexpected confinement. The most ready method is to add seven daysto the first day of the last menstrual flow, count back threemonths, and add one year, when we have the future date when, orabout when, delivery may be expected. 

An _exact_ estimate is but guess work; errors of one or twoweeks either way may be made by the most experienced, as in caseswhere conception occurred shortly before the next menstrualperiod, which did not then appear. 

The present table is constructed on the above principle, thesecond column representing the day of quickening, nineteen weeksafter the beginning of the last menstruation, with seven daysadded; and the third column still twenty weeks later. The date ofquickening is still more variable than that of delivery, from oneto four weeks. 

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

Beginningof lastQuickening. 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 oldsheets for the bed of a parturient woman, but I will repeat thatold ones are to be preferred, and really new ones, that is, onlyonce washed, never used. New towels are of course objectionable, as being too harsh. If the patient likes a rough towel, use aregular bath towel, if you can get it. Be careful, never to letloose and wet ends of the wash cloth drag along exposed parts ofthe body. It is a good plan to sew your wash cloth into a bag, andto slip your hand inside, and work with it put on like a mitten. Arubber or fibre sponge is to be preferred. Keep one for the face, neck, arms, and hands, and another for the feet and legs. Thevulva is bathed best by means of a fountain syringe used as anirrigator, and a little sterilized gauze twisted around yourdressing forceps. The gauze can be changed as often as necessary, and is much more satisfactory than anything else, especially ifthere has been a laceration. 

The square of rubber sheeting, single width, is most useful. Forthe confinement the bed should be made by first spreading over themattress the wide rubber sheet, over this put an old blanket, thenthe under sheet; upon the right side of the bed, where most likelythe woman will lie, place the square of rubber, over that the oldcomfortable, four double, and hold all in place with a sheetfolded like a hospital "draw-sheet. " This must be firmly tucked inat the sides under the mattress. It will seldom be found necessaryto change the under sheet, if the bed is made this way, and therubber square is drawn carefully away, with the comfortable anddraw sheet, when it is time to make the patient clean and dryafter 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 thefirst few days. This saves much washing. 

An old blanket and a small one will be found invaluable for allsorts of things--for example, to spread over the shoulders andchest when the bandage is being pinned; to warm and wrap up thefeet and legs, if they show any signs of being cold; to cover oneknee and part of the body when using the irrigator, which whenthere has been _any_ laceration, is a delicate piece ofbusiness, as every nurse knows. Always fold up this invaluable andconstant friend, and put it in some handy but inconspicuous place;it _is_ a friend, and a good one; but it is not a beautifulobject to look upon, and others not knowing its virtues wouldthink you untidy if it was in a noticeable place. The fountainsyringe is absolutely indispensable; and, though it may seemunnecessarily large, yet I think a four-quart bag better than anyof the smaller sizes. To be sure, you never might need four quartsin the bag, but it is so much easier managed, so much less liableto spill over, if you have a large bag and put it only half orthree-quarters full. Then, too, you get so much more force if youhave more water in the bag, you need not use it all. A Davidsonsyringe is very nice for some things that a fountain syringe couldnot 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 willfind the rubber of the bulb and tubing becoming pasty, and yoursyringe will be utterly spoiled. The paper basin is very light andeasily 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 inmany things, should have abandoned the fashion of short nightgowns, which our grandmothers always provided for themselves atthese times. I remember asking one lady, when talking over whatshe would need for her first baby, and for herself, at the time ofits birth, if she had not something short and plain that she couldwear. She looked very thoughtful for a moment and then said thatshe thought she did have _one_ night-dress that did not havea ruffle or embroidery around the bottom. She could wear that. Itcertainly is not from motives of economy that our wealthy patientsdo not have these most sensible of garments. I think they knownothing about them, and they should have their virtues explainedto them. A pocket could be added to this garment, I think, and itwould 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 adozen times a day. Men always have pockets in their night-shirts, and they are not sick half as much as the women. I wonder whywomen do not imitate this most sensible custom. If your patientwill not let you cut off any of her old night-dresses, you mustuse the long ones, of course, and change them as often asnecessary. 

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

Obstetrical binders, or bandages are now seldom put on aparturient woman, but in case they are to be used, I give the bestkind I know of. They are sometimes made to order, but I never knewone of these to fit, or wash well. 

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

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

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

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

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

I must not forget to say that when you go to see you prospectivepatient, and she shows you the room she expects to occupy, itwould 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 thebed. Some doctors are very neat about their work, but some are--well, perhaps I better not say it; we must not criticise thedoctors. 

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

XII

AS TO WASHING THE BABY

In the first place get together everything you will need for thebath and subsequent dressing. Have the clothes all laid in orderover a chair-back before an open fireplace, or over a radiator, orif no better expedient suggest itself, fill bottles with hotwater, 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 tolay over the rubber apron when needed. Put your baby basket whereyou can reach it, be sure that it contains all the things you willneed--sponge, soap, powder, pins, vaseline, etc. , and an extradiaper or two. Now get the tub (tin) and pour in the water untilit is about four inches deep. Have the water no warmer than 100 degreesF. Bath thermometers are made that are quite cheap, and a greatconvenience; one should always be at hand, as no nurse should evertrust 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 witha thermometer. Another point a nurse should be most careful about, is to be careful that her hands are warm before she takes thebaby, as her cold hands on his warm flesh will surely make himscream. 

All being now ready, take the baby and sit down with him, spreading the blanket over your knees as you do so, and having thetub just in front of you on another chair. The sponge is best touse 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 thetowel. Now hold the baby's head over the tub and give that a goodwashing with soap on your bare hand, and rinse it well with plentyof water, always holding the left hand under the head and neck. Bring him back on your lap and thoroughly dry his head, then washand dry the ears carefully. 

When you get this far you may undress the baby completely, beingmost careful yet not taking any unnecessary time. When he is quiteready for the tub, grasp him firmly with the right hand, lettingthe buttocks rest in the palm of the hand, the fingers beingoutspread, and the thumb coming up almost to the pubic bone. Withthe left hand hold the head and shoulders. Lower him _very_gently into the water. Any sudden movement is most injurious, as ababy must never cry when the band is off, if it can be avoided. Hewill often put out both hands as if trying to catch hold ofsomething. If he seems frightened at the same time, and criesviolently, let the buttocks rest on the bottom of the tub, andwith 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, wellsoaped. Be careful to wash under the arms, in the bend of theelbows, the groins, and under the knees, rinse him with the washcloth or sponge, and now lay one warm towel on your lap, and takeup the baby just as you put him in, slowly, and without shock, andlay him in the warm towel. Lay the second one over him, and drawover all the blanket, wrapping him up warm and snug. Put your handinside the blanket and dry him. This can be easily and quicklydone without at all uncovering the child. Pass the hand with aslight squeezing movement over each arm and leg, and over thefront 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 tothe very bottom of every crease, and be sure it is dry andpowdered. 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 hipto the armpit. Lay the palm of your right hand firmly over bandand pad and turn the child carefully, holding your right handstill 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, andsee that the baby's knees are on the right side of your knee, andthe elbows well over the other side of your lap. Now you have thebaby where he can kick, but he can't wriggle or spring off yourlap. See that the back is dry, rub it a little with your hand, andpowder. Look carefully in the deep dimple just at the coccyx andsee if it is clean. Now pin the band snugly, but not too tight. Use the smallest safety pins, and never pin directly over thespine. Sometimes the abdomen is very large and it will benecessary to make two little tucks in the lower edge of the bandin 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 thepinning blanket. Lay all of these just as they should be, asregards the back, and turn him, being careful to hold all theclothes in place. If he is liable to chafe, or the movements ofthe bowels are in any way irritating, use vaseline about thebuttocks. Now put the arms in the shirt sleeves and tie or buttonit up, and then pin the petticoat or pinning blanket. Lay an extradiaper folded many times under him, and fold the pinning blanketjust 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 passthe fore-finger of the left hand down inside of all the clothes, beginning at the neck, until you find the band (the firstgarment), take a small safety pin or any small ornamental pin, andpin thoroughly through everything. This last pin I consider mostnecessary, 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 ofthe dress, being very careful to get at the band. While the babyis in this position put the blanket he wears during the day overhim, and a final turn brings him around, and he is washed anddressed all but his mouth, which must be carefully washed withclean, warm water or borax and water. This should be also donemany times each day, if the mouth is sore, and always a sharpwatch kept for white patches on lips, cheeks and tongue. If thebaby has hair to brush, it is well to brush it. It makes him lookvery cunning, but if he is tired or sleepy, do not trouble him. This washing and dressing should not occupy more than twentyminutes, I have done it in fifteen where the baby was very wellbehaved. 

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

In taking the clothing off, it is not necessary to turn the childat 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 neverbe put into the tub. If after the stump has sloughed there seemsto be any protrusion, or indeed any ulcerated look about thenaval, it is best to bathe the child on your lap. In all suchcases undress the baby as previously directed, until you come tothe band (flannel belly band). Wash, rinse, wipe and powder him, being careful to make every part absolutely clean and dry. If theband is soiled or wrinkled, or out of shape in any way, remove itand put on a fresh one--looking every day, after three days, tosee if the stump has come off--and if it is still adherent, beingmost careful not to disturb it in any way. Apply the fresh bandimmediately. Turn the baby on its stomach, and when the back isexposed, wash and rub the back gently with your warm hand. If theband does not need changing, unpin it, rub the back, pin it upagain, and proceed in dressing as before. When the cord is oncefairly off, and the navel smooth and clean, you can put the babyinto the tub, very gently, slowly, and cautiously, rememberingthat a sudden movement on your part may, in fact, always will makehim scream, and screaming with no band or compress on is for ababy a very frequent cause of umbilical hernia. If the cord issmall 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 yourfault if the baby's navel is not small and flat when you areleaving your case, but you will always be blamed for it, if it isnot. Notice carefully every morning when you bathe the child ifthere is any umbilical protrusion, and report it without delay toyour doctor, if there is any, no matter how slight. This is not, however, the place to treat of umbilical hernia, and we will go onwith the washing, If the child's skin is very tender, chafingeasily, 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 anygood, then try vaseline. If that will not do, ask the doctor ifyou can try oxide of zinc ointment. Ordinarily, extreme care inwashing, drying and powdering will be sufficient, but it must bedone every time the diaper is changed. In this, as in otherthings, eternal vigilance is absolutely necessary. 

When the baby is about two or three weeks old, it is a good planto put some alcohol into the water in which he is bathed--two orthree ounces to the amount of water used in bathing. Have a smallbowl of cooler water, 70 degrees to 80 degrees, for the face, andafter that is washed, add a tablespoonful of alcohol to that also, for the head. It helps to toughen the skin, and prevents the babyfrom 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 someonehold his hands, so that he will not clutch so wildly ateverything, then lower him into the water, towel and all, and hewill not notice it so much. 

I know of no place where deftness of handling shows to suchadvantage as with a baby. He knows well enough if he is handledproperly or not, and his fretful cry, or violent screams, willtell you without delay if he is not comfortable. 

Once more, let me impress upon the minds of all who read this, thenecessity of having everything used about the tub and subsequentdressing, warm. Anything cold will make the little one scream, andI think all nurses will agree with me, that there is no morenervous work than washing and dressing a baby who is crying (andonce he begins, he is only too apt to keep it up during the entiretime). This is especially true if a weak, ignorant mother is madenervous by the noise, or a doting grandmother hovers about, makingremarks about "new fashioned ways, " and wondering why this childshould cry when his mother was always so good, as a baby, in herbath. 

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

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

If the baby is nursing from the breast, tell the mother, afterthis nursing you wish to wash the child, and not to let him go offfor sound sleep. She can prevent it, and keep him for the twentyminutes or half an hour it is necessary to wait after his meal, meantime you have time to get everything in readiness for thebath. It is a great mistake to attempt to bathe a baby when he ishungry. He will scream for his food from the beginning to the endof the performance, hesitating occasionally when something warmtouches his mouth, and he eagerly seeks his meal, only to redoublehis cries when not satisfied. Nothing is so persevering in itsendeavors, as a hungry baby. Satisfy its appetite first and wait areasonable length of time, wash him deftly and quickly, and hewill be so sleepy by the time you are through, you can lay him inhis bed and he will be asleep in a moment, when you can pick upall the soiled clothing and the general "mess" of the bathingoperation, and leave the room once more tidy. 

And just here, let me say a little about the washing of the baby'sclothes. Of course the dresses or slips, skirts, and the diapersgo to the laundress. Begin every morning on an entirely new, thatis newly-washed, set of diapers. Gather up all that have been usedthe past twenty-four hours and have them washed. Perhaps they maynot 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 nurseshould ever be called upon to do this. Still, I would rather do itthan use a diaper over and over again. 

But it is of the little shirts I particularly wish to speak. Ithink the nurse should wash these, also the socks when they needit, and the knitted shawls most babies wear. It takes very littletime to do this, and if you know how, you will do it much betterthan any laundress. The best way to wash these things is in coolborax water, and if there is any one place the baby has vomitedon, put a little dry powdered borax on (the place being wet), andrub it in. Then wash by plunging it in the water and squeezing itout. Do this again and again until the garment is clean. Rinse inclear cool water, and wring as dry as possible in a towel; thenpull in shape and lay it on a clean towel to dry. It is a goodplan to lay it on a folded towel over a half shut register andplace a single fold of towel over. It will dry very soon. If youare washing a baby's knitted shawl, be very careful about thewringing. Lay a large towel (bath towel is the best) out flat, and, having squeezed the most of the water from the blanket, layit carefully on the towel and roll both together, and wring verytightly. If this towel gets wet take a second. When you aresatisfied that it is as dry as you can make it, lay it out on afolded sheet on the floor, in some room not much used, and pulland arrange it into its original shape and size. 

Anything made of Germantown wool stretches terribly, but you canarrange it as it ought to be. It will look ruffly here and thereand ridgy all over, but when it is dry it will shrink down allright. Only do not hang it up, and when it is dry you will besurprised to find it looks as good as new. If you are everconsulted beforehand as to what would be nice for the baby, useall your eloquence against _any_ color being put into theseknitted shawls. Germantown wool is the best to use, and plainknitting or brioche stitch is the best to wear and wash, and thesethings must be washed with the most careful handling. On thenicest baby they will become dirty, and the delicate blues andpinks become the dismalest wrecks when washed. Therefore, tellyour patient not to put any color in these first plain littlecomfortable shawls. They should be a yard long by about three-quarters wide. Two or three will be all you will need, and do notuse any of the fancy blankets sent in by friends. Lay these allaway, with a sachet bag or two, in some convenient drawer, andnever take them out unless the baby is required to look very finefor a brief display to some friend. These delicate, fancy trifleswhen once wet through or vomited on are ruined, and it should beyour aim to leave everything as good as you found it when you gofrom 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 doesso 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 incurablecase, yet most of us who have done private nursing have foundourselves at some time caring for one who slowly, and painfully, creeps nearer day by day to the great End. We have gone perhaps tostay a few weeks, for some acute disease, but symptoms havechanged, and instead of recovery, a long, slow decline is to befaced, the nurse feeling she is needed, decides to stay and dowhat she can for the poor failing body, and so the weeks drag onin the dreadful monotony of that one sick room, until we feel thatwe have been left out of the real nursing world, that we arestranded with our patient upon an island of pain, that there is nooutlook but the one dread Valley, no moving object but the riverof Death, and no hope for the life we are guarding. Each week wegrow more and more rusty as to our hardly-won surgical technic, more out of touch with those who come and go to one patient afterthe other, and who not unnaturally count upon so and so manyvictories over the very enemy who we know will overcome the lifewe are fighting to save. Yet we realize that all our care willnever bring victory, all our skill can but help to smooth therugged pathway, down which the feet must tread alone. The endlessrepetition of the same symptoms is wearying, the only possiblevariation being some new pain, which indicates another stage inthe development of the disease. An improvement hardly cheers us, as we know it is but temporary, and maybe followed by anexacerbation of the trouble. 

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

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

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

_Firstly_, it is well to study your case from a pathologicalview point. Find out the heredity, the manner of the daily life, the first manifestation of the disease, what circumstances led toit, how it was treated, what success the treatment seemed to have, what symptoms can now be noted, what complications have shownthemselves, and their influence on the original disease. A carefulhistory could be written embracing all of these points, and as newsymptoms appear they should be observed and noted. All this shouldbe valuable and should help some future day to show some one whohas but started on the dreaded pathway, how to avoid what willsurely be a fatal disease. Many a valuable paper could be writtenin the long hours when the nurse feels she is losing her time, ifshe would intelligently study her case, and write the story of thedisease, what led to it, and how it is being combated. 

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

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

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

In the face of these things, how small do the thoughts of our owndignity seem. It is all _service_, and service is what wewere 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 Ishall not pass this way again. " This quotation is familiar to all, and especially does it come to mind when we minister to those whoare to die. When they are gone there will be no bringing them backto explain duties slighted or left undone. "We pass this way butonce. "

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

The patient may not know her condition, and the doctor may notwish her to be told, then, of course, the nurse's lips must besealed, as to any allusion to the dread truth. The religious viewsof the patient and her friends may be different from anything thatthe 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 someportion of the Bible, and unless the part is specified the nursemay be at a loss just where to turn. Some parts of the Scripturesare so generally known and accepted, that they can hardly fail togive hope and comfort, no matter what the religious teaching mayhave been heretofore. 

I will suggest then _in case_ readings are asked for. ThePsalms are full of beautiful comforting thoughts and prayers. The23d has helped many a poor soul about to take its last journey, the 37th, which begins "Fret not thyself, " shows that those aretruly blessed who trust in the Lord, the 51st, "Have mercy uponme, O God, " teaches repentance, the 42d, "As the hart pants afterthe water-brooks, so longeth my soul for Thee, O God, " shows thedesire of the soul for God. 

In the New Testament, the 14th chapter of St. John's gospel is auniversal favorite, on account of its comforting thoughts "In myFather's house are many mansions. " In St. Luke's gospel chapter15th, verse 11, we have the parable of the Prodigal Son, to showhow complete and perfect is God's love, and His forgiveness, whensin is forsaken. In 1st Corinthians, 15th chapter, verse 20, wehave a masterly argument for the resurrection from the dead, and alife beyond the grave. In Revelations, 14th chapter, 13th verse, is a very comforting thought for those who have led a strenuouslife and are in much suffering. 

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

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

Very tiny, dainty little books can be purchased at the church bookstores, 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 inthis book are radiant with the truths of the Resurrection, and theEaster hymns are tuned to the same inspiring theme. 

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