The care of the sick at home and in the hospital : a handbook for families and for nurses
Billroth, Theodor, 1829-1894. n 83135417
Care of the Sick Dr. Th, Billroth 1 1 — 1 r J- Pe-ntaJl Erd ean , / Trausiator. /^qo, ^ // t ^f/'yu -'u. a) t^yiTK, 1) ^'7" (TU^ X c CjJo tz V\J?I (^l£ A- C-g iT7^ //^ /Afotigi ^1^11' giA:trkUc ^ c/^/fv^y t-i-r^ccg^j ^ ‘U'Jp/VU ^ t-i^J , f'^; uCje^^ it'tyL ca, it/ c-/ / ^ J g-iT^ytOO fr> t'’^^L'^^^U-^T\>~lyiJ gj~ C /' A-t^y' ^ Ino&Jkourg yZu^Ae/{ i '^U-f-^/ 4: 6Z /4 \y ut^ iA^l-c- (iAj U: /^' ^ J ^'fTTr u-fjl dA. tff /^LA/f'~ tri vul ^ kt A'C-t. c/ r/^ 4 /^-ir^<je^ p-^A.ki /^l (t ^a^4/jt^Aj mL V Hi y ' uc<t Vp^A /i4^^Uj:k/t l4ylUA , f^cn.,/ It u^u/u , t ttJ>C // I 'tAt /U2-^ Aa/p, THE CARE OF THE SICK. 3^. THE CARE OF THE SICK AT HOME AND IN THE HOSPITAL A HANDBOOK FOR FAMILIES A1VD\F0R A^CIRSES BY kl: ■' a A Dr TH. BILLROTH, PROFESSOR OF SURGERY IN VIENNA, ETC., ETC., ETC. TRANSLATED BY SPECIAL AUTHORITY OF THE AUTHOR BY J. BENTALL ENDEAN “ Shall I succeed ? That is an idle question ! It benefits mankind. Instead of asking. Venture ! ” WITH PORTRAIT AND ILLUSTRATIONS LONDON SAMPSON LOW, MARSTON, SEARLE & RIVINGTON Limited iJunstim’s Souse Fetter Lane, Fleet Street, E.C. 1890 [a1// rig/iis reserved] “ A wise Physician, skill’d our wounds to heal, Is more than armies to the public weal.” Pope’s Homer’s Iliad." “ The Nursing art, like the Healing art, is an act of mercy — in itself too essentially noble to inquire whether the misery that it relieves merits help.” — Wilkie Collins. TLo tf3e /lDemor\? OF MY BELOVED MOTHER, REVERENTLY AND LOVINGLY 5 BeDicate this IDoIume. J. BENTALL ENDEAN. “ One touch of nature makes the whole world kin.” “ Troihis and Cressida." “ But mankind — the race would perish did they cease to aid each other. From the time that the mother binds the child’s head till the moment that some kind assistant wipes the death-damp from the brow of the dying, we cannot exist without mutual help. All, therefore, that need aid, have right to ask it of their fellow-mortals ; no one who has the power of granting can refuse it without guilt.” — Sir  learnt. Qualifications of the Sick Nurse: Inclina- nation, Innate Vocation for Sick-Nursing ; Quiet Character ; Special Talent, Gift of Observation; Love of Truth, Sense of Order, Reliability : Pliancy, Propriety, Morality. Healthy Body. Greatest Cleanlines.s. Light Hand. Skill ; Care. Conduct of the Nurse in her Intercourse with Patients and their Friends: Reticence; Quiet, Silent Activity. Nursing the Incurable: Nursing the Convalescent. High Claims upon the Nurse’s Calling. Schools for Female Nurses. CHAPTER I. The Sick-Room ....... Choice of a Sick-room. Airing (Ventilation). Heating. Cooling. Sun- light. Size. Quiet Position. Cleansing and Furniture. The Sick-Bed — The Bedstead — Iron Bedsteads, their Advantages; Length, Breadth, Height. Spring-bed, with Stuffed Spring Mattress. Woven- wire Spring Mattress. Bedding; Horse-hair Mattress. Sheets. Pillows. Blankets. Aids to the Recumbent Position : Sjing-bolster Head-rest. Pillow for the Loins. Foot-rests. Adjustable Bed-rests. Movable, Protecting extra Bed-sides. Bed-staves. Position of Bed in the Room. CHAPTER II. General Rules for the Care of Patients Confined to THEIR Beds ...... Care for good position and comfort of Patient in Bed. Smoothing Sheets, Changing and Shaking-up Pillows. Bed Crane ; Bed Traces. Changing 8 CONTENTS. PACE l)ody Linen. Clothing in Bed. Evacuations in Bed. Change of Bed, Changing from One Bed to Another. Changing Bed-linen. Underlays. Waterproof Materials. Warming the Bed. Bed-sores and Gangrenous Decubitus. Bed-sores : Preventive Measures, Circular-centre Cushions ; Lotions ; Plasters. Gangrenous Decubitus : Causes. Water-cushion : its Use. Cleansing the Decubitus. Treatment of the Wound. Light at Night in the Sick-room. Large Clock without striking action. Drinking, Eating, Reading in Bed. Sitting up and Drawing-up of Patients in Bed. Impossibility of Efficiently Treating and Nursing the Poor in their Dwellings. Excellent Observations and Remarks of Miss Florence Nightingale upon the Peculiarities of many Patients and upon the Conduct of the Nurses. CHAPTER III. On the Fulfilment of Medical Orders ... 94 I. Administering Medicines. 2. Inhalations. 3. Injections ; Enemata ; Suppositories ; Instillations. 4. Compresses. Applications with a Camel's Hair Pencil. Embrocations. Massage. Gymnastics. Electricity. 5. Leeches. Mustard Plasters. Blisters. 6. Baths. 7. Aflusions (Douches). Damp Friction, Packings, Local Wet Dressings. 8. Continuous Application of Cold and of Heat. CHAPTER IV. Preparations for Operations and Bandagings . . 131 Antiseptic Remedies. Preparations for Operations. Preparation of the Nurse. Selection of Room. Lighting. Preparation of Patient. Tempera- ture of Room. Operation-Table. Amesthesia. Directions for making Sponges and Silk Clean Surgically. Names of most-used Surgical Instru- ments. Preparation for Antiseptic Dressing. Tampons. Plaster. Dressing Wounds at the Sick-bed. Preparation of Solutions of Carbolic Acid. Salve-Dressing. Preparations for Bandaging Fractures, Dislocations, Curvatures. Plaster of Paris Bandage ; Starch ditto ; Silicate or Water- glass ditto. Gutta-percha Splints. Practice in applying Roller and Hand- kerchief-Bandages, with Illustrations. Transport of the Sick. CHAPTER V. Observation and Care of Fever Patients Generally . 183 Fever. Acute, Chronic Diseases. Raised Temperature the Chief Symptom of Fever. Measuring the Temperature of the Body by the Thermometer. Fever Curves. Counting the Pulse and the Respiration. Fever Deliria. Duty of the Nurse. CONTENTS. 9 CHAPTER VI. PAGE Nursing in Epidemics and in Infectious Diseases. Pre- cautions AGAINST Infection. Disinfection . i9S Typhoid Fever: its Origin. Daily Duties of Nurses with Typhoid Patients. Serious Contingencies in Typhoid. Necessary Careful Attention of the Nurse. Treatment of Typhoid Fever with Baths and Cold Water. Care of Typhoid Patients during Convalescence. Cholera. Diarrhoea. Diseases Directly Infectious from Person to Person : Typhus Fever; Relapsing Typhus; Measles: German Measles; Scarlet Fever; Small-Pox (variola); Whooping Cough; Mumps; Erysipelas; Diphtheria. First Symp- toms of Measles, German Measles, Scarlet Fever, Small-Pox. Whooping Cough. Diphtheria: Mannerof its Appearance; Channels of Infection ; Local Treatment. Quinsy. Tracheotomy. Precautionary Measures in Epidemics and in Infectious Diseases. Dis- infection. CPIAPTER VII. Care of Nervous Patients, and Patients Mentally Diseased ....... 241 On the Nervous System, and its Diseases Generally. I. Nursing and Helping in Nervous Diseases, and in Attacks Originating Chiefly in the Nervous Sy-tem: Nursing the Paralyzed. Rendering Help in Fainting; Concussion of the Brain; Congestion of the Brain; Apoplexy; Epilepsy; Hysterical Convulsions; Colic; Spasm of the Stomach; Spasm of the Glottis; Asthma; Hiccough; Facial Neuralgia (Tic). II. Observation and Care of the Mentally Diseased: Generalities, i. Derangements of the Imagination. 2. Conditions of Mental Depression. 3. Conditions of Excitation. General Directions for Nursing the Mentally Diseased, by Dr Ewald Hecker. Instructions for Nurses of the Insane, by Dr J. von Mundy : Treatment of Raving Maniacs. Rejection of the Strait - Jacket. ** No Restraint.'* Dejection; Refusal to take Food. Importance of the Physical Care of the Insane. Occupation and .Amusement of the Insane. The Family System (Gheel). CHAPTER VIII. Aid IN Accidents . ... . . . 276 Rendering aid in — Injuries : Burns, Frost-bites, Contusions, Wounds, Wound-hmmorrhage. Poisoned W ounds : Insect-bites, Snake-bites, Bites of Mad Dogs, Blood- poisoning by Putrid Meat. lO CONTENTS. PACE H(emorrhages : Nose-bleeding, Spitting of Blood, Vomiting of Blood. Attempts to Resuscitate ; In Hanging, and in Drowning. (See Chapter VI I, for histructions on Fainting Fits, Apoplectic Attacks, Convulsions.) Poisoning: Rendering Help in Cases of. CHAPTER IX. Food and Diet. — Conclusion. 290 Appendix — The Structure and Functions of the Human Body ....... 299 Index ........ 327 ILLUSTRATIONS. Portrait of Dr Th. Billroth . . . Frontispiece. The Billroth Bedstead, Bed-Crane, and Bed-Traces . 67 Splints (Provisional) ..... 149-151 Bandaging, &c. ...... 161-181 PREFACE. On Sick-Nursing many books have been published, but I can only recommend the following : — Dr L. G. Courvoisier. Die hausliche Krankenpflege. Basel, 1876. Florence S. Lees. Handbuch fiir Krankenpflegerinnen, iibersetzt von Dr Paul Schliep. Berlin, 1874. Florence Nightingale. Rathgeber fiir Gesundheits- und Krankenpflege, iibersetzt von Dr Paul Niemeyer. Leipzig, 1878. Taschenbucli fiir Krankenpflegerinnen. Weimar, Jahrgiinge 1879, 1880, und 1881. Dr J. Wiel. Diatetisches Kochbuch ; in vielen Auflagen in Freiburg (Fr. Wagner’sche Buchhandlung) erschienen. Dr J. Wiel. Tisch fiir Magenkranke ; ebenfalls in vielen Auflagen in Carlsbad (bei H. Feller) erschienen. These books and others like them, although ably written, contain, in my opinion, either too little or too much. I consider that all systematic, anatomical, and physio- logical expositions in such books just as superfluous as the systematic explanations of the cetiology and the diag- nosis of every possible disease would be. That portion of medical science and art which can be briefly presented in a popular form, must be extremely superficial and in- complete. For an able, aspiring woman it is too little; for a woman who seeks and finds her calling and happiness in sick-nursing, it is superfluous. 1 o speak of patients and the 12 PREFACE. care of them without saying anything of the most important diseases, their causes, and phenomena, is not sufficient. In this book only so much will be given upon these subjects as is indispensable to their full comprehension. The nurse must be the helper of the patient and the doctor j she must learn to execute judiciously and accurately the doctor’s orders, and must not desire to cure on her own account ; she must have as implicit confidence in him as the patient himself has ; when this is not the case, she will often be tempted to criticise his instructions by her own superficial knowledge, and, in her opinion, even to improve upon them. Such a nurse not only renders the practice of his profes- sion more difficult to the doctor, but, under such circum- stances, the patient himself always suffers the most; his confidence in his medical attendant having been shaken by the nurse, he tries first one treatment and then another, but none fully and regularly, until it may even happen at last, that his life is sacrificed. In the German method of treatment of the sick, par- ticularly in hospitals, it is a great advantage that the head doctor and his assistants themselves do as much as pos- sible. This is of material consequence in wound-dressing. Infinite care is necessary in dressing (bandaging) the wounded, and patients who have been operated on ; every young doctor is not qualified for it, and some may 7iever acquire it, because they are not capable of closely con- centrating their attention upon technical manipulation. In the practice of the modern principles of dressing, the personal responsibility of the dresser has become an anxious responsi- bility. In England, France, Italy, Russia the doctors leave wound-dressing almost exclusively to the nurses. All kinds of information on various methods of dressing (bandaging) given in other handbooks for nurses, will, in this PREFACE. 13 book, be sought for in vain. Far from desiring to assert that, properly instructed, a woman is not able to execute a good dressing, however complicated, as carefully as a young doctor, yet, from experience, I know innumerable cases of women who possessed all the qualifications of an excellent nurse, but who were not quite capable of all that a doctor must learn and know. Explanations that might wound feminine delicacy at the very beginning, I have avoided. Much is to be learnt quickly by the sick-bed, and many things will be easily overcome by degrees, the details of which, if printed, would have a de- terrent effect. It will, perhaps, be asked, after having omitted such sub- jects as copiously fill many chapters in other books for female nurses, what then remains? I hope my lady readers will yet find in this book enough to learn and to impress per- manently upon their memories. For those who desire to qualify as Professional Sick-Nurses the contents of this Handbook, in my opinion, should con- stitute the First Lectures (of the Preparatory Course) on the Care of the Sick. It is evident that such a Preparatory Course must be combined simultaneously with practical demonstra- tions; equally is it a matter of course that the Trained Nurse must learn, by degrees, more than this book contains. How much the doctor will entrust to individual, specially- qualified women, will depend upon himself. In the same way he must judge of the suitability of a woman for the post of Head-Nurse in a Hospital and Teacher of the Probationers j length of service must never decide it, but special qualifica- tion alone. For this post, certain qualities of character and of individuality are more necessary than an unusual degree of medical knowledge. Practical intelligence, clear compre- hension of circumstances, knowledge of mankind, impartiality. 14 PREFACE. patience, benevolence, quiet dignity, combined with firmness of character, make the woman, as the man, better fitted to be the leader of others, than great educational attainments. These qualities are not obtained from books — they are partly’ innate, and partly to be acquired by long years of experience and self-training. Let every woman and every girl interested in the Care of the Sick cheerfully take this book into their hands. In it they will find, I hope, many things that will enable them to help and benefit others. But one charge will be brought against me : that I have written much that goes beyond the ordinary thinking powers of nurses in general. This charge I willingly acknowledge. A similar charge was made against me when I wrote a book for students, and yet I have every reason to be satisfied with the success of that book. Whilst not writing for Professional Nurses only, but also for Educated Housewives and Mothers of Families who desire to have, not only something to learn, but also something to think about, and, apart from the con- sideration that women of small intellectual capacity are not generally fitted for nurses, I have always found that practical results in tuition are better gained by a sure method and gradual development of a well-regulated mind than by de- scending to the level of the deepest ignorance and the most inferior endowments. Women of mediocre intellect should rather be dissuaded from the nurse’s calling, not simply because experience proves that the reliable execution of important duties absolutely presupposes a certain education of the in- telligence, but because the greatest kindness of heart can only obtain practical beneficial results in the department of Sick- Nursing when it is united with developed intelligence. Dr TH. BILLROTH. Vienna. PREFACE TO THE THIRD EDITION. Whilst the Second Edition of this book was a simple reprint of the First, it appeared desirable that some alteration should be made in this edition, the editing of which the author en- trusted to me. I would only refer to two additions by which the book has been enriched : one, the Appendix—” On the Structure and Functions of the Human Body,” by Dr Billroth; pre- viously, this was published separately, and was given to those who attended the “ Course on Nursing,” held yearly in the Rudolfiner Haus, Vienna; the other, the Illustrations of Bandaging as practised at these Courses. It was desirable to revise Chapters V. and VI. ; this duty was kindly undertaken by Dr Karl Bettelheim, Senior Physician at the Rudolfiner Haus. Dr R. GERSUNY. Vienna, September 1888. TRANSLATOR’S PREFACE. Co-existent with life is the possibility of pain. The intui- tive consciousness of this possibility is the chief safeguard of the higher organisms. Pain is the active expression of disease, whether that disease be induced within the organism itself, or whether it arise from external causes. Man desires immunity from suffering — in all ages he has striven to secure it, and much knowledge conducive to this end has been obtained. This century marks an eventful era in the history of therapeutics, and the Surgeon and the Physician are now able to achieve vastly more for the prevention and lessening of pain than was ever before possible — the results are universally beneficial. Everywhere the human organism is the same, is subject to like diseases and infirmities, and hence that which alleviates or overcomes these in one country is adapted to alleviate or overcome them in all. From Dr Billroth’s great experience and knowledge of the different methods employed in nursing the sick, he, like many other members of the medical profession, realized how little, comparatively, is known of the essential requirements of the sick-room ; he therefore wrote this book for the instruction and guidance of all interested in the care of the sick, stating therein with much clearness, the causes, nature, and symptoms of various diseases, and the main principles of good sick- nursing. From these instructions a mother will learn, not only what is necessary to the care of a sick member of her TRANSLATOR'S PREFACE. 17 family, but also the best means to adopt for the prevention of sickness and for the maintenance of health in the household. It is the skilled nurse who, with sure but gentle hand, changes the dressing of the sensitive patient without causing unnecessary pain : her very touch is soothing to him ; she shakes his pillows and places him in a comfortable position, so that he feels rested and refreshed after her ministrations; even her voice is music as she cheers him, whilst going about her duties with a silent step ; and her presence in the sick-room is like a ray of sunlight, the messenger of hope and health. In many homes the mission of the intelligent nurse is two- fold : first, to care for the sick ; second, to teach the close affinity existing between cleanliness and health, dirt and disease. The Portrait of Dr Billroth, by J. Lowy, K. u K. Hof-Photo- graph, Vienna, and the Illustration of “ The Billroth Bed- Crane,” &c., have been specially prepared for this Edition. With the kind permission of Miss Florence Nightingale, the Extracts from “Notes on Nursing”’ are given as quoted by Dr Billroth. I desire to express my best thanks to Fr. Goll, M.D., Professor of Pharmacology at the University of Zurich ; to Dr R. Gersuny, of Vienna; to W. Hills, Esq. (Messrs J. Bell & Co., Oxford Street) ; and to other very highly esteemed friends for their valuable assistance in preparing this Edition. J. BENTALL ENDEAN. Canterbury, September 21, 1890. B ‘ Obedience is the sacrifice of Angels.” Shakespeare. ‘ He holds no parley with unmanly fears ; Where duty bids, he confidently steers, Faces a thousand dangers at her call, And, trusting in his God, surmounts them all.” COWPER. INTRODUCTION. Sick-Nursing Must be Learnt. Qualifications of the Sick- Nurse : Inclination, Innate Vocation for Sick-Nursing ; Quiet Character; Special Talent, Gift of Observation; Love of Truth, Sense of Order, Reliability ; Pliancy, Pro- priety, Morality. Healthy Body. Greatest Cleanliness. Light Hand. Skill ; Care. Conduct of the Nurse in her Intercourse with Patients and their Friends : Reti- cence ; Quiet, Silent Activity. Nursing the Incurable; Nursing the Convalescent. High Claims upon the Nurse’s Calling. Schools for Female Nurses. ''Practice surpasses study ; But, if thou hast not learnt the -way, Then ivilt thou oft be led astray." T T E who helps others contributes to his own happiness. Many would like to enjoy such happiness, but do not know how to secure it. To be able to help the suffering is one of the noblest gifts possessed by man, but this gift must be developed to an art, knowledge must be combined with power, if a full and beneficent result is to be obtained. However much innate talent for helping others a man may possess, success can only be secured when he knows how to help. In the Care of the Sick much is gained from personal experience, and by aiming at that which is practical, but at best this is a roundabout groping after knowledge, and occasionally may injure the sufferer, whilst it leads, with infinite slowness, to the object desired ; in such a case quietness and certainty in working — a powerful means for awakening the confidence of the patient — will be very late in 20 THE CARE OF THE SICK attainment. This quietness and certainty can only be acquired by practice in nursing the sick; much, however, can be ex- plained by lectures and books ; the books serve for reference and for repeated reading, in order to fix in the memory what has been learnt. This is the aim of this book : it does not contain all that a qualified sick-nurse can and should know, but it contains The Main Principles to be observed in the Care of the Sick. It teaches what should be done under certain circum- stances; but how this is to be carried out in special cases, demands personal practical experience. Those who master these principles in their chief points know, not only how patients should be nursed, but how to practise sick-nursing successfully. It is the same with all knowledge and power. When practically exercising our calling we are in a position to supplement, from books, not only our knowledge, but our power to act, and not till then are we able, correctly and clearly, to realise what we have read or heard. Much may be said upon the qualifications necessary for sick-nursing ; I will, however, lay stress upon one point : the combination and training of various qualities in the same person are more conducive to success than a highly developed single quality. The doctors and patients who observe her in her work are the best judges whether or no a woman is fitted to discharge the duties of a nurse. In training for this difficult calling one of the first requisites is, a very strong inclination practically to help the sick. In her- self the nurse must realise an ever-present impulse to benefit the suffering, and must feel assured that her highest happiness consists in thus actively doing good. Whether this inclination is strong enough to overcome the many difficulties and painful sensations, the dangers even, that this calling entails, will be AT HOME AND IN THE HOSPITAL. 21 seen in practice. If she feels happier every day in this work, and daily overcomes its unpleasantness more easily, then she should cheerfully pass through her apprenticeship. But if she has deceived herself as to the strength of her inclination — and that may happen to the best — she should choose another calling. Women who quickly kindle to a glow in passionate excita- tion for the beautiful and the sublime, in whom sympathy is so strong that they experience the physical and mental pain of others in equal intensity, or imagine that they do, seldom qualify for the care of the sick, because, seeing the sufferings of others, they are crippled in their own thinking and doing. I have frequently experienced in war, that persons with very tender hearts could render no assistance, from pure sympathy with, and pity for, all the misery around them ; to see others feeling deeply with him may comfort the sufferer for a few moments, but he will be more thankful to those who help him. If women with such ardent sensitive natures can combine energy and self-control so as to compel themselves to master their feelings, still, more quiet natures having less to do in overcoming their feelings are better fitted for nursing the sick. The mental conditions of others not only influence us, but our dispositions likewise operate upon them: generally both are exercised unconsciously. The sick are much more suscep- tible and sensitive to the state of things around them than the healthy ; it is therefore evident that passionate, ardent natures, even when somewhat able to control themselves, work less pleasantly in the sick-room than those who are quiet, gentle, and patient. But there are also phlegmatic and indifferent people, slow to think and to act, who, from these very qualities, make the patient impatient, and finally become objectionable to him. Patients not only differ in their own 22 THE CARE OF THE SICK characters, but different diseases produce different conditions in them. Personal pleasure and displeasure, sympathy and antipathy of one towards another are called into action, and unconsciously influence the close intercourse entered into between patient and nurse. The nurse must never yield to these feelings’; in discharging the duties of her office she must rule, however difficult it may be in particular cases; the doctor will guard her from exacting demands on the part of patients, or their relatives. Sometimes a strict distinction is drawn between the prominent qualities of head and heart. True, a certain innate good-nature can exist, even in persons of limited intellect, as a high degree of astuteness can be combined with strong propensity to evil. Yet true and lasting kindness of heart always goes hand in hand with intelligent thinking and doing; this arises not only from occasional, transient excitation of sympathy, but from the deep inner conviction that our own happiness is indissolubly bound up with the happiness of our fellow- creatures, and that, by good deeds, we not only perfect and make ourselves happier, but we also most powerfully promote good in others — The moral system of the world is not without thee — It is only through thee. Believe it, and thou helpest to make it.” Fr. Th. Vjscher. I must again emphasise that, more or less, a special talent for sick-nursing must exist, if satisfactory results are to be secured. Natural inclination, kindness of heart, intelli- gence, quiet disposition must be combined with this talent: its characteristic is, a mostly unconscious gift of observation of what is occurring in, and to, man. This is quite a special gift — every one has eyes and ears, sense of smell, taste and feel- ing, and yet all are not equally conscious of things perceptible AT HOME AND IN THE HOSPITAL. 23 to the senses. In children, the differences in this respect are often very distinctly marked: some notice nothing, and re- member nothing, of various incidents happening around them ; others observe and remember until, occasionally, one is surprised to see that they had both observed and reflected upon many things which it had never been supposed they had noticed. This power of observation may be more or less innate, but, by exercise under proper instruction, it can be more and more developed : to interpret the wishes of the patient from his eyes, and to assist the doctor in his treat- ment, it is indispensable. The nurse must learn to observe the patient in the medical sense, so that she may report accurately what occurs between the medical visits ; this must be learnt at the bedside of the sick. Love of truth, sense of order, reliable fidelity in her calling, obedience to the medical instructions, pliability under peculiar, sometimes very uncomfortable, circumstances, are indispen- sable qualifications of a nurse — qualifications which must be acquired by self-training, although, depending upon the natural disposition, it may be more difficult to one than to another so to control and subordinate herself. Need I further add, that, under all circumstances, the professional nurse must maintain her respectability and morality ? I scarcely think so, for whoever possesses these qualifications, and takes pains to perfect them, must be respectable and moral. The personal qualities of heart and intellect which a good nurse should possess and cultivate, I have intentionally placed in the foreground, yet these can only be brought into full operation when existing in a healthy body, and that because the demands upon the physical powers of nurses are often very great: a certain wiry endurance is essential. With women, this is seldom assured before the twentieth year. 24 THE CARE OF THE SICK and rarely lasts more than from about fifteen to twenty years ; between twenty and forty years is the limit of age generally fixed for admission to Schools for Nurses. To maintain sound health is a duty of the nurse to herself, or she will soon be incapable for her calling. Nourishing food, never too much at a time, yet frequently in the day, and during night vigils, maintains the strength of the body continuously at uniform tension. A full meal, taken at once, such as the modern, feverishly excited professional life en- tails, in order not to interrupt the day’s work, is unsuitable for women ; besides, for some hours after the meal, it causes inertness and disinclination for work. Of the utmost importance to the nurse’s health, and equally to the patient’s, is the greatest cleanliness. Frequent baths, frequent change of linen, and thorough airing of her clothes the nurse must make her duty; the exhalations and perspiration of the body settle in the clothes, and are in- jurious to her, and offensive to the patient. Her hands must be washed before and after doing anything to the body of the patient ; especially the nails, mouth, teeth, ears, and head must be kept very clean. For a nurse, the greatest cleanliness is one of her best recommendations, as it is one of the most important means of protection against contagion, as much for the invalid, who can become infected from the nurse, as for the nurse, who may become infected from the patient. We now know that the greatest number of cases of infection have their origin, neither in the air nor in miasmata, but that the infectious matters adhere to the secretions of the patient ; that these often retain power to infect, even if dried, and when, as dust and dirt in the room, they adhere to the beds, to the patient’s clothes, and penetrate the skin, the mucous membranes, or the smaller or larger wounds of other persons. AT HOME AND IN THE HOSPITAL. 25 On this subject I shall give special rules for guidance in particular cases. Greater cleanliness is a principal reason why infectious diseases seldom spread so much in well-to-do families as in the dwellings of the poor ■, equally so, among those in easy circumstances, good nourishment and strengthening of the body are further reasons why infectious diseases mostly rtm their course lightly^ and more favourably. Therefore, the greatest cleanliness of the nurse must not be an object of vanity, nor an expedient to better please the patient — it is a protection for all, an indispensable requisite to sick-nursing in the hospital as in the palace. To maintain the health of the nurse, besides nourishing food, fresh air and exercise are essential. After night-watching she must have some hours of rest during the day, the best times for which will depend upon the circumstances in indi- vidual cases, as will also the question whether the patient requires a second sick-nurse during these intervals, or whether some person already in the house shall take the nurse’s place. If some women do wonderful things in repeated spells of night-watching, yet a woman, dedicating her whole life to the nurse’s calling, would soon undermine her health and be- come unfitted for her vocation if she paid little or no regard to it. On accepting the charge of a patient it is sometimes neces- sary to come to an understanding at once with his friends as to the hours of rest indispensable for the nurse, as well as to her food, for there are some injudicious people who will not see the need for such consideration. It is the duty of the Association sending the nurse, or of the doctor who engages her, to make the arrangements at the commencement of the nursing. 26 THE CARE OF THE SICK \ Some doctors and nurses claim to have such a light, gentle hand that they hurt the patients very little during operations, examinations, bandaging, &c. This would seem to be a ; physical quality, but when these famous hands are seen they are often neither specially fine nor soft. Then what i is the cause of it? It is the skilful, sure hand, guided | by experience and, care, which appears light and gentle ' to the patient. I admit that skilfulness in giving assistance and in domestic work is more natural to one woman than to another, yet, by energetic self-training and practice under ! suitable instruction, much skill can be acquired. The main : point always is, that, in everything she does, the nurse thinks ) of what she is doing so as not to hurt the patient — pur- j posely of course she would not. She must also know how | to alter the position of a patient, to put on a poultice, to j give an injection, to apply a dressing without giving him j pain ; she may neither proceed first one way and then ! another in each particular case, nor ignorantly grasp him here j or there. This excites and makes him discontented and cross ; j no patient will knowingly allow experiments to be made upon him; unavoidable pain patients will bear better if they are previously told and assured that it is necessary to their re- covery but that it cannot be done without quick, transitory pain. If a patient be hurt unexpectedly he will be frightened and will scream, but if prepared for a momentary sense of keen pain, then, supposing he has been dealt with firmly but gently, and the object is gained, he will often say, “Well, it was not so severe as I had expected.” Many nurses exaggerate the care necessary in taking hold of a patient, and use the finger-tips only instead of the whole hand. For instance, if the nurse will raise him in the bed by grasping both his shoulders from in front, and lays hold of AT HOME AND IN THE HOSPITAL. 27 him with her finger-tips only, she must dig these into his flesh in order to lift the body, and thus she must bear hard upon the patient, — whilst grasping with the whole hand causes no pain. Something must be said of the miduci of the nurse in her intercourse with the patient and his friends. This intercourse is easiest with those who are seriously ill — they are mostly unconscious, or are delirious. Then she punctually and noiselessly fulfils the doctor’s orders, and observes, and takes note of all changes that occur in the patient in order to report them to the doctor. Her duty is far more difficult with those who are recover- ing (the convalescent), or with patients suffering from a long continuing (chronic) disease, at times feeling tolerably well, and yet requiring much assistance. In private houses such patients will often have their own nurse, specially where there is no one in the family who can or will undertake this care. However various the characters of men may be, the sick man thinks above all things, nay, almost exclusively, about himself and his illness. If he has become accustomed to his nurse and places confidence in her, then, sooner or later, he will be communicative, feeling it urgently necessary to speak of himself and his ailments. He will daily put innumerable questions, and tell her all sorts of things about his most private family affairs. If feeling weak and sleeping little, he will be excited, cross, and violent, even rude. He will cry and look despondent, will complain of the nurse, of the doctors, of the whole human race, and may fall into a rage. If feeling better, then perhaps he will praise everything just as extravagantly, will find all things beautiful, and will pour out his heart in expressions of gratitude. The line of conduct to be pursued by the nurse in these 28 THE CARE OF THE SICK varying moods is extremely difficult, and experience alone will teach her what to do ; above all things she must guard against curiosity and loquacity. Reticence, and quiet, silent, unremitting fuljibnent of her calling is her duty. If the patient wishes to speak his mind freely, she should quietly and sym- pathisingly listen ; she must not gossip about what she has heard, but must quickly forget all that did not relate to the illness. Whilst meeting the patient in a friendly and helpful manner, she must yet guard against becoming too intimate with him, lest she should lose his respect and he cease to obey her. For some patients it is beneficial to change nurses, as the best nurse is liable to weary from monotony in the care of a case lasting for weeks, or even months. Patients too, long confined to bed, sometimes desire a change of both nurse and doctor ; they long to break the everlasting mono- tony ; they hope for improvement from change, from almost anything different, even if they soon weary of it. But the nurse must discountenance in the patient any rising mistrust of the doctor ; on the contrary, she should increase his con- fidence to the best of her ability. No worse service can be rendered to a patient than to make him suspicious of his medical attendant. It is pardonable if, from very long- continued illness, he comes to think the doctor is not treating him properly. Medical science is not omnipotent, although most patients believe it to be so ; no patient will readily admit that his disease was born in him — each considers himself normally healthy — it was only an accident, or negligence, or wrong treatment that made him ill. Many believe that they know the cause of their disease, even in cases where medical science for centuries has searched in vain. It is innate in man, as in the higher animals, to recognise cause and effect in all occurrences perceived AT HOME AND IN THE HOSPITAL. 29 by them. Now where a man observes a result the cause of which he does not know, he prefers to invent a cause rather than admit his ignorance of why this or that has happened. So with man’s judgment on diseases, — each must have a cause. When healthy, it is conceivable that we cannot always recognise these causes, but if one becomes ill himself, this power of renunciation forsakes him. He broods so long over it that at last he believes he has found a cause ; even a fable quiets him like a child; and if it is extraordinary in addition, he is consoled by the semblance of truth it may contain. In such circumstances little contradiction should be given. Sick people should not be contended with, unless absolutely necessary; no scientific lectures should be given about their illness ; they believe only what they deem probable, and will only be charmed by instruction that confirms them in their own ideas. Generally no invalid is of opinion that his is an incu- rable disease. He knows that there are such diseases, for he has seen friends and relatives succumb to them ; but in his own case he seeks and finds the causes in incidental things, and not in the incurability of the disease. This is a happy thing for these patients ; they hope to the last moment— this hope should not be dimmed ; they deceive themselves as to their own condition, and their sanguine ideas should not be dispelled. In such cases both nurse and doctor are often placed in a difficult position. The patient presses to know the whole truth, and says, “ he is prepared for everything.” But this may not be quite believed ; he deceives himself as to his degree of strength to hear the worst, and it becomes a duty to give comfort and ease of mind by sustaining the patient’s hopes, although contrary to one’s own convictions. When we cannot cure we should alleviate suffering as much 3° THE CARE OF THE SICK as possible. Hope is the best palliative, is balm to the afflicted heart, is comfort to the despairing soul. Yet I must repeat, it must never be forgotten that the patient thinks above all of himself and of his disease. It wounds him if his complaints, or the observations he has made, or believes he has made, upon himself, and which he considers very important, are disregarded : they may be quite immaterial to the treatment of the disease, but this he must never be allowed to notice. Every man looks at the world from him- self, and considers himself, as it were, the centre around which all things revolve : if anything happen to him, then it must be something peculiar. I have always found patients unpleasantly affected when told that their disease is quite ordinary, one that has been seen a thousand times, its treat- ment proceeding according to accepted rules. Then it seems to the patient that he is like a cypher among a thousand others, and he fears his case will be slightly attended to. He wishes to be singular, his disease, even if common, with him should run its course exceptionally. On one hand his vanity is flattered, on the other, he thereby expects to receive greater attention from the doctors and nurses. These ideas, which are agreeable to him, should not be dispelled. The nurse, therefore, must never dilate upon her experiences, though she may say she has nursed similar cases ; but she must never say that these cases ran their course unfavourably; and if the patient speak of some who died from disease similar to his, then she may tell him that most probably the cases were different, — with him it will be otherwise. By degrees she becomes just as inventive in soothing replies as the patient is in his enquiries. These few hints point to the most difficult positions in which nurses may be placed by patients ; much is to be AT HOME AND IN THE HOSPITAL. 31 learnt from experience at the bedside. When no longer able to help herself she must ask the doctor for advice, so as not to contradict his statements. Sick people are mostly distrustful, and become all the more so if they are con- tradicted, or think that they are ; then the idea is seized that their ailment is not correctly understood, and consequently will not be treated properly. In such difficult circumstances I advise the nurse to act as she would wish to be treated were she in the position of the patient — “ Would’st know thyself? Behold how others act ! Would’st others know ? Look into thine own heart ! ” Schiller. We will now turn from this sad picture of the care of the incurable ! Such care is a sacred duty, and not so unthankful as at the first glance it would seem to be, because the sick are grateful for every alleviatioh, even if it be transitory. Severe, protracted suffering compels even the strongest and most de- fiant gradually to contentment. It is certainly much more gratifying when, after days or weeks of great anxiety, re- covery begins and advances daily towards perfect health ! The greater the anxiety that had been endured, so much the joy of the nurse is greater in having contributed her share to the happy result. The days and the nights seemed endless and full of pain : restlessly the patient threw himself about, pursued by fevered fancies. How flushed his face, how heavy his breathing, how eagerly the parched lips sipped the prof- fered water ! How dull were his eyes in the morning, after the excited brain had been constrained by medicaments into a short stupefied sleep ! How anxiously the mother looked upon her sick and only son, previously so blooming ! A hundred times her glance enquires. Will he live? How anxious was the wife for her husband, the support and head of 32 THE CARE OF THE SICK the family ! Silently she crept away, fatigued, and sank upon the couch, overpowered by sleep ; then starting up anew, with pale features, shivering, almost numb with pain, she sees the morning dawn, and still no ray of hope, no improve- ment ! At last, the aspect of the disease changes, the fever lessens, the nights become more quiet, a natural re- freshing sleep spreads its soft wings over the patient, and he wakes as if new born, pale and weak indeed, but with the eye clear, the features again in their former healthy form, the voice still faint, yet already it has regained its old loved tones ! And day by day the improvement continues. Like a reprieve, the tidings run through the house. Recovery ! Preservation ! But now 7/iuch must be done to prevent relapse^ — the food must be carefully chosen to strengthen and revive him. All rejoice as further pro- gress is recorded. Only by degrees he realises how ill he has been ; as yet he has no other wish than to eat and sleep ; little by little he takes interest in what is going on around him ; the past is like a lengthened dream, the details of which he only gradually recollects. Now comes the first attempt to leave his bed, to stand, to walk again ; herein he rejoices just as much as those around him. Although the attempt does not succeed so well as was hoped, for he soon feels exhausted, soon wishes to return to his bed, yet the next day he is better, and on the third is better still. At last he takes his first walk out of doors, and his strength increases rapidly from day to day. Then the nurse takes her departure, or the patient leaves the hospital. Many proofs of gratitude on the part of the patient and relatives will not be wanting, but the nurse has herself acquired the best reward : the consciousness of duty faithfully fulfilled^ the blissful feeling of having benefited a human being, AT HOME AND IN THE HOSPITAL. 33 of having contributed to his recovery. T. he Holy Scriptures say, “It is more blessed to give than to receive” (Acts xx. 35). 