initial commit of ebook 6361HEADmain

5 files changed, 3349 insertions, 0 deletions

diff --git a/.gitattributes b/.gitattributes
new file mode 100644
index 0000000..6833f05
--- /dev/null
+++ b/.gitattributes
@@ -0,0 +1,3 @@
+* text=auto
+*.txt text
+*.md text
diff --git a/6361.txt b/6361.txt
new file mode 100644
index 0000000..2a9f857
--- /dev/null
+++ b/6361.txt
@@ -0,0 +1,3333 @@
+Project Gutenberg's Making Good On Private Duty, by Harriet Camp Lounsbery
+
+Copyright laws are changing all over the world. Be sure to check the
+copyright laws for your country before downloading or redistributing
+this or any other Project Gutenberg eBook.
+
+This header should be the first thing seen when viewing this Project
+Gutenberg file.  Please do not remove it.  Do not change or edit the
+header without written permission.
+
+Please read the "legal small print," and other information about the
+eBook and Project Gutenberg at the bottom of this file.  Included is
+important information about your specific rights and restrictions in
+how the file may be used.  You can also find out about how to make a
+donation to Project Gutenberg, and how to get involved.
+
+
+**Welcome To The World of Free Plain Vanilla Electronic Texts**
+
+**eBooks Readable By Both Humans and By Computers, Since 1971**
+
+*****These eBooks Were Prepared By Thousands of Volunteers!*****
+
+
+Title: Making Good On Private Duty
+
+Author: Harriet Camp Lounsbery
+
+Release Date: August, 2004 [EBook #
+]
+[Yes, we are more than one year ahead of schedule]
+[This file was first posted on December 1, 2002]
+
+Edition: 10
+
+Language: English
+
+Character set encoding: ASCII
+
+*** START OF THE PROJECT GUTENBERG EBOOK MAKING GOOD ON PRIVATE DUTY ***
+
+
+
+
+Produced by Ralph Zimmerman, Charles Franks
+and the Online Distributed Proofreading Team.
+
+
+
+
+MAKING GOOD ON PRIVATE DUTY
+
+MAKING GOOD ON PRIVATE DUTY
+
+PRACTICAL HINTS TO GRADUATE NURSES
+
+BY
+
+HARRIET CAMP LOUNSBERY, R.N.
+
+PRESIDENT WEST VIRGINIA STATE NURSES' ASSOCIATION SANITARY SCHOOL
+INSPECTOR FOR CHARLESTON INDEPENDENT SCHOOL DISTRICT
+
+"Not to be ministered unto, but to minister"
+
+
+
+
+PREFACE
+
+
+Though technic is constantly changing, methods improving, and the
+teaching in our schools grows better and more comprehensive, the
+old problems in private work are ever to be faced, and still the
+young sister in our nursing world needs to be counselled, guided
+and helped. It is for these young private duty nurses that this
+book has been written.
+
+For six years I went up and down one of our large cities doing
+private nursing, and I can remember, as if it were but yesterday,
+the curious little sinking of the heart I used to feel, as I
+mounted the steps of a house where there was a new patient needing
+my care. "Would I do everything right?" "Could I please the
+patient and the friends?" "Would the doctor be satisfied with my
+efforts?" "How would I feel when I was leaving?" "Encouraged or
+hopeless?" "Happy or sad?" A strange house looks so forbidding,
+"would this one ever look friendly?" There is time, while walking
+up the steps, for these and many more such thoughts to crowd into
+the nurse's mind. Once in the presence of the patient, however,
+all this quickly changes, and action puts all wondering and doubt
+to flight.
+
+The "hints" here given are the fruit of my own experience and that
+of the graduates of the school of which I was the superintendent.
+Many long talks we had, when they felt the need of coming back to
+their hospital home for advice and comfort. It is an earnest wish
+to help the young graduate over the intricate paths that the
+inexperienced nurse must often tread that has led me to revise
+some early contributions [Footnote: Printed by permission of the
+_Trained Nurse_.] to the _Trained Nurse_ and write a few
+new ones, which have within the past year appeared in the
+_American Journal of Nursing_.
+
+In the chapter "Hints to the Obstetrical Nurse," there is little
+or nothing that is commonly taught in the class-room.
+
+All of that is so well done, repetition here would be tiresome.
+All the asepsis is familiar to every graduate. She knows how to
+sterilize any and every thing, but sometimes she does not know the
+best way to wash and dry the baby's little shirts or knitted
+shawls. Sometimes she will not realize that if the layette cannot
+be purchased at a store, old table linen makes the best diapers
+for the newborn baby, and that his pillowcase should not have
+embroidery in the center.
+
+I wish in this part to give the nurse such hints that she may be
+able to help any woman who wishes to prepare for her confinement.
+I have been asked so many times to tell a young expectant mother
+just _what_ to get, that I have made for convenience as full
+a list as is necessary for any baby or mother, with some hints as
+to the washing of the baby. The rest it is expected every nurse
+who graduates from a training-school would know. The table for
+calculating an expectant confinement was cut from a medical paper
+and given me by a physician some years ago. He did not know who
+wrote it, nor do I, but he always used it, and I have found it
+most accurate.
+
+The recipes I have given are, I know, reliable, having all been
+tested many times. Most of the articles of food every nurse has
+probably prepared, but exact proportions have a dreadful way of
+slipping out of one's memory. Whether it is a pint of milk or a
+quart that must be mixed with two eggs for a custard might not
+seem much of a problem to a housekeeper, but to a nurse who has
+perhaps not made a custard for a year it might carry many
+difficulties.
+
+I have tried to help in this most important part of a nurse's
+duty, and not only as to the food served the patient, but the
+_manner_ of serving it, which last is truly to a sick person
+of as much importance as the food itself. The few leaves I have
+left blank are for such additional recipes as every nurse will
+gather as she goes from house to house. Any cook will be glad to
+give some hints as to how she does this or that, and no nurse
+should be too proud to learn from the cook, or anybody else. I
+shall never forget the fat little Irish woman who taught me to
+make clam broth, or how much pride she took in my first success.
+To ask the family cook for advice is sometimes good policy; she is
+often so ready to resent any extra work caused by the sickness or
+the nurse, it pays well to conciliate her, by asking for her aid
+or counsel. To feel that she can teach the "Trained Nurse" will
+often make a friend of the cook, and this will make things
+pleasanter all around. It is with the hope that these homely and
+perhaps somewhat old-fashioned hints may be of real service, that
+this little book is sent forth to do what good it may to those who
+are setting out on their professional careers. It is ever to the
+young that we elders look, knowing, as Mrs. Isabel Hampton Robb
+has truly said, "Work shall be lifted from our hands and carried
+on to loftier ideals and higher aims by the strong young hands,
+hearts and brains of future nurses." H. C. L.
+
+Charleston, W. Va.
+
+
+
+
+CONTENTS
+
+
+CHAPTER
+
+I. THE NURSE AND HER PATIENT
+
+II. THE NURSE AND THE DOCTOR
+
+III. THE NURSE HERSELF
+
+IV. THE NURSE AND HER PATIENT'S FAMILY, FRIENDS AND SERVANTS
+
+V. GENERAL REMARKS ON FOODS AND FEEDING
+
+VI. THE NURSE AS RELATING TO HER TRAINING SCHOOL AND TO HER FELLOW
+NURSES
+
+VII. WHY DO NURSES COMPLAIN?
+
+VIII. THE NURSE AS A TEACHER
+
+IX. CONVALESCENCE
+
+X. HOW SHALL A NURSE OCCUPY HER DAYS OF WAITING?
+
+XI. SOME HINTS FOR THE OBSTETRICAL NURSE
+
+XII. AS TO WASHING THE BABY
+
+XIII. THE VALLEY OF THE SHADOW
+
+
+
+
+I
+
+THE NURSE AND HER PATIENT
+
+
+You may think it unnecessary for me to tell you any more about
+"the patient." You will say, perhaps: "Have I had all this
+training, and must I yet be told how to treat a patient?" I answer
+that you have been taught how to watch the progress of disease,
+how to follow intelligently the doctor's orders, also certain
+manual arts, your proficiency in which is unquestionably most
+necessary, but there is much more comprehended in the meaning of
+the term "a good nurse" than this. How often do we hear stories of
+nurses who were good--_but_--who were skillful--_but_--
+and after the _but_ comes a long list of such faults as do
+not show so much in hospital life, where the routine and the many
+rules and the constant supervision make them less likely to become
+prominent. "She bangs the doors." "She breaks the fine china."
+"She wears heavy shoes," or "She talks too much," or "She is
+pretty and spends too much time over her front hair"--but why go
+on? You have all heard such tales--_ad nauseam_, and if you
+are wise, you will set up a sign-post against every one of these
+snares into which your sister nurses have fallen, and on this you
+will print in large, clear letters: "Danger! Walking on this place
+forbidden." So much by way of apology for treating you once more
+to a lecture on "the patient."
+
+The relation between nurse and patient should, from the first, be
+a more than amicable one. You have come to bestow the priceless
+blessing of unwearied, skillful care upon one who should
+thankfully receive it, and believe me, if you do not go to your
+patient with a feeling of thankfulness to God for allowing you to
+assume such a sacred trust as the care of a human life, you are in
+no condition to undertake the work. Your nursing should be, in a
+way, an exponent of your own spiritual state; looking at it in its
+highest aspect, an outward and visible sign of an inward and
+spiritual grace.
+
+In the first place, then, you must be in entire sympathy with the
+sick one--and here do not mistake me--by sympathy I do not mean
+sentimentalism. The two emotions are as far asunder as the poles.
+Sympathy, then, you must have, and if you do not intuitively feel
+it, let me tell you what to do to rouse your dormant feelings. Try
+earnestly to put yourself in the patient's place. Has she had an
+operation of some kind, and you have all night been trying to keep
+her quiet on her back, and she has been begging you to let her
+turn "never so little?" When you go to lie down, and have,
+perhaps, a backache, and feel tired, instead of settling yourself
+in the most comfortable position you can, lie straight and square
+on your back and say to yourself, "Now I can't turn over," and
+imagine you have by your side a nurse who will not let you turn.
+You will find out in the course of an hour that your patient has
+had a good excuse for all her complaints, and the next night you
+will know just where to slip your hand in the hollow of the back
+or under the shoulders to give a little ease. The patient will
+profit by such exercise on the part of the nurse, and your
+sympathies will be quickened. Never forget that _the patient is
+sick_, and you are _not_. You can, you must be firm in what
+you know is for your patient's best good, but you must never
+be dictatorial or argumentative. It is hard, I know, to bear with
+all the foolish, unreasonable whims of sick people, but if you are
+true nurses you will do it. There are, however, several consoling
+thoughts which have always helped me, and which I will tell you.
+In the first place, always remember, as I said before, that the
+sick one _is_ sick, and on that ground you can overlook much.
+In the second place, remember that it will not last long. A few
+days or weeks will surely bring a change. She cannot, in the
+nature of disease, remain for long in the very trying stage,
+unless indeed she have some kind of mania, and of course if that
+is the case, you need pay no attention to her whims. If she says
+white is black, let it go. It does not make it so to have her say
+so, but if you argue the point, and bring all your wisdom to bear
+upon your demonstration, you may bring her pulse and temperature
+up to a point that will do her a real injury.
+
+_Tact_, as you know, is worth everything to you, and by it
+you will win your way to all hearts. Try then to feel as the
+patient does, and you will know by instinct how to treat her, and
+will, perhaps, be often rewarded for some little deed by the
+pleased surprise with which she will say, "How did you know I
+wanted it done?" You need not tell her how you knew, but you may
+be sure she will appreciate you all the more for your prescient
+thoughtfulness. Her pillows may be flat and hot, her hair
+uncomfortable, her under sheet wrinkled or untucked from the
+bottom; all these and a dozen more little things can be arranged
+so easily, and they conduce so much to the sick one's comfort when
+done, that you must ever have them in your mind.
+
+Be most careful also as to your patient's belongings, her top
+drawer, her various boxes, and her linen closet. You must keep all
+these things just as she did. You may think it a very foolish
+thing for her to have three piles of handkerchiefs, each of a
+different age, or degree of fineness, but if that is her way, she
+will be better satisfied if she knows you will not lay a fine
+handkerchief over a more common one. So keep them as carefully
+divided as if they were the two parts of a Seidlitz powder.
+
+Hang her clothes up carefully whenever she goes back to bed, be it
+once or oftener during the day. Separate them and hang them up;
+don't pick all up together and put them over a chair. Put her
+shoes away, lay the stockings on a shelf or put them inside the
+shoes. Fold her pretty shawl or kimono and lay it in a drawer. Let
+her see that you know a good thing, and know how to take care of
+it.
+
+Put away fine china or glass and bric-a-brac, if she is very ill,
+and you need space for necessary glasses or other articles. It
+will be a pleasant way of beguiling the tedium of some long day in
+her convalescence to bring forth and arrange them in their
+accustomed places. Be careful of books, table-covers, and all the
+articles of luxury and beauty you will find in many of our city
+houses. Remember that these things belong to some one else, though
+you are for the present custodian, and think how provoked you
+would feel if some stranger should come to your home, and, even if
+she did nurse you back to health, she left many nicked plates,
+broken vases and handleless cups behind her. I think you would not
+want her to nurse you again.
+
+I saw recently in an English magazine devoted to nursing, a very
+clever article on "Talk." The writer, a nurse, thought subjects
+were scarce. She says: "We must not talk to the patient about her
+own complaint, that would make her morbid; or about the doctor,
+for that would be gossip; or the hospital, for hospitals are full
+of horrors; or the other nurses, for that might lead to talking
+scandal; or about other patients, for that would be betrayal of
+confidence. Now what _are_ you to talk about when a patient
+is well enough to talk, and your talking to her will not hurt her
+(but on this point be very sure before you air your eloquence)? It
+is indeed quite a question, and the nurse must often use all her
+ingenuity to keep the patient to the right subjects, for even
+patients, though they hold it so reprehensible in a nurse to talk
+gossip, do not disdain to serve up their neighbors occasionally to
+the nurse, with some very highly seasoned scandal sauce, and here
+the honor of the nurse must come into play; let her forget it if
+possible, as woe will betide the poor girl if in her next place
+she unwittingly lets out any of the secrets she has heard in these
+long talks. Try then to steer clear of the neighbors. If your
+patient be a cultivated person, and you yourself know anything
+about books, you have a never-failing topic. All the latest books,
+the famous books, the most entertaining books, and if you can read
+aloud and the patient likes to hear you, read to her, and it will
+do both good--only be sure not to tire her by reading too much at
+one time. Talk of interesting places you have visited and she will
+do the same, of pictures you have seen, and last, but not least,
+you can talk about clothes. Generally the first serious piece of
+business a convalescent concerns herself about is the purchase and
+making of some new clothes. She wants something new and fresh, and
+if you can give her any new ideas on the subject or tell her of
+any pretty materials you have seen in the shop windows, you will
+prove as entertaining as if you talked on any of the forbidden
+topics, and many times more useful."
+
+I would like, in closing this chapter, to say a word as to reading
+the daily papers. If your patient is a woman, she will want to
+know just about what you, yourself, would be interested in, and
+this is very easy; but if your patient is a man, it is harder to
+know what he will want; politics, the money market, etc., which
+most women skip over. If then your patient is a man, commence on
+the first page and read slowly the headings of the news items,
+when one strikes him, as desirable to hear, he will tell you to
+read it; when you get through the news you may turn to the
+editorial page and do the same there. Unless you know your patient
+very well do not attempt to enlighten him as to the stock market
+quotations, for it is, I suppose, well nigh impossible for an
+ordinary woman to read them so that a man will understand her. He
+will probably laugh over your well meant endeavor, and ask you to
+"kindly let him look at the paper," when he will in a moment find
+out what you have been trying to say.
+
+
+
+
+II
+
+THE NURSE AND THE DOCTOR
+
+
+I suppose no nurse goes through a training school without being
+duly impressed by all the doctors on the staff of lecturers that
+they, the doctors, are the generals of the campaign. She and her
+fellows are the aids, and that she will be kind enough to remember
+this fact, and not make suggestions to him, the doctor, or give
+him the fruits of her ripe experience of three years in a
+hospital, and more or less time, as may be, since she has
+graduated. But though this I think you all know, there are some
+points of your connections with the doctor which may not be quite
+so clear.
+
+In the first place, then, remember that you are his _aid,_
+you are to help him in every way you can, you are never to work
+against him, never weaken the patient's confidence in him. If you
+do not understand why he does thus and so, ask for an explanation,
+if you know him pretty well, and if your questions are reasonable
+ones, and intelligently put, he will be glad to answer you, and
+explain all you wish explained; but if you do not know the reason
+of a certain order, and, moreover, if he will not tell you, do not
+assume that he does not know, or that he is cross; it may be some
+very uncertain, delicate experiment is being tried, and all he
+wants you to do is to tell him, with a free unbiased mind, what
+you see. Always, however, be loyal to him with the patient. When
+you are asked a thousand questions as to, "Why doesn't the doctor
+do this, or why does he do that?" you can always say that he does
+it, or does it not, for the patient's best good, of that you are
+assured, and they must be also.
+
+You collect the facts and put them in an orderly way before the
+doctor; upon your observations and reports he bases his theories
+of the disease in many cases. You can see what perfect faith he
+must have in you, and how true you must be to him in order to
+secure your patient's best good. I have often heard doctors say,
+when speaking of a favorite nurse, as if it was the only virtue
+worth mentioning: "I am perfectly certain that when I am not
+present she will _faithfully_ carry out my orders." Entire
+faithfulness takes precedence, I think, and deservedly so. Your
+accomplishments may be many, but if you have not this faithfulness,
+this obedience to the doctor as a rudder to the ship of your
+professional character, no matter how great may be the load
+of learning and accomplishments and good intentions, your
+self-will and vanity will bring you to the rocks where ruin is
+inevitable.
+
+Do not fear losing your own individuality and independence. "He
+who obeys well, governs well," is a very old, and a very true
+saying, and your responsibilities will never cease. The more
+faithful you are to orders, the more trust and confidence will be
+reposed in you. You will have not only your patient, but the
+entire family looking to you for directions, for, upon your
+faithfulness, and the tact with which you administer your
+authority, will depend much of your success as nurses.
+
+Be careful not to sever your relations with any patient unless
+your doctor knows all about it. Never leave your charge, no matter
+how urgent the reason may be, unless you tell him. You may be
+sick, or the place may be unsuited to you, or you to the place,
+and you may know that it is best for you to go. But speak first to
+the doctor, tell him candidly why you wish to go, and take counsel
+of him how you should act. If he tells you you may go, and you
+know that your place must be filled, do not offer as your
+substitute your best friend, or anyone else. If he wishes your
+counsel he will ask, and then you may tell him of anyone you think
+will suit the position, but do not offer your friend, as he may
+have some favorite of his own to put in your place. Of course the
+patient or her friends must know about the contemplated change--
+that I take for granted. Having consulted the doctor, will make
+everything satisfactory to the most careful practitioner. So, as
+said before, never go away from your patient, leaving in your
+place a nurse whom the doctor does not know. He has, in most
+cases, selected you for his patient, and he wants you, you may not
+be all he wishes you were, but still such as you are, _there_
+you are, he knows what you can and what you cannot do; and it is a
+great piece of impertinence for a nurse to go away unknown to the
+doctor, leaving a stranger in her place. The consequence, so far
+as he is concerned, will most likely be to have her name crossed
+off his list as "unreliable"--so be careful.
+
+As to your records, keep them faithfully; the doctor usually looks
+them over very carefully, but sometimes you find one who passes
+them over in a lofty manner, rather trying when you take such
+pains with them. You may conclude that it is not necessary to keep
+them accurately in such a case, but this same doctor may ask you
+some day how long ago it was that the patient's temperature took
+such a sudden rise, or how many days it is since she first had
+solid food, and if you have accurately kept and carefully
+preserved your records, you can tell without a moment's
+hesitation. It is better, more business-like, and every way to be
+commended, that the nurse should keep, and be exceedingly
+particular about these records. If the doctor will write his
+orders on the fresh daily record at his morning visit, it is a
+great help to the nurse, but very often he is in a hurry and you
+must write them yourself. If you have to do this, take your record
+and write as he tells you, _when_ he tells you. If the orders
+are at all intricate it is your only way of being absolutely sure
+you have everything correct. It is a protection to you also, if
+the family are inclined to criticise.
+
+A nice little point for you to remember is always to leave the
+doctor _alone_ with the patient for a few moments, if it is
+at all possible, at each visit, Wait until he has asked all the
+questions he wishes, or until you have told him all that is
+necessary to tell before the patient, and then on some errand,
+real or imaginary, leave the room. Of course, if the patient is
+desperately ill, you cannot do this, nor will it then be
+necessary.
+
+It is a good plan to wait for the doctor at the head of the
+stairs, or at the foot, if you are likely to be over-heard, and
+tell him there all you could not say before the patient as to her
+condition, etc. He likewise may have something to say,--some
+final instruction to give, some caution he would not wish the
+patient to know of. This is also the time to speak about yourself
+if you are sick or tired, or unhappy in your position. Perhaps
+neither of you have anything to say, and a friendly nod and a
+"patient is doing nicely, nurse," will send you back to the sick-
+room feeling that your work is appreciated, which always goes a
+long way toward making the hard places easy. Your patients may be
+very curious as to what you have to say to the doctor, but you can
+readily and truly tell them that there are many things you have to
+say to him, that would be hard for you to say before them, and
+hard for them to hear too, and these are things you arrange
+outside.
+
+Always be sure to have on a convenient table, if your doctor be of
+a homoeopathic school, a little covered tray, and on it two
+glasses, clean, and turned upside down to keep them from dust,
+teaspoons and covers for the glasses, also a small pitcher of
+fresh water. Many doctors of the old school also use some
+medicines in water, so it is best to have glasses always at hand.
+
+Do not sit down when the doctor is making his professional call,
+unless he or the patient requests it. He will probably sit at the
+side of the bed, your place is at or near the foot. If the doctor
+knows the patient well, as a friend, and is inclined to stay a
+long time, chatting, you can go quietly to another part of the
+room, and take up your work or reading, but be sure the doctor has
+finished asking you questions before you go.
+
+Use sparingly technical terms. If your patient's feet are
+oedematous, tell the doctor they are much swollen; if he
+_ask_ if they are oedematous tell him "yes," but do not
+volunteer to name the peculiar kind of swelling. If the abdomen is
+tympanitic, tell him it seems much distended; and if he questions
+much further, answer the questions fully and intelligently. If
+your patient has the symptoms of phlebitis, tell him of the rise
+of temperature, the swelling of the leg, the tenderness along the
+course of the vein, and he will know that you know and appreciate
+the gravity of the disease; but be sure you do not attempt to give
+the symptoms a name, that is not your place.
+
+I would have you be very careful as to what instruments you carry;
+have them of the best. Let your thermometer be of the very best
+make.
+
+There is nothing more trying in a small way than to have your
+thermometer doubted, and if you _know_ it is the best the
+market affords, if you take it to the instrument maker and have it
+tested once in a while, you need not fear, when you find an
+unusual temperature, and report it to the doctor, and he quietly
+proceeds to test your thermometer by his, which of course is
+always correct. Be sure that your hypodermic syringe will work; if
+the piston slips loosely after much using of brandy, aromatic
+ammonia, etc., take it to be repaired, and see that the needles
+are sharp, they become dulled very quickly; keep also the tiny
+wires pushed through them. It is just as well to keep this syringe
+in the room, its little case is very small and unobtrusive, and if
+you keep it near your thermometer in some safe, handy place, you
+will have it when some unforeseen emergency arises, and you do not
+want to lose time going to your room for it.
+
+
+
+
+III
+
+THE NURSE HERSELF
+
+
+It is just as necessary for the nurse to be careful of herself as
+of the patient, though her care must be manifested in a far
+different way. Always remember that to do really good work you
+must have really good tools. No man owning, and intelligently
+working a valuable machine, would keep it going at its highest
+speed all the time. He takes care of it, keeps it clean, renews
+defective parts, oils it; and then he expects it to run for so
+many hours, and to run well,--to do its work thoroughly. But with
+all his keeping it in order he does not make it work night and day
+for weeks or months. Such folly is never heard of in an engineer;
+but with us human beings, who own and manage a far more wonderful
+machine than any steam engine, we hear of it often, and always,
+_always_ the tale winds up with the inevitable catastrophe.
+The business man develops paresis, the clergyman loses his voice
+or his eyes, the nurse contracts some disease that incapacitates
+her for work, in every case mother Nature makes the careless or
+ignorant owner of the wonderful machine pay the penalty of the
+misuse. It does not matter to Nature what the reason is for our
+breaking the great laws; we can kill ourselves with philanthropic
+work just as surely as with over indulgence. One trouble is, that
+it does not always _kill._ A paralytic may live for years, so
+does a man with paresis. When the wonderful God-given machine
+works badly, or stops entirely, we look on, and sometimes wonder
+why it is that those who are so helpful, such fine examples of
+courage, of skill, of virtue, so hardly to be spared, are the ones
+to be taken away. Do _we_ wonder, we who are nurses? Do we
+not know what did it? Ah! yes--we know, we know, that such and
+such a nurse was tired out when she went to still another case--
+and when we heard she herself was ill we were not slow to say,
+"Foolish girl! Did she suppose she was made of wrought iron and
+sole leather?" But will _we_ take heed, and not do likewise,
+or will we wonder, with the unthinking ones, why it is that the
+good, useful people are always taken away? Do not deceive
+yourselves; they are not "taken away," they take themselves away,
+for God will not reverse His wise laws because we (no matter how
+good we are) act in defiance of them.
+
+Please remember I am only speaking now to the good nurses--the
+enthusiastic ones,--poor nurses, lazy nurses have no temptation to
+overwork themselves. They may die of indigestion, but they will
+not die of exhaustion.
+
+It seems to you so natural for others to be sick. You have seen
+the sick by scores in the hospital, and have waited on them, felt
+sorry for them, sympathized with them; but have you thought that
+it was within the bounds of possibility that _you_ could ever
+come into such a pitiable condition? You go from house to house in
+your private nursing, always you find the sick, and it seems
+natural, quite the proper thing. You care for them, they get well,
+or die--and on you go to the next--but reflect on what made them
+sick, and though you _know_ you are made of like flesh and
+blood, do not conduct yourself as if you were not. "Oh, yes" (how
+often have I heard it said), "I know she worked too hard, but I am
+so strong, you never heard _me_ complain; I can nurse a fever
+case for two weeks and never go out of doors for air or exercise."
+Is it not foolish? Is it not wrong for any sensible woman to talk
+thus?
+
+Now listen to some few practical hints as to how to keep
+yourselves in good working order. In the first place, then, never
+go to a case unless you are feeling well. It is far wiser, as far
+as you are concerned, and better also for the sick one, for you to
+say so frankly, if you are not well. Tell the one who comes for
+you, that you could not do justice to the case, as indeed you
+could not. Sick people are as sensitive as babies to the subtle
+influence exerted by the one who is so constantly over them. If
+you are in full health and strength, your rubbing will be quieting
+and effectual, your very presence, if you are careful and gentle,
+will be soothing. On the contrary, if you yourself are suffering
+and are using the nervous force you ought to be giving your
+patient in hiding your own malady, your presence will not be so
+eagerly welcomed; your patient will not know what is the matter,
+but she feels rather a relief when you are absent. Going to a case
+feeling perfectly well, the next thing is to keep well.
+
+Be careful about your _eating_. Your meals will of necessity
+be often irregular, that is unavoidable, but eat only wholesome
+things. Do not eat candy; and at dinner, which you will probably
+have in the evening after the family are through, avoid patties,
+and rich puddings, ice cream, and such like. You will always find
+plenty of plain food and fruit in the most luxurious homes; eat
+these and let the rest alone. If you want to keep your stomach and
+whole digestive apparatus in good order, you must care for it, and
+not overtax it. If you have a pretty good stomach it will bear a
+good deal of abuse, but in the end it will grumble, and a
+dyspeptic nurse is not an attractive object. As to your night
+suppers, which you should always have, should your case require
+constant watching, I would recommend plenty of coffee, tea, or
+cold milk, if you can drink it, bread and butter, cold meat and
+fruit. Never eat candied fruits, cake, or pies at night. Have eggs
+if you care for them, and pickles if you like. Remember, the
+plainest food, the most easily digested, the most nourishing is
+what you must have. Believe me, you will be rewarded for the
+temperate use you make of all the dainties you see, by a clear
+complexion, and good color, which will make you "good to look at,"
+especially good for a sick person to look at.
+
+As to the nurse's night toilette, it is quite a problem sometimes
+as to just what is best to wear. When the patient is not ill
+enough for the uniform to be retained for night duty, the nurse
+should be comfortable enough so that she can sleep; yet dressed
+enough for any emergency. I think a house gown of pretty material
+much neater than the kimono. Be sure this fits about the
+shoulders, and never have loose flowing sleeves. A white frill in
+the neck looks very trim, and is always becoming. The corset and
+all tight clothes should be removed, stockings and underwear kept
+on. The hair should be arranged simply, but not allowed to hang in
+a loose braid, unless you are _very_ sure you will not see
+any but the patient, and even then it may be unwise, as a braid of
+hair has an exasperating way of slipping from its proper place
+(hanging down the back) and dipping into whatever you are stooping
+over. Dressed thus, with night shoes to protect the feet, one can
+lie down on a lounge and sleep very comfortably, being freed from
+tight clothes, and yet being entirely presentable, no matter what
+happens. To undress regularly and put on the diaphanous low-necked
+short sleeved night dress of the present mode, and go to bed, when
+you are sure you will have to get up one or a dozen times during
+the night is not good judgment, I think. You get out of a warm
+bed, and if you only put on your shoes and stockings, your patient
+must wait while you do it. If anything serious occurs suddenly,
+you either run the risk of taking cold from being insufficiently
+clad while doing what must be done, or your patient must wait
+while you dress--both bad.
+
+Never get into bed with your patient. This seems to most people a
+quite unnecessary caution, but it is the commonest experience of
+the successful nurse, that a woman, feeble and nervous, should ask
+and almost insist that she shall lie down by her, or get into bed
+with her. I always wonder that a sick woman can not realize that
+she is not a pleasant bed-fellow, but she seldom does. Of course
+you are not to tell her that she is not fit to sleep with, but you
+_can_ say that she needs and ought to have the whole bed to
+herself, and you will sit by her and hold her hand, or if she
+insists on it, you can lie down, with your house gown on, on the
+_outside_ of the bed, being careful to give her plenty of
+space, and when she is asleep, get up quietly and lie down on your
+lounge, which should be placed so that you can see her every
+movement.
+
+Never let the patient think for a moment that you fear her
+disease; if she has diphtheria, do not tell her or the family that
+you have a delicate throat or that it is sore, and do not examine
+it by the help of a hand-glass where any one can see you. Do not
+go to such cases if you really fear them, but if you go, and have
+reason to feel that you have contracted the disease, tell the
+doctor as soon as you can, and if he thinks you ill, he will send
+you home. Never tell a patient you have a weak back or any
+weakness. Tell the doctor and he will see to it that you have rest
+or medicine, but do not let the patient know it. Never go about a
+sick room with a long face; it is enough for the sick one to have
+to be sick; the family sympathies are all enlisted for her. You
+are there to be a help and a comfort, not an added anxiety. Of
+course these remarks do not apply to any of you who are tired from
+a long, exhausting case. The family in such instances are ready
+and willing enough to let you rest. Keep your cheery manner: all
+higher considerations aside, it is money in your pocket to look
+cheerful. I have known one or two good, faithful, conscientious
+nurses who were dismissed from case after case, merely because
+they looked "so doleful." It may seem curious to place a
+commercial value on a smile, but in reality it amounts almost to
+that.
+
+Be very careful to have your dresses fit you perfectly, and have
+them well laundered, especially do not have them too stiff. In
+this connection I cannot do better than to relate an incident that
+I heard of some time ago. A nurse went to care for a patient whose
+first nurse had been called to her own home, and she had not been
+in the room an hour before the patient called her and taking her
+hand said, "My dear, I can't tell you how thankful I feel that
+your dress is not too short in the waist. Miss----'s dress was
+frightful!" This was only a nervous woman's whim, but our success
+as nurses depends in many cases on just such whims, so it is well
+to be careful. When the patient is well enough for you to come to
+the family table at meal time, be sure to have on a spotless
+apron, and let no sickroom odors announce your presence. It is
+worth more to a nurse to have soft, dry, warm, sympathetic hands,
+than to have the prettiest face ever seen under a cap, so be
+careful of them; after using any antiseptics always have at hand
+glycerin and rose water, cold cream, or something soothing to use.
+Never put a cold or clammy hand on a patient. If it is cold and
+dry it can be laid on a hot, aching head, but never do so if it is
+the least damp. If the hand is always damp, pour on it a little
+alcohol, or eau de cologne, if that is preferred, or some toilet
+water, then put it on the patient's head, and it will be all
+right. A simple and very cold lotion is alcohol and water, about
+equal parts, and a piece of ice added. Hold your hand in this a
+moment and then gently comb the patient's hair (that which grows
+on top of the head) with the dripping fingers, taking care not to
+let any cold water-drops fall on the face. This is wandering
+somewhat from my subject, but I will let it stand and speak of one
+more thing that is good to remember. Never lay a warm hand on a
+patient's head, or a cold one on the body. If you have to rub your
+patient's body, and your hand is warm and damp, shake a little
+talcum powder into it, or use a little cold cream, cocoa butter,
+or lanolin, and the dampness will not be perceived. Alcohol may
+also be used, or bay rum.
+
+Some nurses are much troubled by excessive perspiration,
+especially under the arms, any hard work making the dress quite
+wet. The ordinary shields are not very good, as they are not
+absorbent enough. A piece of flannel basted inside of the shield
+is a help, as that is absorbent. The auxiliary space might be
+bathed with a solution of alum; alcohol is good or alcohol with
+white-oak bark. Many preparations for this trouble are on the
+market, most of them are good but some are expensive. A late copy
+of the _Journal of Nursing_ gives the following: "Take two
+ounces of baking soda, mix with half an ounce of corn starch, and
+use as a dusting powder, after the parts have been thoroughly
+cleansed and dried. It will check the perspiration and remove
+every particle of odor." This is very successful, but I find it
+leaves a slight yellow stain on a white dress. Another remedy from
+_Journal of Nursing_ is this: "Zinc oxide" applied to axillae
+twice a week, after bathing at night, will dissipate the odor. If
+the perspiration has a disagreeable odor, no effort should be
+spared to free oneself from what is a serious drawback to the
+acceptableness of a nurse.
+
+Be very careful not to contract any little annoying habits, such
+as frequent clearing of the throat, sniffing, etc. You may have a
+catarrh, but use your handkerchief quietly; such noises are very
+disgusting, and these habits, I am sorry to say, are not rare, and
+seem very hard to conquer.
+
+I suppose that I have better opportunities to hear stories of
+nurses and their doings, good and evil, than some have. I
+certainly hear some very curious things. The most extraordinary
+was of a nurse who always made it a rule, when she went to a
+patient's house, to stipulate immediately for her hours "off
+duty." She thought she was doing a very clever thing, and making a
+most commendable business-like arrangement. It will not be
+necessary for me to show you what a lack of tact she exhibited,
+and what an antagonistic feeling she aroused.
+
+Never kiss your patient or allow yourself to show any
+demonstrative affection, unless you are very sure it will be
+welcome, and be careful even then. A kiss for "goodbye" when you
+leave the patient is usually quite enough, and many ladies are
+repulsed by anything of the kind. If you feel an affectionate
+regard for your patient, you can show it by your constant
+thoughtfulness and your care. Do not fear that you will lead
+lonesome, repressed lives; if you are the nurses you ought to be,
+you will have all the affection you want, and often more than you
+know what to do with. Never do any sewing or fancy work for
+yourself until you are sure there is none you could do for the
+patient. Remember that she pays for your time, and govern yourself
+accordingly.
+
+Read to her, sew for her, play cards with her, but do not amuse
+yourself or regulate your wardrobe at her expense. When I say "sew
+for her" I do not mean make her dresses, but do the little odd
+things that mothers of families always do, and which must remain
+undone if she is sick, unless you do them. Do not write letters
+when on duty, and, above all things, do not write with a scratchy
+pen. To a nervous person the sound of a scratchy pen traveling
+over the paper is torturing, and it can be heard even if you are
+in the next room. A fountain pen is, I think, the best to use. See
+that it is full before you go to your case, and it will need no
+attention for three or four weeks. This pen makes no noise as you
+write, and you have it always at hand, and if you have to leave
+your letter in haste, you can put the cap on the pen and slip it
+in your pocket, and no one is in any danger of finding fault with
+the nurse for leaving an open ink-bottle for somebody to tip over.
+
+Remember finally (and I think, from what I read in the daily
+papers, you are in no danger of forgetting this), that you are not
+domestics, and, while in an emergency I would have you shrink from
+nothing that needs doing, I do not think you should do any
+washing. Cooking you will very often have to do, but the ordinary
+housework does not come at all into your province. If your patient
+is a chronic invalid, I would have you make yourself useful in the
+house. Do the shopping, order the meals, anything that will show
+your patient you are anxious to help make the wheels of domestic
+machinery run more smoothly.
+
+You must use all the tact you possess; you will not find two
+houses just alike, or two patients with the same tastes. A "lady"
+in an emergency does many things she usually leaves to the
+servants. So must you. There is sickness, trouble with the
+servants, every domestic wheel turning with difficulty, and, if
+you have time, if you can leave your patient without doing her an
+injury, you can, perhaps, by some little service earn much
+gratitude from the family, and help to remove the impression that
+trained nurses are "so helpless and need so much waiting on."
+
+In conclusion, let me tell you, with all the earnestness of which
+I am capable, that upon each one of you rests not only the
+reputation of your school, but, in a measure, the reputation of
+the profession. No one needs to be told how much more widely known
+is an inconsistent Christian than a faithful one, how much harm
+one does and how comparatively little good comes of the others'
+faithfulness. And it is just so with you nurses, a careless nurse
+makes a far wider reputation than a careful one.
+
+If one physician is unskillful or unprincipled, the whole
+profession is not found fault with, but the individual is blamed
+and another one found who will do better, but it is not so in most
+cases where a nurse proves unsatisfactory. The whole profession
+suffers and every nurse sinks more or less if one of her sister
+nurses commits an indiscretion, or does any of the thousand things
+she ought not to do. I recollect very well, many years ago, a
+Brooklyn nurse, of about thirty-five years, married her patient, a
+boy nineteen years old. It made a great stir in the city, and, as
+I was living there at the time and the superintendent of a
+training school, I had to bear my share of the odium cast upon all
+nurses. For months after, almost every one I met took pains to
+tell me that hereafter they would keep their young sons out of the
+clutches of the designing nurse, and I doubt not, such slighting
+remarks were borne by every nurse in town, and it was not
+pleasant, to say the least of it, for any of us.
+
+Keep your standards high. Let nothing but the very best satisfy
+you, as far as you and your work are concerned. Keep your mind
+well informed; if it is full of scientific facts, of skillful
+methods, of good literature, or fine pictures, there will be no
+room in it for the memory of all the disagreeable things every one
+must encounter in one's work, and if you do not remember them, you
+cannot tell others of them.
+
+Finally, remember (and this lies at the root of it all) to keep
+your hearts right,--ever thankful that you are permitted to pursue
+this high calling, and ever striving to be more worthy of it, with
+many prayers that your life and conduct may show, what is better
+_lived_ than talked about, the grace and peace of God, which
+verily do pass man's understanding.
+
+
+
+
+IV
+
+THE NURSE AND HER PATIENT'S FAMILY, FRIENDS, AND SERVANTS
+
+
+Try to realize when you go to a house where there is dangerous
+illness, that the family is glad to see you when you come. You
+have come to help them, to stay with them, to comfort them by your
+presence, by your knowledge, by your experience. They have needed
+you, have sent for you, and are to pay you for your time. There is
+a general sense of relief when you are once fairly installed in
+your place by the bedside, yet you are a stranger. Your friend,
+the doctor, has told them what a treasure you are. Mrs. This and
+Mr. That have perhaps let them know how invaluable you were when
+at their houses; but yet they must look at you a little, they must
+note if you make a pleasant impression on the invalid, if you are
+as skillful here as you were somewhere else, if you look with
+scorn on the plain furniture, or how much you will be displeased
+that the bath-room is at the other end of the house. They do not
+feel exactly critical: they are too tired or too anxious for that;
+but still, unless everyone is too exhausted from watching to do
+anything but thankfully surrender everything to you, you will be
+pretty closely looked after at first.
+
+You must look for some espionage; and it is only right that you
+should be subjected to it. If _your_ mother was lying very
+sick, and some stranger, having knowledge and strength superior to
+your own, had to come and care for her, would you not feel that
+though you were glad to see her, glad she would give your mother
+the benefit of her superior skill, yet you would wish to consider
+her a little, to note when she did thus and so; or if she did
+something you did not understand, could you refrain from asking
+her why she did it?
+
+Be patient, therefore, with the suggestions of the family, after
+all, though you know the disease and the probable course it will
+run, the chances for recovery, and what to do in emergency, etc.,
+_they_ know the patient, all her peculiarities, her likes and
+dislikes, and if you are wise you will get and keep many little
+hints from those who have cared for her before you came. If she
+likes milk, will she insist upon tea? Does coffee keep her awake?
+Does she hate the sight of gruel, or beef-tea? Does she like much
+sugar in her drinks? All these are little matters of individual
+taste that you must find out for each patient, and if you have the
+necessary tact and forethought, you never need ask the patient one
+question; usually the friends are pleased to be consulted on such
+small matters, and gladly tell you all you wish to know. To be
+sure, they generally tell much more than you asked for; but that
+does not matter, it is better to listen patiently for five minutes
+to someone's tiresome descriptions than to repulse them, and so
+lose just so much kindly feeling from the one who wished to talk
+to you.
+
+If the amateur nurse has been doing something actually wrong for
+the patient, do not tell her so. She did the best she knew how;
+but say, as pleasantly as you can, "I think perhaps _this_
+would make our patient more comfortable," or "The doctor thinks
+such and such things are not now necessary, and it would be better
+to do this way." Then you can do what you know to be right, and
+not hurt the feelings of the one who has preceded you, and,
+feeling your way carefully, have everything just as it ought to
+be, and no one's feelings will be hurt, and no one will feel that
+you are looking down upon their ignorance; and here I would say
+that in your little confidential talks with the doctor, you could
+ask him to say a word to the family if they persist in doing what
+you know to be wrong. Ask him to give you orders before some of
+them, and that will set _you_ straight in a moment.
+
+With tact, that most invaluable gift, you can get on with
+_almost_ every one, and when you find that there is no such
+thing as making friends with the family, you can tell the doctor,
+and he will let you go; but such places are very rare. Let all see
+that you are thoroughly interested in your patient, and do not
+hesitate to perform any little kindness that falls in your way for
+the rest of the family, and you will win all their hearts without
+a struggle.
+
+When you go for your rest, be sure to leave carefully written
+directions for the one who is to take your place, just as you do
+when in charge of a hospital ward, you leave your orders written
+out when you go for your "off duty." Show her how to keep the
+sick-room record, and be sure she understands it all before you
+leave.
+
+As for the visitors, they are often difficult to manage, and here
+again you must have the family help you. Of course _no_
+visitors are allowed until the doctor gives permission. So far all
+is easy, but when they are admitted you will do well to make a
+little plan with the family. Tell them the patient may be seen at
+such an hour. Perhaps between eleven and twelve, perhaps between
+two and three, just as you consider her brighter in the morning or
+afternoon. Ask them who of the first and dearest friends is the
+quietest and most discreet, and then say that if they will kindly
+arrange for one visitor only to come each day, it would be so much
+better for the convalescent. The friends can always do this and
+they never object. They tell Mrs. Jones to come on Monday at two,
+and stay just fifteen minutes. On Tuesday Mrs. Smith can come, and
+so on, until by the end of the week the arrangement ceases to
+cause any comment, and soon, if all goes well, and the convalescence
+goes on without interruption, _your_ rules and extreme care
+can be relaxed to suit the patient's own fancy.
+
+Always carefully note if any visitor tires your patient, and
+manage so as not to let her come again until the sick one has more
+strength. It is better, I think, to sit in an adjoining room when
+your patient has a visitor. This gives you a chance to come into
+the room when the person has stayed long enough, and generally
+your entrance tells her very plainly that she ought to go, and she
+departs without you saying a word. If she does not, you will have
+to tell her that the doctor is very particular about not letting
+the patient talk too much, etc., etc., and get her out in that
+way. Be careful, when the visitor has gone, not to sit down and
+talk at length yourself. Give the patient a little nourishment,
+turn over her pillows, and if she seems at all wearied make her
+comfortable for a nap and let her sleep.
+
+As to the servants they require pretty careful handling. Above all
+things, keep on the right side of the _cook_. If you have to
+go to the kitchen to do any of the cooking, do not make a
+_mess_, or, if you do, don't run off upstairs and leave it.
+Gather up your utensils and put them into the sink, and let the
+water run over them, and ask for the dishcloth: and if you do it
+pleasantly, the cook will probably tell you to "Niver need thim
+things," and you will thankfully obey her. If you really cannot
+stop to make all tidy after your cooking, you can say, "I'm sorry
+to make you extra work with these dishes, but I must hurry back
+upstairs." Some such little speech, with a pleasant smile, will
+make all things easy for you below stairs, and for the sake of all
+the friction it will save you, it is well worth the trouble. Often
+the cook will be glad to do the cooking if you tell her how; be
+careful to tell her, if it is eaten and enjoyed; and never let her
+know if it is rejected. Get rid of it upstairs by some contrivance,
+and be sure not to order that dish again. In many cases
+of course the cook will know all the little dishes the sick one
+will fancy, and you will have very little to do with her. Such
+instances are somewhat rare, and very delightful when they occur.
+
+If there is much extra washing, you may have to use much diplomacy
+as regards the laundress; and if it is very disgusting washing, it
+is well to have a large pail, with a cover, upstairs. Thoroughly
+disinfect the clothes before you send them to the washing, as the
+odors are often sickening, and the laundress, like other servants,
+is very much afraid, usually, of clothing from a sick-bed. Carry
+or send the clothes to the washing as soon as possible after
+removing them from the bed; never, on any account, allow them to
+remain in the room.
+
+The nurse cannot be too careful as to the amount of clothes she
+sends to the laundry. She should of course keep herself and the
+patient scrupulously clean; but she must reflect that private
+families do not have an unlimited store of towels and sheets, and
+if she is extravagant in this matter it will seriously detract
+from her acceptability.
+
+In concluding, let me remind you that all these hints are intended
+for nurses going from one strange place to another, as you would
+in nursing fevers, or short surgical cases. Nurses who have
+chronic cases need none of these rules. They fall into a routine,
+and if they are detained in the family for any length of time,
+that shows that their work and methods are right, as far as that
+patient and family are concerned. But let them be careful when at
+last they leave the case, and go amongst strangers. The ways of
+one family are not the ways of another, and they must exercise
+much discretion to accommodate themselves to the new environment.
+
+
+
+
+V
+
+GENERAL REMARKS ON FOODS AND FEEDING
+
+
+Always have all food presented to an invalid as tempting as
+possible. Use pretty china and glass, if you are permitted to do
+so, yet not the very finest the house affords; that might make the
+patient nervous lest some evil befall it. Absolutely clean napkins
+and tray cloths, a few green leaves about the plate, a rose on the
+tray; the chop or piece of chicken, the bird or the piece of steak
+ornamented with sprigs of parsley, the cold things really cold,
+and the hot ones _hot_, these are necessities of invalid's
+feeding, that mark the nurse who has a proper appreciation of a
+sick person's delicate sensibilities. Have all plates, cups and
+saucers _hot_, when they are for the reception of hot toast,
+coffee, tea, etc. Hot water plates are very convenient, and easily
+procured at any large china shop; but if they cannot be found, put
+the hot plate containing the chop over a bowl of boiling water,
+and cover with a hot saucer, fold a napkin around the baked
+potato, and you can carry the tray containing the dinner through
+cold halls and up staircases and it will arrive at your patient's
+room _hot._ Be careful not to fill the bowl so full of hot
+water that it will spill. Never fill a cup so full that it will
+spill its contents over into the saucer, it makes a disgusting
+looking _mess._ Have all fruit _cold,_ oranges and grapes
+especially. Always look over a bunch of grapes and cut off
+the soft ones before you hand them to a patient. If you have
+foreign or California grapes, hold them for a moment under the
+cold water faucet and let the water run through the bunch, and all
+the cork dust will then be washed out.
+
+If you peel and quarter an orange for your patient never let her
+see you do it, unless you are perfectly sure you will not get your
+hands covered with juice. Wash your hands before you bring it to
+be eaten.
+
+Be careful not to have any suspicion of grease about the beef tea,
+broths, etc. A quick and easy way to remove all grease, is to fill
+a cup or bowl _brimming_ full, let it stand a few moments
+that the grease may rise to the top, tip the cup a very little to
+one side, and the grease, to the last atom, will flow over the
+side of the cup; pour your broth carefully into a clean hot cup,
+and serve. Beef juice is more palatable with a little very brown
+toast.
+
+Remember, that an invalid hardly ever likes any food made sweet.
+No matter what the taste may be in health, in sickness, sweet
+things are nauseous; for this reason ice cream bought at
+confectioners' is often rejected. Salt also must be used with
+caution, if the mouth and lips are tender, as is often the case;
+use the salt sparingly in all broths, etc.
+
+If your patient cannot take milk, when, as in typhoid fever, the
+doctor wishes the diet to be wholly or for the most part of milk,
+try at first to remove the thick, bad taste by giving a little
+pure water or carbonic acid water after it. If that will not do,
+mix the carbonic acid water with it, and have both nice and cold.
+If a glass of milk is too much (and it will be in nine cases out
+of ten, especially if it is cold), give half a glass; if that is
+still too much, give quarter of a glass, or put more water with
+it. Never repeat a dose (of food) if it nauseates the patient.
+Make some change in quantity or quality, and you will, if you
+watch carefully, find out the right proportions.
+
+A person lying flat down in bed cannot, of course, drink from a
+glass or cup, and a feeding cup is apt, by pouring too freely, to
+cause choking. A bent glass tube is the best arrangement, the
+patient can drink easily through this, and can regulate by
+sucking, the rapidity with which the food is taken. The tube
+should be cleaned immediately after each using, and if any beef
+tea or other food cannot be dislodged by letting water run through
+it, pass a string with a knot tied in it, through. Make the knot
+big enough to touch all sides of the tube, have it thoroughly wet,
+and the cleansing will be easily and quickly accomplished. If a
+patient prefers drinking from a glass, and can be raised in bed,
+always lay a napkin under the chin before you give the drink, and
+on no account have the glass or cup more than half full, if you
+do, it will surely spill.
+
+In giving medicine that tastes very bitter or unpleasant in any
+way, bring, at the _same time_ with the medicine, some water,
+milk, or whatever may be preferred, to take after it. Also a
+napkin to wipe the lips, especially if the patient be a man.
+
+Always keep milk, beef tea, etc., _covered_ in the
+refrigerator, and, if you can, see that this is cleaned every day.
+But this might cause the cook to feel aggrieved, so I put it as a
+suggestion merely. But if the refrigerator has a _smell,_ and
+the cook seems touchy, the milk, etc., better be kept upstairs on
+some sheltered window-ledge, and carefully covered.
+
+If you have your own little refrigerator upstairs, see to it that
+it is cleaned _every_ day. Never put away anything in tin
+pails; always use earthen or china bowls or pitchers.
+
+BEEF TEA.
+
+Beef from the round, finely chopped and free from fat.
+Proportions, 1 lb. beef to 1 pint of water, cold. Let the beef
+soak in the water, stirring occasionally, for two hours; then put
+it on the stove and heat it until the red color disappears; never
+boil it. Skim off all grease, salt to taste.
+
+BEEF JUICE.
+
+Round steak cut an inch thick; slightly broil like beefsteak for
+the table, cut into squares of an inch, squeeze in a lemon
+squeezer, skim carefully and salt. Serve either very cold, or
+place the cup containing the juice in a bowl of boiling water,
+stir carefully, and as soon as the juice is warm serve. If left a
+moment too long it is spoiled, as it curdles. One pound of beef
+makes an after dinner coffee cup almost full of juice.
+
+BEEF TEA IN A BOTTLE.
+
+Put into a Mason's preserve jar, tightly corked, one pound of beef
+chopped as for ordinary beef tea. Put this into a kettle of cold
+water, with a saucer on the bottom, let it come slowly to a boil
+and boil for an hour. Take out of the bottle and squeeze the beef.
+
+SCRAPED BEEF.
+
+Take a piece of lean round steak, scrape with the edge of a spoon
+until the place scraped has no more meat on the surface, but only
+the white fibre, cut this off with a sharp knife, exposing once
+more a fresh surface. Season, and spread raw on bread and butter,
+or make into little cakes and broil slightly, according to the
+doctor's orders, or your patient's taste.
+
+MUTTON BROTH.
+
+Mutton from the neck. Proportions, 1 lb. of mutton to 1 quart of
+water, put the mutton and the water (cold) on the back of the
+stove, let it come slowly to a boil, boil until the meat is ready
+to fall from the bones. After straining out all the meat etc. add
+one tablespoonful of rice or barley. Simmer half an hour after
+adding rice or barley.
+
+CLAM BROTH. NO. 1.
+
+Take 1 qt. clams. Strain off the juice and chop the clams fine,
+return clams to the juice and simmer one hour. Put on to scald as
+much milk as juice. Strain out the clams, thicken with a little
+corn starch, making about as thick as cream, pour juice into a
+bowl and add the milk.
+
+CLAM BROTH. NO. 2.
+
+Same as above, only cut off the hard part of the clams, chop the
+soft parts and leave them in the broth. For convalescents.
+
+CLAM BROTH. NO. 3.
+
+Take little neck clams unopened, wash them very clean with a
+brush. Place them on the top of the stove in a clean dry pan, and
+when the shells open take them off, remove the clams and pour the
+juice into a cup. To be served hot. If it is too strong, add a
+little boiling water. This is for very sick people; give only a
+teaspoonful at a time. It sometimes corrects nausea.
+
+CHICKEN BROTH.
+
+A fowl, not too young, cut in pieces, 1 qt. water to 1 lb. fowl.
+Put it on the stove in cold water, let it heat slowly, then boil
+gently until the meat is ready to fall from the bones, strain,
+skim and add rice, boil once more for 1/2 hour. Salt to taste.
+Serve with toast or hot crackers.
+
+OYSTER BROTH.
+
+Equal quantities of juice and milk, put each in separate vessels
+on the stove; when the juice comes to the boil, skim and slightly
+thicken, pour in the milk boiling hot, add the oysters one by one,
+let them remain on the stove about five minutes, or until the
+beards begin to curl, and they are no longer slippery. Serve with
+crackers heated very hot.
+
+OYSTERS BROILED.
+
+Dry the oysters, large ones are best, in a towel, have a piece of
+toast slightly buttered on a hot plate, near, pour over this a
+little hot oyster juice, not enough to make the toast wet through.
+Arrange the oysters on a fine buttered broiler, cook over a brisk
+fire like steak, until the beards curl. Turn them often. It takes
+about five minutes. Arrange them on the toast, add a little salt
+and a very little butter, serve very hot.
+
+BROILED CHICKEN.
+
+The chicken must be young, split down the back. Lay on the
+gridiron and broil evenly, turning frequently. Serve on a piece of
+buttered toast, salt and slightly butter the chicken. A little
+parsley garnishes the dish prettily.
+
+All birds to be broiled should be split down the back and broiled
+evenly, laid on thin toast and served hot.
+
+BEEF STEAK.
+
+Steak must be cut 3/4 inch thick, and evenly broiled, rare, unless
+particularly requested to do otherwise. Be careful not to smoke
+it; the grease dropping into the fire may make trouble in this
+way.
+
+OATMEAL GRUEL.
+
+Take two large iron tablespoonfuls of oatmeal freshly cooked for
+breakfast, add one cup of boiling water, slowly stirring all the
+time, then add an equal quantity of milk. Let all boil for ten
+minutes, and strain through a fine wire sieve. If you have no
+cooked oatmeal put 1/2 cup raw oatmeal in a double boiler with two
+cups of boiling water and cook for two hours, then proceed as
+above. It makes the gruel richer to add all milk, or 1-1/2 cups of
+milk and 1 cup of cream. Be sure not to forget the salt. Never put
+any sugar in unless requested to do it by the patient.
+
+KOUMYSS.
+
+Dissolve a third of a cake of compressed yeast (Fleischmann's) in
+a little warm water (not hot). Take a quart of milk fresh from the
+cow, or warmed to blood heat, add to it a tablespoonful of sugar,
+and the dissolved yeast. Put the mixture in beer bottles with
+patent stoppers, fill to the neck, cork, and let them stand for
+twelve hours where the temperature is about 68 degrees or 70 degrees,
+then put the bottles on ice, upside down.
+
+MILK PUNCH.
+
+One glass of milk, 1 or 2 tablespoonfuls of brandy, 2 teaspoons of
+sugar.
+
+Shake well or beat with an eggbeater. Give cold. Have patient take
+slowly.
+
+EGG-NOG.
+
+One egg, half glass of milk, 2 teaspoons of sugar, 2 teaspoons of
+sherry or brandy, ice. Beat the yolk of egg in a glass, add the
+sugar and beat, then a little milk, continue beating, then four or
+five pieces of ice about as big as a hickory nut; add brandy--
+regulate to the taste of your patient--add rest of milk; beat
+whites of eggs and add all but a teaspoonful with which garnish
+the top. It should make a glass brimming full. Have a spoon with
+which to eat it.
+
+EGG LEMONADE.
+
+One egg, one-half a lemon, 2 teaspoonfuls of sugar, beat the white
+and yolk separately as for egg-nog; add the sugar to the yolk,
+then the lemon juice, then the ice, lastly the white beaten to a
+stiff froth.
+
+WINE WHEY.
+
+One pint of boiling milk, one-half pint sherry; add sherry to the
+milk while scalding hot; stir a moment until the curd gathers;
+strain through a fine muslin, sweeten. To be taken cold. This
+takes a little practice to gather the curd as it should be done.
+
+POACHED EGGS.
+
+The best way of cooking for an invalid. Slip the egg, previously
+broken into a saucer (the fresher the egg the better), carefully
+into salted water which is boiling in a frying pan, then
+immediately set the pan at the side of the stove so that the water
+does not boil, keep it there for about five minutes. Let the water
+be about two inches deep in the iron frying pan. Each egg must be
+broken separately and slipped carefully into the water. When
+cooked so that the white is firm but jelly like, no part being raw
+or hard, take it out with a skimmer and slip it on a piece of thin
+buttered toast, sprinkle a little salt and pepper on top, serve
+immediately. Garnish with parsley.
+
+SCRAMBLED EGGS.
+
+Beat two eggs until thoroughly mixed, add two tablespoonfuls of
+milk, salt and pepper. Pour into a very hot frying pan, buttered,
+and stir constantly for about two minutes. Pour over buttered
+toast.
+
+SHIRRED EGGS.
+
+Heat the shirring cup very hot. Put in a piece of butter as big as
+a large pea. Shake it about and break in the egg. Let it remain on
+the stove a few moments and serve in the shirring cup. Sprinkle
+salt and pepper on it.
+
+OMELETTE.
+
+Beat very stiff two eggs, whites and yolks separately, add two
+tablespoonfuls of milk and a little salt. Pour carefully into a
+small frying pan, _hot_ and buttered. As soon as the egg is
+_set_, slip a knife under one side and fold one side over the
+other. Slip on a piece of toast and serve at once. A little finely
+minced ham or parsley flavors it very well.
+
+RENNET.
+
+One pint of milk slightly warmed and sweetened and flavored, add
+one large teaspoon of liquid rennet. Stir for a moment and set it
+in a refrigerator. To be eaten with sugar and cream.
+
+BOILED CUSTARD.
+
+One pint of milk and 2 eggs. Beat the eggs, add the milk heated
+almost to the boiling point. Stir in 2 tablespoonfuls of sugar.
+Return to the double boiler, and cook for about 3 minutes,
+stirring gently all the time. When done it will be about as thick
+as cream. Be careful not to let it cook too much as it will
+"separate" and be spoiled.
+
+BAKED CUSTARD.
+
+Same ingredients and proportions as for boiled custard, only let
+milk be cold. Pour into custard cups. Stand these in a dripping
+pan half full of warm water and bake in a pretty hot oven. Watch
+carefully, bake 15 minutes.
+
+THIN BREAD AND BUTTER.
+
+Have a loaf of good home-made bread, yesterday's baking, cut off
+the crust, then butter the loaf and cut the slice in this way,
+buttering first and cutting afterwards. The slice can be made
+_very_ thin and dainty, and the thinner it is, the better. A
+patient will sometimes relish this when tired of all kinds of
+toast or crackers.
+
+
+
+
+VI
+
+THE NURSE AS RELATING TO HER OWN TRAINING SCHOOL AND TO HER FELLOW
+NURSES
+
+
+Always be loyal to your own school and hospital. It may not have
+been in every respect perfect; but it is not necessary to tell
+strangers of its imperfections: probably those in authority are
+just as sensible of its short-comings as you are, and perhaps they
+work harder than you do to right its wrong; in any case it does no
+good to tell others of the things you disapproved. It may indeed
+be that your criticism is one-sided and unfair, that the very
+rules you hated and found hard to keep are the wisest ones, and,
+if you let strangers see that you disapprove of these wise
+regulations, the opinion they will form of your intelligence will
+certainly not be flattering to you.
+
+When you meet other nurses in your work, as you are sure to do,
+and when you compare your school with the one the other nurse came
+from, try to realize that the other school is neither wholly above
+nor wholly below your own; each has probably its own merits and
+its own drawbacks. You should not tell the other nurse any of your
+own school's shortcomings, any sooner than you would tell them to
+any other stranger; be loyal everywhere to the place where you
+were fitted for your work.
+
+Never tell revolting hospital stories to your patients. Some
+people have the most morbid wish to hear dreadful details. I
+remember a patient of mine, years ago, asking me in all good faith
+to tell her the most horrible thing I had ever seen in all my
+hospital experience. I asked her why she wished to hear such
+things, and after some reflection she acknowledged that it was a
+foolish, morbid curiosity. It is best to keep the dreadful side
+entirely out of sight; there are plenty of bright, interesting,
+pleasant things always occurring; tell of these. Tell of the
+cunning little babies in the lying-in ward, the absurd little
+black ones, the fat little German and Swede babies. Tell of the
+surly drunken men that come, and how a week of cleanliness in bed,
+with a broken leg, or it may be a cracked skull, will change them
+into quiet, polite, pleasant patients; and how, later, they will
+take their turn at washing dishes, with a docility that would make
+their wives stupid with amazement. All such matters (and the more
+you try to think of them, the more you will be able to recall)
+will amuse and really edify your patient, many of whom think of a
+hospital only as a place of terror.
+
+Never gossip about your sister nurses; of the stupidity of one,
+the untidiness of another, or the overbearing nature of the third.
+It can do no good, and it lowers you in the estimation of every
+one who hears you talk.
+
+As for your duties to each other, I would have you always observe
+the same punctilious etiquette outside that you do in the
+hospital. When you are called to assist another nurse, remember
+that _she_ is the head nurse; the case is hers. She gives
+directions, and you follow them; be sure you do it faithfully. If
+you have some one to assist _you_, be sure you arrange for
+her rest and exercise, and that you leave intelligently written
+orders when you go for your own rest.
+
+Some very awkward complications may arise where there are two
+nurses, and the worst, I think, is for the patient and family to
+like the second nurse better than the first one, and to criticise
+her and find fault with her to the other nurse. This is hard all
+around. The second nurse expects the first one to be preferred,
+and usually dislikes to go to such a case, for that very reason;
+but if any of you find that under such circumstances you are
+preferred, never allow the people to retail to you the faults of
+the other nurse, and never gossip about her. She may not suit
+them, but she is probably doing the best she can, and such idle
+talk can do no good. If they _will_ talk, make all the excuses
+for her you can, and never let her suspect from any action
+of yours, that you are preferred above her. If, on the other hand,
+you are the first nurse and some second one is called in, and
+preferred before you, study her well. See how it is that she wins
+the patient's confidence, when you did not. Try to find out, in a
+quiet way, wherein lies her charm. If it is quietness, exactness,
+cheerfulness, or ready tact--it must be something--and if you are
+clever you must see how it happens that she is preferred. It will
+be a good lesson for you. Perhaps you will never have such another
+chance for learning what you have found out by experience you
+lack. So do not waste your time by allowing yourself to feel
+jealous, but use it as a time of study, and you may reap a rich
+reward by winning your next patient's confidence.
+
+
+
+
+VII
+
+WHY DO NURSES COMPLAIN?
+
+
+It seems to some of us, judging from the prevailing tone of
+nurses' conversations, that this is a veritable age of discontent.
+We hear that a nurse's life is confining; that it is wearing on
+the nerves; it keeps one from enjoying society; it is not
+sufficiently remunerative, etc., etc. We all know, without going
+into further particulars, what a nurse could complain about, and
+though each one's tale of woe may be perfectly true, it seems to
+me we are not wise, as nurses, to allow the trials of our
+professional life to occupy such a prominent position in our
+thoughts.
+
+Let us glance at some of the other professions, and see how the
+members of each regard their chosen work. What is the prevailing
+theme of the religious newspapers? Is it complaints from the
+ministers that they are not appreciated, or that their life wears
+on their nerves? Not that surely, but we read of more and more
+work to be done; more and more need of the gospel to be preached
+and lived, that all may be attracted to it. What do we read in the
+medical journals? Not how often Dr. Jones or Dr. Smith has been
+called up at night, or how often they have been dismissed or
+maligned by ungrateful patients; neither do they talk of such
+things. Do they complain that they are kept from the presence of
+"Society?" Not so, and why? Their enthusiasm is such that these
+matters are accepted as part of the inevitable, and the higher,
+nobler aim is so real that the lower and meaner consideration of
+personal comfort sinks into insignificance. What is the soldier's
+favorite tale? Not that all through the war he had to drink his
+coffee without cream, that he did not have sheets on his bed, and
+that he ate from a tin plate. Would he ever speak of such things,
+except to show that a man can for a noble aim accept inconvenience,
+and laugh over it? Yet the soldier has probably been used
+to these comforts and many more all of his life in his home;
+but viewed in the light of his enthusiasm for the country he
+is striving to save, and seen by the side of her peril, such
+inconveniences sink into their merited nothingness.
+
+Now the profession we have entered is, we are told, a noble one.
+We have been ranked shoulder to shoulder with the doctors, we have
+been compared to soldiers, we have been assured that our
+opportunities for doing good to souls are second only to those of
+the ministers. What more do we want? We want this, and we want it
+very much. We want the courage to accept our trials which must
+come if we are to have any glory. It is all very fine to be called
+a ministering angel, but it is pleasanter to minister to those who
+are appreciative. We _can_ be heroic, in an emergency, but if
+we are not properly thanked, we do like to growl a little. It is
+gratifying to our vanity to be ranked with our masculine
+associates, but when it comes to the hard, thankless tasks which
+they accept without a murmur, then we proceed to show that we know
+what is what, and that our refined tastes cannot be so inconsiderately
+treated.
+
+The trouble with these fretful nurses is that they _are_
+nurses. If they are not satisfied with the profession they have
+chosen, why do they not make a change and enter some other? Do
+they not know when they enter the work that it is hard, do they
+not hear on every side that it is exacting and confining? They
+knew it perfectly well before they began, why then do they
+complain? Why not say candidly, "I cannot have such enthusiasm for
+my fellow-men that I can forget myself," and then do something
+that is easier?
+
+The Superintendent of the training school shows each new aspirant
+for the nursing profession that the life is not an easy one, that
+patience is one of the most necessary characteristics for the
+nurse. She tells her of the trials, the irritations, the unreason,
+the tiresomeness of sick people, and still women will come to the
+school, and forgetting the warnings, they will complain when some
+exasperating incident occurs. If a nurse, from overwork and the
+consequent weakening of her nervous energy, has lost her patience,
+she will be a wise woman if she drops out of nursing work for a
+year or more; this will probably help her, complaining never will.
+
+Do you feel that your patient is cross or unreasonable? That is
+most likely, and is to be expected in nine cases out of every ten.
+Put yourself in your patient's place for a little while; try to
+realize what it is to have a pain, constant and sickening; to have
+it every minute of the twenty-four hours; try to imagine the
+fatigue of a respiration of forty; the ache and restlessness of a
+fever of 103 degrees; the agony of longing to change a position when it
+cannot be done; the despair of a hope for recovery growing daily
+less, or the realization of absolute weakness that comes with
+early convalescence; try to imagine yourself bearing some of these
+ills with nerves and brain weakened by disease, and you will not
+wonder that your patient is irritable, that he thinks the minutes
+of your absence are "hours," that the unevenness of the bed is
+"hard lumps," that the food is "slops," and the medicine "no
+good." Remember that he is a prisoner, and he has a cruel jailer;
+his bed is his prison, his disease is his jailer, and he suffers
+whatever torments his jailer chooses to inflict. Now prisoners are
+not, as a rule, a happy class of men; so bear with your prisoner
+and help him. Complaining about his shortcomings will never make
+them any the less. He is sick. Oh! the pathos of that short
+sentence, "He is sick;" that says all. You are well, or you ought
+to be; therefore bear with him.
+
+You have chosen a hard profession, but we are told it is the
+noblest one a woman can follow. Why is it noble? Exactly because
+it is hard, and the hardness consists in your forgetting yourself
+and giving your strength to others. There are many hard lives that
+are not in the least noble, but there is no noble life that is not
+hard. A coal miner has, I suppose, a hard life, yet no one calls
+it a noble one; why? Because he works solely for his wages, and he
+complains and "strikes" when his wages and his hours do not suit
+him; but a doctor going from house to house, and in spite of all
+discouragements carrying cheer and hope; a city missionary going
+to the degraded, the ignorant, and by his own efforts helping his
+fellow-men to a better life, to a knowledge of God--these are
+noble lives. You can see I am sure the difference, and you will
+not gainsay me when I assure you that the doctor and the
+missionary, though they may not be satisfied with themselves, or
+with their manner of working, are happy men, happy because they
+live outside of themselves. The coal miner who is not content with
+his wages is miserable, because he himself and his needs loom up
+before him so large that every thing else is shut out. It is
+because you take a hard task and do it well, that so much praise
+is given to nurses. If you undertake a difficult task and fret
+over it all the time you are doing it, if you propose to benefit
+your fellow creatures and grumble because you have not comforts,
+or appreciation, or gratitude, where does the nobility go? Where
+is the heroism? If the task is easy, agreeable, delightful, the
+idea of heroism, of nobility, of all high aspiration dies
+directly. Did any one ever do a grand work and have an easy time
+while doing it? Did Florence Nightingale have all the comforts of
+life when she did her great work? Was it not by her indomitable
+perseverance, her great patience, and her enthusiasm for others
+that she won such an honored place for herself? You know almost
+before I say it, that there can be no loftiness of purpose, no
+enthusiasm, if there are not difficulties to be conquered, and you
+all know that complaining about sick people will never alter their
+characteristics, and that complaining about the nervousness of the
+relatives will never make less unreasoning, when they are fearful
+that a loved one is going to die.
+
+Do we want gratitude and appreciation? We get it very often, and
+very often we do not; and when this last is the case, we may
+reflect that we are in very good company. How did the French
+reward Joan of Arc? The warmth of their gratitude led her to the
+stake. Galileo, as reward for his discovery, was put into prison
+and loaded with chains, as were also Christopher Columbus and Sir
+Walter Raleigh, a notable company these, and every one suffered
+from the ingratitude of their fellow-men. Many more examples you
+must call to mind, of ingratitude more base than any thing we
+shall ever be called upon to bear.
+
+The profession of nursing is still one of the most recent that
+women have engaged in. The world had until the past few decades
+been so used to being nursed by the old-fashioned nurse, who was a
+servant, and who never expected any treatment but that of a
+servant, that it has taken some years to always remember that we
+are not servants, in the usual acceptation of the term; but no one
+will be convinced of the fact that we are ladies by our
+_telling_ them so. If you are a lady, with a lady's
+refinement, every one in the house will know it, will feel it, and
+you will never mention the subject; they must feel it, then there
+will be no arguing on the subject. It must be demonstrated by your
+deftness, your quietness, your cheerfulness, your education, your
+intelligence, your quick appreciation of other good qualities. We
+must all of us show the world that it is being nursed by its
+compeers, that a lady can do even the most revolting service in a
+way that robs it of its difficulties; and when the hard part of
+the illness is over, when your patient is ready and anxious to be
+entertained, you can show that you are not a machine for carrying
+out the doctor's orders; that you are capable of something more
+than the ability to take temperature, pulse, and respiration.
+
+We must remember that even yet we are, in a way, pioneers of one
+part of that great woman movement in the world. It is not enough
+to educate one family up to the realization that we are its
+equals; the next house we go to, the same work may have to be done
+over again; but each time it is done, and done well, the whole
+profession has been benefited, which is an aim worth striving for.
+
+
+
+
+VIII
+
+THE NURSE AS A TEACHER
+
+
+It does not occur to every nurse, when she graduates, that she has
+been preparing herself, during all these strenuous years of study
+and hospital work, for the life of a teacher. She fondly imagines
+that she is a nurse, and only that; but after she has been doing
+private duty for a year or more, she realizes that she is
+generally a teacher as well as a nurse, and that often she is a
+missionary also.
+
+Perhaps no private duty nurse needs to be told what subject she
+must teach; the patient or the patient's friends never let her
+rest until she has told the "why" of every thing she does, or does
+not. There are, however, some important subjects that the nurse-
+teacher should try to make very clear to every patient.
+
+We will begin with the baby, as the babies are with us always, and
+if doctors and nurses, science and sanitation have their way,
+there will some time be no call but that of the baby, for nurse or
+doctor either. The ignorance of the young mother is proverbial;
+her wish to know about her baby and its care is pathetically
+earnest. The new life is so precious, she would take such good
+care of it, if she only knew how. Here is a pupil eager for
+knowledge, ready to do all that can be intelligently taught to
+her. The nurse should have very clearly in her mind all the
+mysteries of digestion, all the reasons for regularity in feeding,
+the necessity for fresh air, for long and uninterrupted slumber,
+for loose clothing, for regular bathing. She should be able to
+give the mother the rules for her own living that she may be able
+to provide the best milk for the baby, or, if the little one has
+to be artificially fed, the methods of preparing the particular
+food chosen should be explained, and the indications of
+indigestion pointed out. All this is real teaching, real
+missionary work, and if well done will help the mother immensely
+and probably save the baby many attacks of colic or worse. Washing
+the baby is usually regarded by the young mother as a terrible
+ordeal. No nurse should leave her young-mother patient until she
+is fully able to perform this task. Let the mother watch, a few
+mornings, while the nurse does all the work, then let her undress
+the baby, when the nurse can take him and finish the operation.
+Day by day let her do a little more, as her strength and ambition
+permit, until at the end of a week she is fairly used to handling
+the child and can, perhaps, keep him until the last finishing
+touches are put on. The nurse should always be near, to help, to
+advise, to take the child should the mother become exhausted.
+Finally, she should go into another room, and, leaving all things
+ready, allow the mother to perform the duty by herself, letting
+her know that at any time she will be relieved if necessary. In
+this way the mother becomes accustomed to the child, and the bath
+is always a pleasure to her. How many times have we heard pathetic
+stories of a young mother trying for the first time to wash the
+baby?--the tears of despair, the nervous blunders, the exhaustion
+when the performance was brought to a hasty close. All such
+stories mean that the nurse in charge was not a teacher and that
+her work when she left the case was not completed.
+
+Suppose that this baby is the third or fourth, the mother knows
+what to do for the new little one, but how about the others? She
+is still anxious to do what is right, or perhaps she is not
+anxious, and her attitude toward the children is not what it
+should be. Perhaps she does not realize that she will be called to
+account for these souls intrusted to her care, that these bodies
+will do their part in life, well or ill, as she treats them wisely
+or foolishly. Here is true missionary work. A thoughtful,
+intelligent, judicious nurse can show a mother that an adenoid may
+be responsible for Johnny's inattention, as it causes dullness of
+hearing, how Mary's fretfulness is caused by too little sleep or
+by insufficient ventilation of her room at night. She can explain
+how irregular eating causes the children to be cross and
+irritable. She can show why the first teeth should be removed when
+the second begin to push towards the gum. She can teach the mother
+that the headaches so often met with, in children who go to
+school, are due, perhaps, to eye strain, and can not be corrected
+with pills, and should never be soothed with headache powders. She
+can show the evils of the gallons of soda water too many young
+women swallow, of the injudiciousness of allowing young girls to
+congregate in drug stores. These last two evils, "soda water and
+the drug store habit," the mother may know nothing about. She is
+busy at home with the "little ones," and the fourteen- or sixteen-
+year-old girl only too often is allowed to wander off "down town"
+with other young girls, and what she does there would astonish
+many a mother.
+
+Every nurse should know how to teach her patient to guard herself
+and her children from tuberculosis. She should be able to show
+what the early symptoms are, what is then necessary to do, what
+care should be taken of the sputum, of the patient's food, of his
+eating and drinking vessels, his bed and bedding. She should know
+how to teach a tuberculosis patient to care for himself, how he
+can avoid giving his disease to others, if he stays at home; and
+where he will find proper hospital or sanatorium accommodations if
+he goes away.
+
+Most mothers are very thankful for practical hints from one who is
+supposed to know, and who, during a four to six weeks' stay, makes
+herself one of the family, and offers advice in the _right
+way_ and _at the right time_.
+
+The great sex question is almost sure to be discussed at such a
+time. The advent of a new baby is such a wonderful thing that
+nearly always the other little ones want to know (very naturally)
+where it came from. Little folks are brimful of curiosity. It is
+Nature's way, I suppose, of teaching them. Every new thing fills
+them with admiration, with joy, and they must know all about it.
+"Oh, mamma, what a lovely new pony! Where did you get it?" "Is it
+really mine?" "Oh, papa, what a dandy, new sled! Where did you get
+it? Can't I use it right now?" "Oh, have we got a new baby? A real
+baby? Is it ours? Where did it come from?" "Can't I hold it?"
+
+All are familiar with these expressions of wonder, of delight, of
+joy of possession, but how to satisfy the eager mind aright is a
+problem requiring our most careful thought. Books, papers, and
+magazines tell us what to say and how to say it. All this should
+be talked over, and, if the mother does not know, the nurse should
+know what books to tell her to read.
+
+The medical world to-day is much concerned over the question of
+prostitution and its effect upon the coming race, through the
+transmission of syphilitic taint to an innocent wife, who is
+thereafter barren, or who bears syphilitic children. The folly of
+the double standard, purity insisted on for the wife, unchasity
+condoned in the husband; all these subjects are sure to be brought
+up, and the nurse who goes prepared on these and kindred topics
+can do an immense amount of good to the women she nurses.
+
+She can show how useful the knowledge of chastity is to a boy-the
+strength that comes from self-control, the weakness that follows
+self-indulgence, the danger to himself and to those he really
+loves when he contaminates himself with prostitutes. A young man
+once said to a friend of mine, "Oh! if my mother had only warned
+me of the suffering I would cause myself and others, I never would
+have polluted my body and shamed my soul." The nurse should know
+how to instruct the mother as to the signs of self-abuse in her
+little boys, so that she may know what causes the nervous
+movements, the pallor, the fitful appetite, the dark circles under
+the eyes, the listlessness, the fondness for being alone--any one
+of which should call for extreme watchfulness. All these things a
+nurse should be sure to know, so that, as far as in her lies, she
+should be one more earnest woman striving to make the world better
+for her having lived and worked in it. A wise man has given this
+quaint description of a perfectly educated man: "When a man knows
+what he knows, when he knows what he does not know, when he knows
+where to go for what he should know, I call that a perfectly
+educated man." So with the nurse. When she finds a social problem
+with which she is not familiar, let her turn to this list of
+books, magazine articles, and pamphlets upon the subject: Chapman,
+Rose R., The Moral Problems of Children; Dock, Lavinia L., Hygiene
+and Morality; Hall, Winfield Scott, Reproduction and Sexual
+Hygiene; Henderson, Charles W., Education with Reference to Sex;
+Lyttelton, E., Training of the Young in the Laws of Sex; Morley,
+Margaret W., The Renewal of Life; Morrow, Dr. P. A., Social
+Diseases and Marriage; Saleeby, Caleb W., Parenthood and Race
+Culture; Wilson, Dr. Robert N., The American Boy and the Social
+Evil, The Nobility of Boyhood, 50 cents (contained in "The
+American Boy and the Social Evil"); Hall, Stanley, Educational
+Problems, Chapter on the Pedagogy of Sex, Adolescence, Youth;
+Northcoate, H., Christianity and Sex Problems; Janney, Dr. Edward
+O., The White Slave Traffic in America; Report of the 3 8th
+Conference of Charities and Corrections, in Boston, June, 1911,
+Sex-Hygiene Section; Kauffman, Reginald Wright, The House of
+Bondage; Summary of the Chicago Vice Commission, in the May number
+of _Vigilance_; Education with Reference to Sex in the August
+number of _Vigilance_ (published monthly at 156 Fifth Ave.,
+New York City, at five cents per copy); The Cause of Decency,
+Theodore Roosevelt, _Outlook_, July 15, 1911; articles on The
+Causes of Prostitution in _Collier's Weekly_, from time to
+time, since April 1, by Reginald Wright Kauffman; articles on the
+Necessity for Teaching Sex Hygiene, in _Good Housekeeping_,
+beginning with the September number; Dr. Dale's articles on Moral
+Prophylaxis, in the JOURNAL OF NURSING since the July number;
+Instructing Children in the Origin of Life, Elisabeth Robinson
+Scovil, in October JOURNAL OF NURSING; Leaflets and pamphlets
+published by American Motherhood, 188 Main Street, Cooperstown,
+New York; Publications of the American Association of Sanitary and
+Moral Prophylaxis, New York City, JOURNAL OF NURSING, February,
+1912.
+
+One last word and I have finished. Be careful, oh so careful, that
+your instructions are acceptable, that your pupil is anxious to be
+taught. Most mothers are anxious on these subjects; if one is
+encountered who does not care, first try to make her care (and
+this is a task, indeed), and then teach her what to do and how to
+do it.
+
+
+
+
+IX
+
+CONVALESCENCE
+
+
+One frequently hears the private duty nurse deplore the necessity
+of her remaining with a patient during convalescence. "I wish,"
+such a one would say, "that I never need stay with a patient after
+the temperature has been normal for ten days," or, "I do not mind
+the first two weeks of an obstetric case, then there is something
+to do, but after that I am ready to leave," or again, "When my
+patient is ready to go out driving, I always wish she would drive
+me home; half-sick people are not to my taste." I have often
+wondered if this feeling is not caused by the atmosphere of the
+hospital which has, during training, been the nurse's home,--the
+hospital, where the patient leaves at the earliest possible moment
+of recovery, to make room for someone else. The pupil nurse gets
+used to the excitement of critical illness, used to the hard work
+of constant watching and fighting for the patients' lives, and
+that, and only that, it seems to her, is nursing. So when she goes
+to her private cases, and her patient has a long period of
+convalescence, she feels out of place, she does not seem to be
+doing what she was trained to do, and she frets over it, until
+some happy day when the doctor releases her, and she is at liberty
+to go once more to some one who is at death's door.
+
+Nurses seem to feel that caring for a convalescent is not
+"nursing," but there they are mistaken. After a serious illness it
+takes a long time to restore the patient to perfect health, some
+function may need the close watching which only trained eyes can
+give, and it is not beneath the dignity of the nurse to remain,
+and keep watch until every part is once more in perfect working
+order. Many nurses feel that it is not nursing to amuse a patient,
+but it is nursing to help him on to the healthy plane from which
+he has fallen, to play games with an invalid and to watch him, to
+read with him, and to watch, to walk or ride or travel with him,
+and to watch, always to watch, that the dreaded symptom does not
+appear, that the one part which still needs care gets it.
+
+A surgeon does not spend all day, every day, with his gloves on,
+and his scalpel in his hand; he is not _always_ operating, or
+even arranging for operations; he can find time to see patients,
+to sit and talk with them, to advise them, to cheer them, even to
+tell funny stories to them, but all the time he is watching them.
+A lawyer is not always pleading in the court room, a clergyman is
+not forever in the pulpit. The lawyer when talking to his client
+is just as truly a lawyer; the clergyman, when visiting his
+congregation, is just as truly a clergyman,--the sermon on Sunday
+is the climax, if I may so express it, of his week's work. The
+lawyer's speech to the jury is the point to which all his efforts
+tend after, perhaps, weeks of preparation. So the convalescence of
+a patient is the post climax of the nurse's undertaking. She
+begins with the climax, severe illness, operation, or obstetric
+case, whatever it may be, gradually the stress lessens, the whole
+atmosphere of the house becomes natural as the patient progresses
+toward recovery; but the process is not complete, and the nurse's
+work is not done until the doctor pronounces her trained care no
+longer necessary; then she may go, and feel that her work has been
+thoroughly done-no small comfort surely.
+
+I wish I could show my young sister nurses how good _for
+them_ this period of the patient's convalescence might be. The
+delightful rest of regular sleep, and regular meals comfortably
+eaten at a table instead of in solitude from a tray, the
+opportunity for regular exercise--these things come as a real
+luxury when one has been nursing a critically-ill patient, and
+anxiety has been with one, night and day. This is the period when
+the nurse's nerves, strained to their utmost, can regain their
+tone, where the responsibility borne by the doctor and shared by
+the nurse is not so great a weight, and the knowledge of one more
+victory over death, one more human life saved, gives a joyousness
+to the day that is good to experience.
+
+The satisfaction of knowing that by your help the patient has
+come, perhaps, from the gates of death; the pleasure of noting day
+by day the return of healthful sensations, the gradual ever-
+growing desire to once more take his accustomed place in the life
+work that has been interrupted--all these are missed by the nurse
+who flies from convalescents.
+
+May it not be that the change in occupation has something to do
+with this unwillingness to remain with a patient when he is
+convalescing? When a temperature has to be taken but once a day,
+or when the doctor only makes visits twice a week, when all the
+routine of the sick-room gives way to a more natural atmosphere,
+many nurses do not feel at ease, they do not read aloud
+pleasantly, they do not care for books, and, if the patient asks
+for this amusement, the reading is a torment to the nurse, and I
+imagine it does not afford much pleasure to the listener. A nurse
+once gave me a graphic description of her efforts to read "Romola"
+to a convalescent typhoid patient. The poor nurse knew nothing of
+Florence or of the Italian language, and her struggles over the
+foreign words in that book must have been funny enough. Her
+patient was not much edified--of that I am certain. If a nurse
+does not read aloud understandingly, she should make every effort
+to learn. She thereby increases her usefulness, and makes herself
+more acceptable to her patients. She adds to her own value. She is
+worth more. No nurse can tell when this method of passing the
+weary hours will be required of her, as it is almost certain that
+a patient of intelligence will ask for some mental refreshment.
+
+Another pleasant way to pass the long hours of convalescence, is
+by playing games with your patient. I am sure no training school
+for nurses has added the study of cribbage, pinochle, bezique,
+chess, checkers, backgammon, or dominos to its curriculum. All
+these are two-handed games, the playing of which will help the
+convalescent to forget himself and his past illness and present
+weakness. The nurse, if she knows only one game that is unfamiliar
+to the patient, gives him new thoughts while she teaches him, and
+it is quite astonishing how much pleasure such simple things can
+give both to teacher and pupil. I would suggest that nurses in
+their club houses or homes could profitably fill some vacant
+evenings practising these two-handed games. I am sure they would
+never regret the time so spent.
+
+If the convalescent is a woman, the means of amusing her are more
+varied and more congenial perhaps. In addition to reading aloud
+and playing games, there is the vast realm of "fancy work," where
+most women feel at home. It is a pity, so few women nowadays know
+anything about knitting, crochetting or tatting,--many do not even
+know which is which. A lady asked me very innocently, not long
+ago, how I could tell the difference between knitting and
+crochetting! Since Irish crochet has returned to favor, however,
+many have once more taken up their crochet needles. The nurse who
+can deftly turn her hand to these dainty arts, and can teach them
+to her patients, or any of the patient's family, has the means of
+making herself a very acceptable companion, apart from her nursing
+skill. Embroidery is very fascinating, and appeals to every woman.
+A dainty little garment for your patient, embroidered while you
+watch her return to health, will be long treasured by her. For a
+nurse, what art, what accomplishment can she have that will not
+help some poor invalid, that will not shorten the weary hours for
+some sick body, or bring consolation to a weary soul? A perfect
+nurse is one who brings comfort to her patient. It is because
+trained nurses bring more comfort that they have replaced the old
+style nurse; the more comfort the nurse brings, the more
+successful she is. The ability to talk well, when talk is needed,
+to read well, to amuse understandingly, to wisely meet each need
+of the invalid as it presents itself, this is to be the ideal
+nurse.
+
+
+
+
+X
+
+HOW SHALL A NURSE OCCUPY HER DAYS OF WAITING?
+
+
+To many nurses the time between cases is dreaded as a period when
+money is being spent for necessary maintenance, and none is coming
+in; a nervous time, as the ring of the telephone which may mean a
+call is wished for or dreaded, perhaps both; an anxious time, as
+no one knows how long she may have to wait; a dreary time, as the
+days drag on and still no call comes. It _is_ a trying time,
+but much can be done in these days of waiting that is delightful
+in the doing, and that will prove a source of pleasure to all
+future patients, and no little profit to the nurse also.
+
+Let me preface my few hints by saying that all patients and
+patients' friends expect the nurse to know all about the diseases
+and their cures, the care and management of the sick,--that is
+common, ordinary nurses' business,--but there too many nurses
+stop; they often can go no further; and when one comes to a family
+and adds to this a broad culture, and an intelligent interest in
+the topics of the day, the respect and admiration of the patient
+and family are unbounded, and their surprise genuine.
+
+I would like, if possible, to impress upon the nurse graduate that
+really there is much to learn after she has left the training
+school. All the technic of hospital and operating room is fresh in
+mind, but there is so much that lies necessarily outside the walls
+of a hospital, and this knowledge that comes with experience is a
+great part of what makes a successful nurse.
+
+I will not touch here upon what every nurse knows so well,
+relating to the "preparedness" of clothes, satchel, and
+instruments. We take it for granted that all this is ready. The
+case before has been a hard one, we will imagine, and several days
+have been given to the luxury of whole nights in bed, and whole
+days of resting; this is all done, and the next case is awaited.
+
+The best thing to do first is for the nurse to examine a little
+her mental equipment, see what she has stored away in her mind
+that can help the next patient, or that can assist in fighting the
+battle of hygienic cleanliness versus disease-bearing dirt. Let
+her consider whether she reads aloud acceptably, understandingly.
+Has she a good list of books which most women would enjoy? Does
+she know what books to suggest for the children? Can she tell what
+would interest the boys, or what a man would like to listen to?
+Does she know humorous books, interesting histories, or
+biographies? Here, then, is occupation for many idle days.
+
+To go to a public library is always a pleasure, to make friends
+with the librarian is an added pleasure, as is also the making
+one's self familiar with some good books that can always be
+procured, and that will give pleasure and profit to patient after
+patient. This search for good literature will give happiness in
+the quest, and happiness in the reading. Librarians are usually
+glad to direct one to the books needed, and many delightful hours
+may be spent in the library, and all the while the comfortable
+feeling experienced that the pleasure felt will be transferred
+later to future patients.
+
+The subject of hygiene is taught in most training schools, and
+indeed in many day schools as well; but this is a branch of
+knowledge that is growing so rapidly that, unless the very latest
+discoveries are learned, the nurse may find herself of use merely
+when the infection has done its work.
+
+I wonder how many nurses have made use of the bulletins issued by
+the U. S. Department of Agriculture in Washington. These are
+called Farmers' Bulletins, but many of them are of use to all
+mankind, be they farmers or not. They are free to any who ask for
+them, and up to the present time about five hundred have been
+issued. They are upon all sorts of subjects--Flies, Malaria, The
+Destruction of Rats, Care of Food in the House, Fruit as a Food,
+Cereal Breakfast Foods, etc., etc., subjects _ad infinitum._
+Here, then, is a mine of information open to anyone who asks; all
+one has to do is to write to the Secretary of Agriculture and ask
+to have sent a list of the Farmers' Bulletins published by his
+department, and from the list any bulletins may be selected, and
+they will be sent. Ask for what is needed; it is all meant for the
+education of the public. The information is absolutely reliable,
+and represents the best thought of the country--expert advice by
+the foremost scientists.
+
+I have often thought that a nurse who made the nursing of children
+a specialty, or even those who nursed children occasionally, would
+be much profited by a course in a Kindergarten Training School.
+The private duty nurse, however, having but a few days at her
+disposal, cannot do anything as extensive as that; but a very good
+substitute is at hand, in the kindergarten department of any of
+our public schools. It is most interesting to go to a public
+school, ask to see the Principal, and let the nurse explain her
+visit, and show her how helpful it would be to future little sick
+folks, if she might be allowed to study some of the kindergarten
+methods, and permission will readily be given. When the nurse
+reaches the room of the "littlest ones," let her sit down, and
+quietly watch what is done for them, and how they are managed. The
+kindergartner will be glad to tell where she finds the charming
+stories she relates; she will give models of the wonderful things
+her pupils cut out of paper, the canoes, the men to sit in them,
+the wigwams, the sleds, automobiles, swings, stoves, trees,
+apples, etc., etc., articles well-nigh innumerable, and all so
+simple and so deftly made. A small convalescent could be amused
+for weeks with the things one could learn in a few hours in one of
+our city kindergartens. I speak of the things I know, for I have
+tried it, and I never yet found a Principal who was not glad to
+have her kindergarten studied, nor a kindergartner who was not
+pleased to know that she could assist in the work of nursing sick
+children, even in this seemingly roundabout way.
+
+In all of our large cities are fine art galleries, and in many
+there are fine loan collections on exhibition every summer. There
+are, besides pictures in these loan collections, many things; some
+curious, some beautiful, and all of them interesting. Some days
+spent in these galleries will bring much knowledge and beauty into
+one's life. Time must be taken for these visits; no one can
+appreciate the patience and skill of oriental handiwork in a
+hurry. If unacquainted with the exhibits, a catalogue should be
+purchased, and each one studied until one knows why it is there,
+and what is its beauty. I remember seeing, one day, in a
+collection, a cup of jade, with a very finely wrought handle; I
+thought it fine, but did not appreciate it until the Custodian
+told me that it took the artist twenty years to carve that one
+cup, jade is such a hard stone. This cup was so valuable that the
+Kensington Museum, in England, had paid an immense sum of money
+for it, as a nearly perfect specimen. This information was my
+reward for close study of an exhibit. In these exhibitions one
+could spend many vacant days with much pleasure and profit.
+
+In whatever town a nurse lives she should familiarize herself with
+the philanthropic efforts of the place. In the largest cities it
+is not possible to know them all, but she should know about some
+of the settlement work, the day nurseries, the babies' hospitals,
+the rescue work, the homes for aged. Of course she will know about
+the hospitals and dispensaries, but what is done for the poor, the
+ignorant, the sinful, and the stranger--these she should learn.
+Many times she could do much to help these institutions, by
+relating, simply and truthfully, when occasion offers, what she
+has seen, of the great needs of such efforts, and the heroic work
+of those who go down and live amongst the needy and try to uplift
+them. Many a rich, idle patient might become interested and give
+money, if not time, to help in these good works; and my experience
+shows that they generally need all the help they can get. So the
+nurse should know about the anti-tuberculosis work, the night
+schools, the playgrounds on the roofs of the school-houses, all
+the philanthropic work of her town, and she cannot know about it
+unless she takes some of her vacant days, her days of waiting, and
+turns them into days of learning, and the expansion of both her
+mind and her heart.
+
+Another pleasant way to spend some days of waiting is to study the
+trolley system of the town where you live. Learn how far it can
+go, to how many other towns. If a river is near, become familiar
+with its steamboats. Excursions on boat or trolley will be
+delightful, and will teach the best routes, the best terminal
+stations, and the best restaurants, and some day when a patient is
+well enough to take an excursion, some part of his own immediate
+neighborhood may be shown him which he has never seen before.
+Believe me, all this will be appreciated. Space fails me to tell
+of music to be heard, theatres to be enjoyed, and all to be used
+hereafter for the benefit of those to whom you will be called to
+minister. The information constantly gathered in the "days of
+waiting," rightly used, intelligently imparted to the patient or
+her friends, will make of the nurse such a broad-minded,
+sympathetic woman that everyone who employs her will appreciate
+the fact that she has a wide culture, and brings to her patient
+something besides mere technical skill.
+
+
+
+
+XI
+
+SOME HINTS FOR THE OBSTETRICAL NURSE
+
+THE BABY'S WARDROBE.
+
+
+When a nurse goes to see a woman who wishes to engage her, some
+months hence, to care for her baby and herself, it is very nice to
+be able to give her, should she ask, a list of all the things she
+will need, both for her own comfort and the baby's.
+
+The following is a good sensible wardrobe, and will be found
+ample, though many articles more or less fanciful will, most
+probably, be added by friends. The things enumerated below should
+last the baby until he is put into short clothes:
+
+Slips, 10. Dresses, 8 to 10. Pinning blankets, 4. Flannel skirts,
+4. White skirts, 5. Shirts, 4. Bands, plain flannel, 4. Bands,
+Jersey made, 4. Diapers first size, 17 inches square, 20. Diapers
+second size, 20 inches square, 30. Diapers third size, 26 inches
+square, 30. Knitted blankets, plain white, 2; if with any color, 4
+to 6. Knitted sacques, 4 (two sizes). Little pillow (hair), 6
+cases. Crib sheets, 6. Crib blankets, 2.
+
+FOR BASKET.
+
+Two small gold safety pins. Large safety pins, I box. Small safety
+pins, i box. Powder box and puff. Coudreay's powder. Small box of
+equal parts borax and powdered sugar. Old damask towels. One cake
+old white castile soap, or Colgate's nursery soap. One bottle
+unscented vaseline. As many sachets as you can get. Some few yards
+of the narrowest ribbon, pink and blue. Two old handkerchiefs. One
+lap protector. Brush and comb. Absorbent cotton.
+
+FOR THE MOTHER.
+
+All the old sheets in the house. Rubber sheet, double width. A
+square of rubber sheeting single width. An old comforter.
+[Footnote: When the Kelly pad is used for the delivery, the
+old comfortable, the blankets and the single width rubber
+sheet need not be provided.]Two or three old blankets. Fountain
+syringe. Paper basin. Towels ad libitum. Six or seven night
+dresses, three of them old. Undershirts, if worn in bed, 4
+(large). Bandages, 6. Cheese cloth, 10 yards. Absorbent cotton, 2
+lbs. A large flannel sacque, or a nightingale. Soft unbleached
+muslin, 2 or 3 yards. Colgate's fumigating wafers, I box. Bedpan,
+I.
+
+Layettes can be purchased at any good department store, but many
+expectant mothers prefer to make all the clothes for the little
+one. These lists are for the benefit of these mothers.
+
+These look, perhaps, like two very formidable lists, but a second
+glance will convince any one that all these articles are
+absolutely necessary, and none of them are expensive.
+
+The slips should be made very plainly. The material may be as fine
+as can be bought, but beyond a few tucks about the yoke, and a
+little lace or fine embroidery about neck and sleeves, should be
+perfectly plain. The dresses, of course, are somewhat more
+elaborate, but the fashion now decrees that infant's clothing
+shall be perfectly plain, and a most sensible fashion it is.
+Pinning blankets are open all down the front, and are usually made
+in the shops with a broad band of stiff white muslin, which shows
+that the people who made them never tried to dress a baby. The
+band should be of flannel or coarse linen many times washed so
+that it may be soft, and the pins will go through many folds of
+it. Flannel skirts are usually made of two breadths of flannel,
+and are more or less embroidered. These are not left open, except
+just enough to make the dressing easy. Shirts are made so well in
+stores that few people care to knit them. They should always be
+high in the neck and long sleeved, and it is better to get two
+sizes, as, if the baby is small, it never can be comfortable in a
+large shirt that does not fit.
+
+The four flannel bands should be 6 inches wide by 17 or 18 long,
+torn the length way of the flannel and left just as torn. Not
+hemmed or ornamented in any way. No hemming or stitching can be so
+fine that it will not mark the baby's flesh. Besides this, if you
+have these plain bands and find they are several inches too big,
+nothing is easier than tearing off a strip and making them fit. If
+the child has a very large, round abdomen, they can be made to fit
+over it nicely by taking two little tucks on the lower edge, about
+half an inch from the middle of the band, and letting the tucks
+run up about an inch or a little more, tapering it off gradually.
+When these are discarded and the Jersey made bands are put on,
+always put them on the baby feet first, as it is hard to get them
+over the shoulders.
+
+The very best material for the first small diapers is old, soft
+table damask. The better the quality, the softer it will be; be
+sure they are exactly square. Nothing is more trying, in a small
+way, than to get a diaper that cannot be folded true. These should
+be made double and the edges turned in and sewed around. By the
+time the baby has outgrown them they will be fit only for the rag-
+bag, and may be thrown aside. The second size diaper, also the
+third should be many times washed to make them soft enough for
+use. These may be used at first folded eight times and put under
+the baby next the damask diaper, between that and the pinning
+blanket, and will often save the nurse the trouble of changing the
+baby's clothing, because it is wet through. In this way they will
+get more washings and be softer when you have to use them next the
+baby's skin.
+
+Cotton flannel, with a good nap and not a very close web, is very
+good also and can be used instead of the damask where that cannot
+be procured. Put it on with the nap next the skin. It is an
+excellent absorbent.
+
+The baby should have at least one little (rather flat) hair
+pillow, covered on one side with blue or pink silk, on the other
+with plain white over the ticking. The prettiest pillow cases I
+ever saw were made of broad hemmed pocket handkerchiefs. Two sewed
+neatly together round three edges, and on the fourth button holes
+for mother-of-pearl studs. The handkerchiefs may be fine or not,
+embroidered or plain, and may have lace sewed on the edge, but
+they can't help being pretty, and the embroidery will never be in
+the middle. I shall never forget my pity for one poor little mite
+I saw once, who, on waking from his sleep, was discovered to have
+the print of an embroidered S on his cheek. It had been worked in
+the centre of the little pillow case by some loving but ignorant
+hands. When the baby uses the pillow, let him sleep on the white
+side; at other times turn up the colored side and the pink or blue
+will show very prettily through the linen. If you let the child
+sleep on the colored side he may, most likely will, vomit some
+sour milk on it, sooner or later, and the beauty of your pillow
+will be gone.
+
+If the regular little crib blankets are thought too expensive, a
+very good substitute may be made from white eiderdown cloth, which
+is warm, soft, and not at all costly.
+
+The gold safety pins are intended for the final pinning of the
+dress in the front and in the back. Of course any little
+ornamental baby pin answers the purpose just as well, and, indeed,
+an ordinary safety pin will do should no other be at hand.
+
+The little box of equal parts of borax and sugar should not be
+forgotten. Mix the two very thoroughly, and if any little white
+aphthous spots appear on baby's lips, tongue or cheeks, apply a
+little of this mixture several times a day, and they will probably
+all be gone by night. Put it on very carefully with the tip of
+your finger slightly moistened so that some of the powder will
+adhere. Examine the baby's mouth every day for these spots. They
+are likely to appear any time after ten days or two weeks, and are
+more often seen in weak children, or those who are fed by a
+bottle. If the spots appear on a child who is taking the breast,
+the nipples are very apt to be sore. Much care, therefore, must be
+exercised in this matter.
+
+Sachets are a real luxury in the drawers of the baby's bureau.
+Atkinson's sachets are the best, though Colgate's violet is very
+delicate and pleasant. Put one or two amongst the little shirts,
+and some among the knitted blankets, but mostly have them in the
+dresses, and be sure when you take out a clean dress, or slip, to
+take the sachet and slide it into the neck of the slip that will
+be worn tomorrow. Nothing can be more attractive than a clean,
+sweetly smelling baby, and, _per contra_, nothing is more
+disgusting than a wet, sour, cold, crying baby. If he be wet and
+sour he will surely have cold feet and hands, and as surely will
+he cry. Poor little thing! It is his only way of expressing his
+opinion of the state of his toilette.
+
+It is very pretty, when the baby is fresh and clean, and has on a
+fine slip with lace edging the sleeves, to tie around the wrist,
+outside of the sleeve, a piece of pink or blue ribbon. Make a nice
+little bow and let the lace fall over the fat little hands, like a
+frill. Be careful not to tie the ribbon too tight, and keep it
+clean. If it becomes soiled or wet, take it off directly.
+
+A lap protector is made by covering a piece of rubber cloth about
+14 inches square with several thicknesses of old blanket. To cover
+this have some slips like pillow cases, of linen or cotton, plain
+or fancy, as the lady may have time or money. Slip the "protector"
+in its case, and lay it on your own, or any one else's, lap who
+wishes to hold the baby, and it perfectly protects from all
+wetting.
+
+TABLE FOR ESTIMATING THE PROBABLE DURATION OF PREGNANCY
+
+Two hundred and eighty days, forty weeks, ten lunar months, or
+nine calendar months are here estimated as the usual duration of
+pregnancy (the actual computed average being 276-2/3 days). The
+exact day of conception (_not_ the fertile coition), can
+never be accurately determined; the only date from which
+conception can be dated, and the probable confinement day
+predicted with some chance of certainty, is the first day of the
+last menstrual flow, adding to this one week (seven days) for the
+average duration of the flow (with a few days lee-way). We count
+nine calendar months forward, and have the approximate date of the
+expected confinement. The most ready method is to add seven days
+to the first day of the last menstrual flow, count back three
+months, and add one year, when we have the future date when, or
+about when, delivery may be expected.
+
+An _exact_ estimate is but guess work; errors of one or two
+weeks either way may be made by the most experienced, as in cases
+where conception occurred shortly before the next menstrual
+period, which did not then appear.
+
+The present table is constructed on the above principle, the
+second column representing the day of quickening, nineteen weeks
+after the beginning of the last menstruation, with seven days
+added; and the third column still twenty weeks later. The date of
+quickening is still more variable than that of delivery, from one
+to four weeks.
+
+Intermediate dates may be fixed by adding the necessary number of
+days to each column. Thus, for Jan. 11th, the second column should
+read 31st of May, and the third column, October 18th, and so on.
+
+Beginning
+of last
+Quickening.       Confinement.       Menstruation.
+
+
+Jan.  1st.........May   20th.........Oct.  8th.
+Feb.  1st.........June  20th.........Nov.  8th.
+March 1st.........July  18th.........Dec.  4th.
+April 1st.........Aug.  18th.........Jan.  6th.
+May   1st.........Sept. 17th.........Feb.  5th.
+June  1st.........Oct.   8th.........March 8th.
+July  1st.........Nov.  17th.........April 7th.
+Aug.  1st.........Dec.  18th.........May   8th.
+Sept. 1st.........Jan.  18th.........June  6th.
+Oct.  1st.........Feb.  17th.........July  8th.
+Nov.  1st.........March 20th.........Aug.  8th.
+Dec.  1st.........April 19th.........Sept. 7th.
+
+
+
+
+ARTICLES FOR THE MOTHER'S USE.
+
+
+Perhaps it is not necessary to say why it is better to use old
+sheets for the bed of a parturient woman, but I will repeat that
+old ones are to be preferred, and really new ones, that is, only
+once washed, never used. New towels are of course objectionable,
+as being too harsh. If the patient likes a rough towel, use a
+regular bath towel, if you can get it. Be careful, never to let
+loose and wet ends of the wash cloth drag along exposed parts of
+the body. It is a good plan to sew your wash cloth into a bag, and
+to slip your hand inside, and work with it put on like a mitten. A
+rubber or fibre sponge is to be preferred. Keep one for the face,
+neck, arms, and hands, and another for the feet and legs. The
+vulva is bathed best by means of a fountain syringe used as an
+irrigator, and a little sterilized gauze twisted around your
+dressing forceps. The gauze can be changed as often as necessary,
+and is much more satisfactory than anything else, especially if
+there has been a laceration.
+
+The square of rubber sheeting, single width, is most useful. For
+the confinement the bed should be made by first spreading over the
+mattress the wide rubber sheet, over this put an old blanket, then
+the under sheet; upon the right side of the bed, where most likely
+the woman will lie, place the square of rubber, over that the old
+comfortable, four double, and hold all in place with a sheet
+folded like a hospital "draw-sheet." This must be firmly tucked in
+at the sides under the mattress. It will seldom be found necessary
+to change the under sheet, if the bed is made this way, and the
+rubber square is drawn carefully away, with the comfortable and
+draw sheet, when it is time to make the patient clean and dry
+after the birth. It is a good plan now to tear this square in two,
+and keep one piece directly under the clean draw sheet for the
+first few days. This saves much washing.
+
+An old blanket and a small one will be found invaluable for all
+sorts of things--for example, to spread over the shoulders and
+chest when the bandage is being pinned; to warm and wrap up the
+feet and legs, if they show any signs of being cold; to cover one
+knee and part of the body when using the irrigator, which when
+there has been _any_ laceration, is a delicate piece of
+business, as every nurse knows. Always fold up this invaluable and
+constant friend, and put it in some handy but inconspicuous place;
+it _is_ a friend, and a good one; but it is not a beautiful
+object to look upon, and others not knowing its virtues would
+think you untidy if it was in a noticeable place. The fountain
+syringe is absolutely indispensable; and, though it may seem
+unnecessarily large, yet I think a four-quart bag better than any
+of the smaller sizes. To be sure, you never might need four quarts
+in the bag, but it is so much easier managed, so much less liable
+to spill over, if you have a large bag and put it only half or
+three-quarters full. Then, too, you get so much more force if you
+have more water in the bag, you need not use it all. A Davidson
+syringe is very nice for some things that a fountain syringe could
+not be used for. Oil enemas, for instance, also nutritive enemas.
+After an oil enema be sure to wash your syringe _thoroughly_
+with a strong solution of washing soda or ammonia, else you will
+find the rubber of the bulb and tubing becoming pasty, and your
+syringe will be utterly spoiled. The paper basin is very light and
+easily handled and much to be preferred to a large china affair,
+which may easily slide from warm, wet, slippery hands.
+
+I often wonder that the women of our day, who are so sensible in
+many things, should have abandoned the fashion of short night
+gowns, which our grandmothers always provided for themselves at
+these times. I remember asking one lady, when talking over what
+she would need for her first baby, and for herself, at the time of
+its birth, if she had not something short and plain that she could
+wear. She looked very thoughtful for a moment and then said that
+she thought she did have _one_ night-dress that did not have
+a ruffle or embroidery around the bottom. She could wear that. It
+certainly is not from motives of economy that our wealthy patients
+do not have these most sensible of garments. I think they know
+nothing about them, and they should have their virtues explained
+to them. A pocket could be added to this garment, I think, and it
+would be a real comfort to a woman. I know it would be to a nurse,
+who usually has to hunt up the ever missing pocket handkerchief a
+dozen times a day. Men always have pockets in their night-shirts,
+and they are not sick half as much as the women. I wonder why
+women do not imitate this most sensible custom. If your patient
+will not let you cut off any of her old night-dresses, you must
+use the long ones, of course, and change them as often as
+necessary.
+
+Bandages should always be made of soft unbleached muslin; double
+is best, though I have used them of the single fold, and hemmed,
+but they are firmer if double. They should be wide enough to come
+down to the great trochanters, and up to a place two inches above
+the umbilicus; long enough to fit the woman before she became
+pregnant. She has likely some measure, or could get it from her
+dress-maker. Women vary so much, it is hard to give an exact
+measure in inches, but you might begin with a bandage fifty inches
+long, and if the ends are too long, cut them off, and turn in the
+edges of the cloth and overhand it neatly.
+
+Obstetrical binders, or bandages are now seldom put on a
+parturient woman, but in case they are to be used, I give the best
+kind I know of. They are sometimes made to order, but I never knew
+one of these to fit, or wash well.
+
+The method of their application is of course taught in the
+schools. The nurse should always know from the doctor, or the
+prospective patient, if binders are to be worn, and instructions
+given as to how to make them. Four or six will be enough.
+
+Two or three yards of soft, unbleached muslin for breast-bandages
+should be provided in case they are needed. A six-tailed bandage
+is, I think, the best for this purpose. Tear down the first two
+"tails" to within three inches of the others, and these passing
+over the shoulders, and fastening to others, which are adjusted
+over the breasts, keep the whole bandage in place.
+
+It is not necessary to speak of the napkins or pads; these are
+universally used, and readily bought, sterilized, and ready for
+use. All sterilization is so thoroughly taught in the schools, I
+have taken proficiency in this particular for granted.
+
+There should always be a disinfectant or antiseptic of some sort
+on hand.
+
+Carbolic I-30, Platt's chlorides, permanganate of potash, or
+something that will answer the purpose; bichloride of mercury,
+etc. You must find out from the physician which he prefers, and of
+what strength.
+
+I must not forget to say that when you go to see you prospective
+patient, and she shows you the room she expects to occupy, it
+would be well to cast your eyes about for some rug, that you can,
+if necessary, turn wrong side out and spread at the side of the
+bed. Some doctors are very neat about their work, but some are--
+well, perhaps I better not say it; we must not criticise the
+doctors.
+
+But sometimes it is best to have protection for the floor, it
+gives the nurse a comfortable feeling quite beyond description to
+know, that, no matter what may happen, the carpet will not be
+ruined.
+
+
+
+
+XII
+
+AS TO WASHING THE BABY
+
+
+In the first place get together everything you will need for the
+bath and subsequent dressing. Have the clothes all laid in order
+over a chair-back before an open fireplace, or over a radiator, or
+if no better expedient suggest itself, fill bottles with hot
+water, or get a hot water bag and fill that, and lay it
+_over_ the clothes arranged in the order you will need them,
+beginning the pile with the dress and having the band the last.
+Have _two_ large, soft towels and keep them warm. If possible,
+have an apron made of rubber cloth to tie about your waist.
+At your side, on the floor, have a small blanket ready to
+lay over the rubber apron when needed. Put your baby basket where
+you can reach it, be sure that it contains all the things you will
+need--sponge, soap, powder, pins, vaseline, etc., and an extra
+diaper or two. Now get the tub (tin) and pour in the water until
+it is about four inches deep. Have the water no warmer than 100 degrees
+F. Bath thermometers are made that are quite cheap, and a great
+convenience; one should always be at hand, as no nurse should ever
+trust her feelings as to whether the water is hot enough or not.
+Always test any water to be used for the sick or the delicate with
+a thermometer. Another point a nurse should be most careful about,
+is to be careful that her hands are warm before she takes the
+baby, as her cold hands on his warm flesh will surely make him
+scream.
+
+All being now ready, take the baby and sit down with him,
+spreading the blanket over your knees as you do so, and having the
+tub just in front of you on another chair. The sponge is best to
+use for the washing, but a piece of old table damask is very good.
+Wash the eyes very carefully first, then the face, and dry on the
+towel. Now hold the baby's head over the tub and give that a good
+washing with soap on your bare hand, and rinse it well with plenty
+of water, always holding the left hand under the head and neck.
+Bring him back on your lap and thoroughly dry his head, then wash
+and dry the ears carefully.
+
+When you get this far you may undress the baby completely, being
+most careful yet not taking any unnecessary time. When he is quite
+ready for the tub, grasp him firmly with the right hand, letting
+the buttocks rest in the palm of the hand, the fingers being
+outspread, and the thumb coming up almost to the pubic bone. With
+the left hand hold the head and shoulders. Lower him _very_
+gently into the water. Any sudden movement is most injurious, as a
+baby must never cry when the band is off, if it can be avoided. He
+will often put out both hands as if trying to catch hold of
+something. If he seems frightened at the same time, and cries
+violently, let the buttocks rest on the bottom of the tub, and
+with the right hand hold both of his, and he will be comforted.
+
+I think it well to wash the whole body with your bare hand, well
+soaped. Be careful to wash under the arms, in the bend of the
+elbows, the groins, and under the knees, rinse him with the wash
+cloth or sponge, and now lay one warm towel on your lap, and take
+up the baby just as you put him in, slowly, and without shock, and
+lay him in the warm towel. Lay the second one over him, and draw
+over all the blanket, wrapping him up warm and snug. Put your hand
+inside the blanket and dry him. This can be easily and quickly
+done without at all uncovering the child. Pass the hand with a
+slight squeezing movement over each arm and leg, and over the
+front of the body. When this is done, you must undo the blanket,
+and take the upper towel and dry most carefully all the creases,
+and powder everywhere, especially if he is very fat. Get down to
+the very bottom of every crease, and be sure it is dry and
+powdered. Lay over the navel a compress of absorbent cotton,
+unless the child is over four weeks old, and over this the band,
+which should be unhemmed, and wide enough to extend from the hip
+to the armpit. Lay the palm of your right hand firmly over band
+and pad and turn the child carefully, holding your right hand
+still under him, and with the left, clear away all damp towels,
+and then straighten out the band that is wrinkled under one side.
+Keep your knees close together. Now take away the right hand, and
+see that the baby's knees are on the right side of your knee, and
+the elbows well over the other side of your lap. Now you have the
+baby where he can kick, but he can't wriggle or spring off your
+lap. See that the back is dry, rub it a little with your hand, and
+powder. Look carefully in the deep dimple just at the coccyx and
+see if it is clean. Now pin the band snugly, but not too tight.
+Use the smallest safety pins, and never pin directly over the
+spine. Sometimes the abdomen is very large and it will be
+necessary to make two little tucks in the lower edge of the band
+in front to make it fit snugly.
+
+While the baby is still on his stomach, lay in place the diaper,
+and next the shirt, which should be open in the front, and the
+pinning blanket. Lay all of these just as they should be, as
+regards the back, and turn him, being careful to hold all the
+clothes in place. If he is liable to chafe, or the movements of
+the bowels are in any way irritating, use vaseline about the
+buttocks. Now put the arms in the shirt sleeves and tie or button
+it up, and then pin the petticoat or pinning blanket. Lay an extra
+diaper folded many times under him, and fold the pinning blanket
+just in three, bring the hem up to the waist and pin in place.
+
+The dress goes on feet first. Slip it on over the pinning blanket,
+and pass the right hand up under the buttocks, and with the left,
+pull the dress into place, put the little hands in the sleeves,
+and get it perfectly straight and smooth over the chest. Now pass
+the fore-finger of the left hand down inside of all the clothes,
+beginning at the neck, until you find the band (the first
+garment), take a small safety pin or any small ornamental pin, and
+pin thoroughly through everything. This last pin I consider most
+necessary, as it keeps the dress, shirt, band and all in place.
+Turn the baby over once more and put a similar pin in the back of
+the dress, being very careful to get at the band. While the baby
+is in this position put the blanket he wears during the day over
+him, and a final turn brings him around, and he is washed and
+dressed all but his mouth, which must be carefully washed with
+clean, warm water or borax and water. This should be also done
+many times each day, if the mouth is sore, and always a sharp
+watch kept for white patches on lips, cheeks and tongue. If the
+baby has hair to brush, it is well to brush it. It makes him look
+very cunning, but if he is tired or sleepy, do not trouble him.
+This washing and dressing should not occupy more than twenty
+minutes, I have done it in fifteen where the baby was very well
+behaved.
+
+Be sure that the room is warm and that the windows and doors are
+kept closed. Do not allow admiring relatives to come and go,
+opening and shutting the doors as they do so. If they want to see
+the operation, let them come and stay. A baby should never be
+bathed in a tub until the stump of the cord is off and the navel
+well and strong. If there is any inclination to pouting of the
+navel, wash the child on your lap and do not take off the band
+until the rest of the baby is all washed, dried, and powdered.
+Then take off band and compress, and put on fresh ones as quickly
+as possible, turn the child and pin as before directed.
+
+In taking the clothing off, it is not necessary to turn the child
+at all, the band being the only thing pinned in the back.
+
+N. B.--This method of bathing is for a normally healthy child,
+from the time it is one week old, until it is six months or more.
+
+Until the stump of the cord has sloughed off, a baby should never
+be put into the tub. If after the stump has sloughed there seems
+to be any protrusion, or indeed any ulcerated look about the
+naval, it is best to bathe the child on your lap. In all such
+cases undress the baby as previously directed, until you come to
+the band (flannel belly band). Wash, rinse, wipe and powder him,
+being careful to make every part absolutely clean and dry. If the
+band is soiled or wrinkled, or out of shape in any way, remove it
+and put on a fresh one--looking every day, after three days, to
+see if the stump has come off--and if it is still adherent, being
+most careful not to disturb it in any way. Apply the fresh band
+immediately. Turn the baby on its stomach, and when the back is
+exposed, wash and rub the back gently with your warm hand. If the
+band does not need changing, unpin it, rub the back, pin it up
+again, and proceed in dressing as before. When the cord is once
+fairly off, and the navel smooth and clean, you can put the baby
+into the tub, very gently, slowly, and cautiously, remembering
+that a sudden movement on your part may, in fact, always will make
+him scream, and screaming with no band or compress on is for a
+baby a very frequent cause of umbilical hernia. If the cord is
+small when the child is born, there will be less danger of hernia,
+but if it be a large one, then beware! It will not always be your
+fault if the baby's navel is not small and flat when you are
+leaving your case, but you will always be blamed for it, if it is
+not. Notice carefully every morning when you bathe the child if
+there is any umbilical protrusion, and report it without delay to
+your doctor, if there is any, no matter how slight. This is not,
+however, the place to treat of umbilical hernia, and we will go on
+with the washing, If the child's skin is very tender, chafing
+easily, wash with castile soap suds, rinse and dry carefully,
+after every time he urinates, as well as when you bathe him.
+Powder with talcum powder. Sometimes no powder will do it any
+good, then try vaseline. If that will not do, ask the doctor if
+you can try oxide of zinc ointment. Ordinarily, extreme care in
+washing, drying and powdering will be sufficient, but it must be
+done every time the diaper is changed. In this, as in other
+things, eternal vigilance is absolutely necessary.
+
+When the baby is about two or three weeks old, it is a good plan
+to put some alcohol into the water in which he is bathed--two or
+three ounces to the amount of water used in bathing. Have a small
+bowl of cooler water, 70 degrees to 80 degrees, for the face, and
+after that is washed, add a tablespoonful of alcohol to that also,
+for the head. It helps to toughen the skin, and prevents the baby
+from taking cold so easily.
+
+If the baby seems much frightened by being put into the tub,
+spread a bath towel or small thin blanket over it and have someone
+hold his hands, so that he will not clutch so wildly at
+everything, then lower him into the water, towel and all, and he
+will not notice it so much.
+
+I know of no place where deftness of handling shows to such
+advantage as with a baby. He knows well enough if he is handled
+properly or not, and his fretful cry, or violent screams, will
+tell you without delay if he is not comfortable.
+
+Once more, let me impress upon the minds of all who read this, the
+necessity of having everything used about the tub and subsequent
+dressing, warm. Anything cold will make the little one scream, and
+I think all nurses will agree with me, that there is no more
+nervous work than washing and dressing a baby who is crying (and
+once he begins, he is only too apt to keep it up during the entire
+time). This is especially true if a weak, ignorant mother is made
+nervous by the noise, or a doting grandmother hovers about, making
+remarks about "new fashioned ways," and wondering why this child
+should cry when his mother was always so good, as a baby, in her
+bath.
+
+Now, as to the time of washing a baby. The morning is
+unquestionably the time, but if the baby be very young (less than
+two weeks) and has been wakeful during the night, I would let him
+have his nap, even if it did delay you and interfere with your
+plan of work. If he sleeps he is comfortable, and, unless for some
+more serious reason than the bath, he ought not to be disturbed.
+This, for babies in private practice. Hospital babies cannot be so
+tenderly cared for. When there are ten or eleven to be washed in
+one morning, choose, of course, the ones that are awake, as far as
+you can, but there will always be one or two sleepy, warm little
+ones about whom you will have some twinges of conscience as you
+begin to wash their faces, but the work presses so, it must be
+done.
+
+A baby should not be bathed just after nursing, or when he is
+hungry. Yet, most little babies go to sleep at the breast, and
+very often do not waken until they are once more ready for eating.
+This seems like stating a difficult problem, and I know it is not
+always easy to select just the proper time, but the best way, I
+think, is this.
+
+If the baby is nursing from the breast, tell the mother, after
+this nursing you wish to wash the child, and not to let him go off
+for sound sleep. She can prevent it, and keep him for the twenty
+minutes or half an hour it is necessary to wait after his meal,
+meantime you have time to get everything in readiness for the
+bath. It is a great mistake to attempt to bathe a baby when he is
+hungry. He will scream for his food from the beginning to the end
+of the performance, hesitating occasionally when something warm
+touches his mouth, and he eagerly seeks his meal, only to redouble
+his cries when not satisfied. Nothing is so persevering in its
+endeavors, as a hungry baby. Satisfy its appetite first and wait a
+reasonable length of time, wash him deftly and quickly, and he
+will be so sleepy by the time you are through, you can lay him in
+his bed and he will be asleep in a moment, when you can pick up
+all the soiled clothing and the general "mess" of the bathing
+operation, and leave the room once more tidy.
+
+And just here, let me say a little about the washing of the baby's
+clothes. Of course the dresses or slips, skirts, and the diapers
+go to the laundress. Begin every morning on an entirely new, that
+is newly-washed, set of diapers. Gather up all that have been used
+the past twenty-four hours and have them washed. Perhaps they may
+not be ironed, but washed they should be, every twenty-four hours,
+even if you have to do it yourself, and I do not think a nurse
+should ever be called upon to do this. Still, I would rather do it
+than use a diaper over and over again.
+
+But it is of the little shirts I particularly wish to speak. I
+think the nurse should wash these, also the socks when they need
+it, and the knitted shawls most babies wear. It takes very little
+time to do this, and if you know how, you will do it much better
+than any laundress. The best way to wash these things is in cool
+borax water, and if there is any one place the baby has vomited
+on, put a little dry powdered borax on (the place being wet), and
+rub it in. Then wash by plunging it in the water and squeezing it
+out. Do this again and again until the garment is clean. Rinse in
+clear cool water, and wring as dry as possible in a towel; then
+pull in shape and lay it on a clean towel to dry. It is a good
+plan to lay it on a folded towel over a half shut register and
+place a single fold of towel over. It will dry very soon. If you
+are washing a baby's knitted shawl, be very careful about the
+wringing. Lay a large towel (bath towel is the best) out flat,
+and, having squeezed the most of the water from the blanket, lay
+it carefully on the towel and roll both together, and wring very
+tightly. If this towel gets wet take a second. When you are
+satisfied that it is as dry as you can make it, lay it out on a
+folded sheet on the floor, in some room not much used, and pull
+and arrange it into its original shape and size.
+
+Anything made of Germantown wool stretches terribly, but you can
+arrange it as it ought to be. It will look ruffly here and there
+and ridgy all over, but when it is dry it will shrink down all
+right. Only do not hang it up, and when it is dry you will be
+surprised to find it looks as good as new. If you are ever
+consulted beforehand as to what would be nice for the baby, use
+all your eloquence against _any_ color being put into these
+knitted shawls. Germantown wool is the best to use, and plain
+knitting or brioche stitch is the best to wear and wash, and these
+things must be washed with the most careful handling. On the
+nicest baby they will become dirty, and the delicate blues and
+pinks become the dismalest wrecks when washed. Therefore, tell
+your patient not to put any color in these first plain little
+comfortable shawls. They should be a yard long by about three-
+quarters wide. Two or three will be all you will need, and do not
+use any of the fancy blankets sent in by friends. Lay these all
+away, with a sachet bag or two, in some convenient drawer, and
+never take them out unless the baby is required to look very fine
+for a brief display to some friend. These delicate, fancy trifles
+when once wet through or vomited on are ruined, and it should be
+your aim to leave everything as good as you found it when you go
+from the house. There will be plenty of time after you have left,
+for the fond mamma to spoil all the pretty things, and as she does
+so she will appreciate more and more your care of them.
+
+
+
+
+XIII
+
+THE VALLEY OF THE SHADOW
+
+
+I suppose that no nurse deliberately chooses to go to an incurable
+case, yet most of us who have done private nursing have found
+ourselves at some time caring for one who slowly, and painfully,
+creeps nearer day by day to the great End. We have gone perhaps to
+stay a few weeks, for some acute disease, but symptoms have
+changed, and instead of recovery, a long, slow decline is to be
+faced, the nurse feeling she is needed, decides to stay and do
+what she can for the poor failing body, and so the weeks drag on
+in the dreadful monotony of that one sick room, until we feel that
+we have been left out of the real nursing world, that we are
+stranded with our patient upon an island of pain, that there is no
+outlook but the one dread Valley, no moving object but the river
+of Death, and no hope for the life we are guarding. Each week we
+grow more and more rusty as to our hardly-won surgical technic,
+more out of touch with those who come and go to one patient after
+the other, and who not unnaturally count upon so and so many
+victories over the very enemy who we know will overcome the life
+we are fighting to save. Yet we realize that all our care will
+never bring victory, all our skill can but help to smooth the
+rugged pathway, down which the feet must tread alone. The endless
+repetition of the same symptoms is wearying, the only possible
+variation being some new pain, which indicates another stage in
+the development of the disease. An improvement hardly cheers us,
+as we know it is but temporary, and maybe followed by an
+exacerbation of the trouble.
+
+Often the actual nursing calls but for a portion of the day, but
+that portion is so necessary that the nurse's presence is
+imperatively demanded. The remainder of the time little is to be
+done, except perhaps a guard maintained over the failing strength,
+a watch kept for untoward accidents that might snap the frail
+thread that binds the spirit still to earth. Probably the bedroom
+must be kept tidy, and the patient's clothing cared for, and the
+nurse feels she has degenerated into a servant.
+
+One who has gone through with an experience like this, and who has
+courageously remained with her patient to the end, has passed
+through a training more severe than any she has had in her
+hospital life, and she has earned a new diploma.
+
+There are some things which the nurse may do to lighten these dark
+days, some things which may help both herself and her patient, and
+these I will try to show.
+
+_Firstly_, it is well to study your case from a pathological
+view point. Find out the heredity, the manner of the daily life,
+the first manifestation of the disease, what circumstances led to
+it, how it was treated, what success the treatment seemed to have,
+what symptoms can now be noted, what complications have shown
+themselves, and their influence on the original disease. A careful
+history could be written embracing all of these points, and as new
+symptoms appear they should be observed and noted. All this should
+be valuable and should help some future day to show some one who
+has but started on the dreaded pathway, how to avoid what will
+surely be a fatal disease. Many a valuable paper could be written
+in the long hours when the nurse feels she is losing her time, if
+she would intelligently study her case, and write the story of the
+disease, what led to it, and how it is being combated.
+
+Perhaps, if it could be arranged, the nurse might be spared part
+of a day once or twice a week, and she could go to her hospital
+out patient department, or to some dispensary and do some work
+that carries a little feeling of success with it; work in a babies
+milk station, or almost any of the numerous charitable activities,
+would rest and refresh one who has for months been with the same
+patient.
+
+_Secondly_, as a psychological study. We all know we must
+die, we feel that we talk to people every day who perhaps will not
+be alive a twelvemonth hence; but we are not actually certain that
+ourselves or any of our friends will so soon be dead, and we
+habitually act and speak as if we all were to live on indefinitely.
+So to be closely associated with some one who we know is
+drawing closer and closer to the life beyond the grave, is a
+very solemn thing; whether the sick one knows it or not, the
+nurse knows it, and such an one must be viewed with peculiar
+interest.
+
+She is so near to knowing the great Mystery. She will so soon see
+those who have gone before. The present helplessness will so
+marvelously become Life Everlasting. It seems, as the end comes
+nearer, and yet more near, as if, perhaps, one could send a
+message to some of our own loved ones gone on before, "If you see
+some of my dear ones, on that other shore, bear them a loving
+greeting from me, tell them I am trying to live as they would have
+me live." Such a thought trembles on the tongue, so near does the
+unseen seem to come to us.
+
+In the face of these things, how small do the thoughts of our own
+dignity seem. It is all _service_, and service is what we
+were made for.
+
+"I pass this way but once, if, therefore, there is _any_
+service I can perform for my fellow man let me do it now, for I
+shall not pass this way again." This quotation is familiar to all,
+and especially does it come to mind when we minister to those who
+are to die. When they are gone there will be no bringing them back
+to explain duties slighted or left undone. "We pass this way but
+once."
+
+_Thirdly_, from a religious point of view. It is quite
+impossible to say, what exactly is the nurse's duty as regards the
+religious side of her ministration, though the wish to help must
+be often in the mind of every thoughtful nurse who has charge of
+an incurable case.
+
+The patient may not know her condition, and the doctor may not
+wish her to be told, then, of course, the nurse's lips must be
+sealed, as to any allusion to the dread truth. The religious views
+of the patient and her friends may be different from anything that
+the nurse knows, or perhaps the family pastor comes frequently,
+and instructs and comforts the sick one, and the family.
+
+A patient will sometimes _ask_ for the reading of some
+portion of the Bible, and unless the part is specified the nurse
+may be at a loss just where to turn. Some parts of the Scriptures
+are so generally known and accepted, that they can hardly fail to
+give hope and comfort, no matter what the religious teaching may
+have been heretofore.
+
+I will suggest then _in case_ readings are asked for. The
+Psalms are full of beautiful comforting thoughts and prayers. The
+23d has helped many a poor soul about to take its last journey,
+the 37th, which begins "Fret not thyself," shows that those are
+truly blessed who trust in the Lord, the 51st, "Have mercy upon
+me, O God," teaches repentance, the 42d, "As the hart pants after
+the water-brooks, so longeth my soul for Thee, O God," shows the
+desire of the soul for God.
+
+In the New Testament, the 14th chapter of St. John's gospel is a
+universal favorite, on account of its comforting thoughts "In my
+Father's house are many mansions." In St. Luke's gospel chapter
+15th, verse 11, we have the parable of the Prodigal Son, to show
+how complete and perfect is God's love, and His forgiveness, when
+sin is forsaken. In 1st Corinthians, 15th chapter, verse 20, we
+have a masterly argument for the resurrection from the dead, and a
+life beyond the grave. In Revelations, 14th chapter, 13th verse,
+is a very comforting thought for those who have led a strenuous
+life and are in much suffering.
+
+These few references will help, I hope, if any nurse is called
+upon to read the Bible, and she feels a little nonplussed as to
+exactly where to turn.
+
+There are of course innumerable passages besides these, that could
+be found by the aid of a concordance, and which it would be wise
+to note on a slip of paper, ready for any call. Sometimes a
+patient will ask for a prayer, and it is not often that a nurse
+would feel competent to kneel down by the bedside and make an
+acceptable extemporaneous prayer, so I would suggest buying a
+volume of "Prayers for the Sick."
+
+Very tiny, dainty little books can be purchased at the church book
+stores, full of these prayers.
+
+In the Episcopal Book of Common Prayer are many helpful prayers.
+
+The sentence, the collect, and the whole of the Easter service in
+this book are radiant with the truths of the Resurrection, and the
+Easter hymns are tuned to the same inspiring theme.
+
+This last thought I leave with you. What more helpful
+consideration can come to a weary nurse, than that the sick one to
+whom she has ministered for so many weeks or months should at
+last, on entering in to the life Eternal, lay before the Lord of
+Glory, the name of the one who was with her, who helped her, who
+cared for her, and who was faithful to her trust to the end?
+
+
+
+
+
+End of the Project Gutenberg EBook of Making Good On Private Duty
+by Harriet Camp Lounsbery
+
+*** END OF THE PROJECT GUTENBERG EBOOK MAKING GOOD ON PRIVATE DUTY ***
+
+This file should be named 6361.txt or 6361.zip
+
+Produced by Ralph Zimmerman, Charles Franks
+and the Online Distributed Proofreading Team.
+
+Project Gutenberg eBooks are often created from several printed
+editions, all of which are confirmed as Public Domain in the US
+unless a copyright notice is included.  Thus, we usually do not
+keep eBooks in compliance with any particular paper edition.
+
+We are now trying to release all our eBooks one year in advance
+of the official release dates, leaving time for better editing.
+Please be encouraged to tell us about any error or corrections,
+even years after the official publication date.
+
+Please note neither this listing nor its contents are final til
+midnight of the last day of the month of any such announcement.
+The official release date of all Project Gutenberg eBooks is at
+Midnight, Central Time, of the last day of the stated month.  A
+preliminary version may often be posted for suggestion, comment
+and editing by those who wish to do so.
+
+Most people start at our Web sites at:
+https://gutenberg.org or
+http://promo.net/pg
+
+These Web sites include award-winning information about Project
+Gutenberg, including how to donate, how to help produce our new
+eBooks, and how to subscribe to our email newsletter (free!).
+
+
+Those of you who want to download any eBook before announcement
+can get to them as follows, and just download by date.  This is
+also a good way to get them instantly upon announcement, as the
+indexes our cataloguers produce obviously take a while after an
+announcement goes out in the Project Gutenberg Newsletter.
+
+http://www.ibiblio.org/gutenberg/etext03 or
+ftp://ftp.ibiblio.org/pub/docs/books/gutenberg/etext03
+
+Or /etext02, 01, 00, 99, 98, 97, 96, 95, 94, 93, 92, 92, 91 or 90
+
+Just search by the first five letters of the filename you want,
+as it appears in our Newsletters.
+
+
+Information about Project Gutenberg (one page)
+
+We produce about two million dollars for each hour we work.  The
+time it takes us, a rather conservative estimate, is fifty hours
+to get any eBook selected, entered, proofread, edited, copyright
+searched and analyzed, the copyright letters written, etc.   Our
+projected audience is one hundred million readers.  If the value
+per text is nominally estimated at one dollar then we produce $2
+million dollars per hour in 2002 as we release over 100 new text
+files per month:  1240 more eBooks in 2001 for a total of 4000+
+We are already on our way to trying for 2000 more eBooks in 2002
+If they reach just 1-2% of the world's population then the total
+will reach over half a trillion eBooks given away by year's end.
+
+The Goal of Project Gutenberg is to Give Away 1 Trillion eBooks!
+This is ten thousand titles each to one hundred million readers,
+which is only about 4% of the present number of computer users.
+
+Here is the briefest record of our progress (* means estimated):
+
+eBooks Year Month
+
+    1  1971 July
+   10  1991 January
+  100  1994 January
+ 1000  1997 August
+ 1500  1998 October
+ 2000  1999 December
+ 2500  2000 December
+ 3000  2001 November
+ 4000  2001 October/November
+ 6000  2002 December*
+ 9000  2003 November*
+10000  2004 January*
+
+
+The Project Gutenberg Literary Archive Foundation has been created
+to secure a future for Project Gutenberg into the next millennium.
+
+We need your donations more than ever!
+
+As of February, 2002, contributions are being solicited from people
+and organizations in: Alabama, Alaska, Arkansas, Connecticut,
+Delaware, District of Columbia, Florida, Georgia, Hawaii, Illinois,
+Indiana, Iowa, Kansas, Kentucky, Louisiana, Maine, Massachusetts,
+Michigan, Mississippi, Missouri, Montana, Nebraska, Nevada, New
+Hampshire, New Jersey, New Mexico, New York, North Carolina, Ohio,
+Oklahoma, Oregon, Pennsylvania, Rhode Island, South Carolina, South
+Dakota, Tennessee, Texas, Utah, Vermont, Virginia, Washington, West
+Virginia, Wisconsin, and Wyoming.
+
+We have filed in all 50 states now, but these are the only ones
+that have responded.
+
+As the requirements for other states are met, additions to this list
+will be made and fund raising will begin in the additional states.
+Please feel free to ask to check the status of your state.
+
+In answer to various questions we have received on this:
+
+We are constantly working on finishing the paperwork to legally
+request donations in all 50 states.  If your state is not listed and
+you would like to know if we have added it since the list you have,
+just ask.
+
+While we cannot solicit donations from people in states where we are
+not yet registered, we know of no prohibition against accepting
+donations from donors in these states who approach us with an offer to
+donate.
+
+International donations are accepted, but we don't know ANYTHING about
+how to make them tax-deductible, or even if they CAN be made
+deductible, and don't have the staff to handle it even if there are
+ways.
+
+Donations by check or money order may be sent to:
+
+Project Gutenberg Literary Archive Foundation
+PMB 113
+1739 University Ave.
+Oxford, MS 38655-4109
+
+Contact us if you want to arrange for a wire transfer or payment
+method other than by check or money order.
+
+The Project Gutenberg Literary Archive Foundation has been approved by
+the US Internal Revenue Service as a 501(c)(3) organization with EIN
+[Employee Identification Number] 64-622154.  Donations are
+tax-deductible to the maximum extent permitted by law.  As fund-raising
+requirements for other states are met, additions to this list will be
+made and fund-raising will begin in the additional states.
+
+We need your donations more than ever!
+
+You can get up to date donation information online at:
+
+https://www.gutenberg.org/donation.html
+
+
+***
+
+If you can't reach Project Gutenberg,
+you can always email directly to:
+
+Michael S. Hart <hart@pobox.com>
+
+Prof. Hart will answer or forward your message.
+
+We would prefer to send you information by email.
+
+
+**The Legal Small Print**
+
+
+(Three Pages)
+
+***START**THE SMALL PRINT!**FOR PUBLIC DOMAIN EBOOKS**START***
+Why is this "Small Print!" statement here? You know: lawyers.
+They tell us you might sue us if there is something wrong with
+your copy of this eBook, even if you got it for free from
+someone other than us, and even if what's wrong is not our
+fault. So, among other things, this "Small Print!" statement
+disclaims most of our liability to you. It also tells you how
+you may distribute copies of this eBook if you want to.
+
+*BEFORE!* YOU USE OR READ THIS EBOOK
+By using or reading any part of this PROJECT GUTENBERG-tm
+eBook, you indicate that you understand, agree to and accept
+this "Small Print!" statement. If you do not, you can receive
+a refund of the money (if any) you paid for this eBook by
+sending a request within 30 days of receiving it to the person
+you got it from. If you received this eBook on a physical
+medium (such as a disk), you must return it with your request.
+
+ABOUT PROJECT GUTENBERG-TM EBOOKS
+This PROJECT GUTENBERG-tm eBook, like most PROJECT GUTENBERG-tm eBooks,
+is a "public domain" work distributed by Professor Michael S. Hart
+through the Project Gutenberg Association (the "Project").
+Among other things, this means that no one owns a United States copyright
+on or for this work, so the Project (and you!) can copy and
+distribute it in the United States without permission and
+without paying copyright royalties. Special rules, set forth
+below, apply if you wish to copy and distribute this eBook
+under the "PROJECT GUTENBERG" trademark.
+
+Please do not use the "PROJECT GUTENBERG" trademark to market
+any commercial products without permission.
+
+To create these eBooks, the Project expends considerable
+efforts to identify, transcribe and proofread public domain
+works. Despite these efforts, the Project's eBooks and any
+medium they may be on may contain "Defects". Among other
+things, Defects may take the form of incomplete, inaccurate or
+corrupt data, transcription errors, a copyright or other
+intellectual property infringement, a defective or damaged
+disk or other eBook medium, a computer virus, or computer
+codes that damage or cannot be read by your equipment.
+
+LIMITED WARRANTY; DISCLAIMER OF DAMAGES
+But for the "Right of Replacement or Refund" described below,
+[1] Michael Hart and the Foundation (and any other party you may
+receive this eBook from as a PROJECT GUTENBERG-tm eBook) disclaims
+all liability to you for damages, costs and expenses, including
+legal fees, and [2] YOU HAVE NO REMEDIES FOR NEGLIGENCE OR
+UNDER STRICT LIABILITY, OR FOR BREACH OF WARRANTY OR CONTRACT,
+INCLUDING BUT NOT LIMITED TO INDIRECT, CONSEQUENTIAL, PUNITIVE
+OR INCIDENTAL DAMAGES, EVEN IF YOU GIVE NOTICE OF THE
+POSSIBILITY OF SUCH DAMAGES.
+
+If you discover a Defect in this eBook within 90 days of
+receiving it, you can receive a refund of the money (if any)
+you paid for it by sending an explanatory note within that
+time to the person you received it from. If you received it
+on a physical medium, you must return it with your note, and
+such person may choose to alternatively give you a replacement
+copy. If you received it electronically, such person may
+choose to alternatively give you a second opportunity to
+receive it electronically.
+
+THIS EBOOK IS OTHERWISE PROVIDED TO YOU "AS-IS". NO OTHER
+WARRANTIES OF ANY KIND, EXPRESS OR IMPLIED, ARE MADE TO YOU AS
+TO THE EBOOK OR ANY MEDIUM IT MAY BE ON, INCLUDING BUT NOT
+LIMITED TO WARRANTIES OF MERCHANTABILITY OR FITNESS FOR A
+PARTICULAR PURPOSE.
+
+Some states do not allow disclaimers of implied warranties or
+the exclusion or limitation of consequential damages, so the
+above disclaimers and exclusions may not apply to you, and you
+may have other legal rights.
+
+INDEMNITY
+You will indemnify and hold Michael Hart, the Foundation,
+and its trustees and agents, and any volunteers associated
+with the production and distribution of Project Gutenberg-tm
+texts harmless, from all liability, cost and expense, including
+legal fees, that arise directly or indirectly from any of the
+following that you do or cause:  [1] distribution of this eBook,
+[2] alteration, modification, or addition to the eBook,
+or [3] any Defect.
+
+DISTRIBUTION UNDER "PROJECT GUTENBERG-tm"
+You may distribute copies of this eBook electronically, or by
+disk, book or any other medium if you either delete this
+"Small Print!" and all other references to Project Gutenberg,
+or:
+
+[1]  Only give exact copies of it.  Among other things, this
+     requires that you do not remove, alter or modify the
+     eBook or this "small print!" statement.  You may however,
+     if you wish, distribute this eBook in machine readable
+     binary, compressed, mark-up, or proprietary form,
+     including any form resulting from conversion by word
+     processing or hypertext software, but only so long as
+     *EITHER*:
+
+     [*]  The eBook, when displayed, is clearly readable, and
+          does *not* contain characters other than those
+          intended by the author of the work, although tilde
+          (~), asterisk (*) and underline (_) characters may
+          be used to convey punctuation intended by the
+          author, and additional characters may be used to
+          indicate hypertext links; OR
+
+     [*]  The eBook may be readily converted by the reader at
+          no expense into plain ASCII, EBCDIC or equivalent
+          form by the program that displays the eBook (as is
+          the case, for instance, with most word processors);
+          OR
+
+     [*]  You provide, or agree to also provide on request at
+          no additional cost, fee or expense, a copy of the
+          eBook in its original plain ASCII form (or in EBCDIC
+          or other equivalent proprietary form).
+
+[2]  Honor the eBook refund and replacement provisions of this
+     "Small Print!" statement.
+
+[3]  Pay a trademark license fee to the Foundation of 20% of the
+     gross profits you derive calculated using the method you
+     already use to calculate your applicable taxes.  If you
+     don't derive profits, no royalty is due.  Royalties are
+     payable to "Project Gutenberg Literary Archive Foundation"
+     the 60 days following each date you prepare (or were
+     legally required to prepare) your annual (or equivalent
+     periodic) tax return.  Please contact us beforehand to
+     let us know your plans and to work out the details.
+
+WHAT IF YOU *WANT* TO SEND MONEY EVEN IF YOU DON'T HAVE TO?
+Project Gutenberg is dedicated to increasing the number of
+public domain and licensed works that can be freely distributed
+in machine readable form.
+
+The Project gratefully accepts contributions of money, time,
+public domain materials, or royalty free copyright licenses.
+Money should be paid to the:
+"Project Gutenberg Literary Archive Foundation."
+
+If you are interested in contributing scanning equipment or
+software or other items, please contact Michael Hart at:
+hart@pobox.com
+
+[Portions of this eBook's header and trailer may be reprinted only
+when distributed free of all fees.  Copyright (C) 2001, 2002 by
+Michael S. Hart.  Project Gutenberg is a TradeMark and may not be
+used in any sales of Project Gutenberg eBooks or other materials be
+they hardware or software or any other related product without
+express permission.]
+
+*END THE SMALL PRINT! FOR PUBLIC DOMAIN EBOOKS*Ver.02/11/02*END*
+
diff --git a/6361.zip b/6361.zip
new file mode 100644
index 0000000..62bdc33
--- /dev/null
+++ b/6361.zip
diff --git a/LICENSE.txt b/LICENSE.txt
new file mode 100644
index 0000000..6312041
--- /dev/null
+++ b/LICENSE.txt
@@ -0,0 +1,11 @@
+This eBook, including all associated images, markup, improvements,
+metadata, and any other content or labor, has been confirmed to be
+in the PUBLIC DOMAIN IN THE UNITED STATES.
+
+Procedures for determining public domain status are described in
+the "Copyright How-To" at https://www.gutenberg.org.
+
+No investigation has been made concerning possible copyrights in
+jurisdictions other than the United States. Anyone seeking to utilize
+this eBook outside of the United States should confirm copyright
+status under the laws that apply to them.
diff --git a/README.md b/README.md
new file mode 100644
index 0000000..a8cc7b0
--- /dev/null
+++ b/README.md
@@ -0,0 +1,2 @@
+Project Gutenberg (https://www.gutenberg.org) public repository for
+eBook #6361 (https://www.gutenberg.org/ebooks/6361)