Chapter XLI · (continued 3)

DUTIES OF THE SICK-NURSE.

2416. All women are likely, at some period of their lives, to be called on to perform the duties of a sick-nurse, and should prepare themselves as much as possible, by observation and reading, for the occasion when they may be required to perform the office. The main requirements are good temper, compassion for suffering, sympathy with sufferers, which most women worthy of the name possess, neat-handedness, quiet manners, love of order, and cleanliness. With these qualifications there will be very little to be wished for; the desire to relieve suffering will inspire a thousand little attentions, and surmount the disgusts which some of the offices attending the sick-room are apt to create. Where serious illness visits a household, and protracted nursing is likely to become necessary, a professional nurse will probably be engaged, who has been trained to its duties; but in some families, and those not a few let us hope, the ladies of the family would oppose such an arrangement as a failure of duty on their part. There is, besides, even when a professional nurse is ultimately called in, a period of doubt and hesitation, while disease has not yet developed itself, when the patient must be attended to; and, in these cases, some of the female servants of the establishment must give their attendance in the sick-room. There are, also, slight attacks of cold, influenza, and accidents in a thousand forms, to which all are subject, where domestic nursing becomes a necessity; where disease, though unattended with danger, is nevertheless accompanied by the nervous irritation incident to illness, and when all the attention of the domestic nurse becomes necessary.

2417. In the first stage of sickness, while doubt and a little perplexity hang over the household as to the nature of the sickness, there are some things about which no doubt can exist: the patient's room must be kept in a perfectly pure state, and arrangements made for proper attendance; for the first canon of nursing, according to Florence Nightingale, its apostle, is to "keep the air the patient breathes as pure as the external air, without chilling him." This can be done without any preparation which might alarm the patient; with proper windows, open fireplaces, and a supply of fuel, the room may be as fresh as it is outside, and kept at a temperature suitable for the patient's state.

2418. Windows, however, must be opened from above, and not from below, and draughts avoided; cool air admitted beneath the patient's head chills the lower strata and the floor. The careful nurse will keep the door shut when the window is open; she will also take care that the patient is not placed between the door and the open window, nor between the open fireplace and the window. If confined to bed, she will see that the bed is placed in a thoroughly ventilated part of the room, but out of the current of air which is produced by the momentary opening of doors, as well as out of the line of draught between the window and the open chimney, and that the temperature of the room is kept about 64°. Where it is necessary to admit air by the door, the windows should be closed; but there are few circumstances in which good air can be obtained through the chamber-door; through it, on the contrary, the gases generated in the lower parts of the house are likely to be drawn into the invalid chamber.

2419. These precautions taken, and plain nourishing diet, such as the patient desires, furnished, probably little more can be done, unless more serious symptoms present themselves; in which case medical advice will be sought.

2420. Under no circumstances is ventilation of the sick-room so essential as in cases of febrile diseases, usually considered infectious; such as typhus and puerperal fevers, influenza, hooping-cough, small- and chicken-pox, scarlet fever, measles, and erysipelas: all these are considered communicable through the air; but there is little danger of infection being thus communicated, provided the room is kept thoroughly ventilated. On the contrary, if this essential be neglected, the power of infection is greatly increased and concentrated in the confined and impure air; it settles upon the clothes of the attendants and visitors, especially where they are of wool, and is frequently communicated to other families in this manner.

2421. Under all circumstances, therefore, the sick-room should be kept as fresh and sweet as the open air, while the temperature is kept up by artificial heat, taking care that the fire burns clear, and gives out no smoke into the room; that the room is perfectly clean, wiped over with a damp cloth every day, if boarded; and swept, after sprinkling with damp tea-leaves, or other aromatic leaves, if carpeted; that all utensils are emptied and cleaned as soon as used, and not once in four-and-twenty hours, as is sometimes done. "A slop-pail," Miss Nightingale says, "should never enter a sick-room; everything should be carried direct to the water-closet, emptied there, and brought up clean; in the best hospitals the slop-pail is unknown." "I do not approve," says Miss Nightingale, "of making housemaids of nurses,—that would be waste of means; but I have seen surgical sisters, women whose hands were worth to them two or three guineas a week, down on their knees, scouring a room or hut, because they thought it was not fit for their patients: these women had the true nurse spirit."

2422. Bad smells are sometimes met by sprinkling a little liquid chloride of lime on the floor; fumigation by burning pastiles is also a common expedient for the purification of the sick-room. They are useful, but only in the sense hinted at by the medical lecturer, who commenced his lecture thus:—"Fumigations, gentlemen, are of essential importance; they make so abominable a smell, that they compel you to open the windows and admit fresh air." In this sense they are useful, but ineffectual unless the cause be removed, and fresh air admitted.

2423. The sick-room should be quiet; no talking, no gossiping, and, above all, no whispering,—this is absolute cruelty to the patient; he thinks his complaint the subject, and strains his ear painfully to catch the sound. No rustling of dresses, nor creaking shoes either; where the carpets are taken up, the nurse should wear list shoes, or some other noiseless material, and her dress should be of soft material that does not rustle. Miss Nightingale denounces crinoline, and quotes Lord Melbourne on the subject of women in the sick-room, who said, "I would rather have men about me, when ill, than women; it requires very strong health to put up with women." Ungrateful man! but absolute quiet is necessary in the sick-room.

2424. Never let the patient be waked out of his first sleep by noise, never roused by anything like a surprise. Always sit in the apartment, so that the patient has you in view, and that it is not necessary for him to turn in speaking to you. Never keep a patient standing; never speak to one while moving. Never lean on the sick-bed. Above all, be calm and decisive with the patient, and prevent all noises over-head.

2425. A careful nurse, when a patient leaves his bed, will open the sheets wide, and throw the clothes back so as thoroughly to air the bed; She will avoid drying or airing anything damp in the sick-room.

2426. "It is another fallacy," says Florence Nightingale, "to suppose that night air is injurious; a great authority told me that, in London, the air is never so good as after ten o'clock, when smoke has diminished; but then it must be air from without, not within, and not air vitiated by gaseous airs." "A great fallacy prevails also," she says, in another section, "about flowers poisoning the air of the sick-room: no one ever saw them over-crowding the sick-room; but, if they did, they actually absorb carbonic acid and give off oxygen." Cut flowers also decompose water, and produce oxygen gas. Lilies, and some other very odorous plants, may perhaps give out smells unsuited to a close room, while the atmosphere of the sick-room should always be fresh and natural.

2427. "Patients," says Miss Nightingale, "are sometimes starved in the midst of plenty, from want of attention to the ways which alone make it possible for them to take food. A spoonful of beef-tea, or arrowroot and wine, or some other light nourishing diet, should be given every hour, for the patient's stomach will reject large supplies. In very weak patients there is often a nervous difficulty in swallowing, which is much increased if food is not ready and presented at the moment when it is wanted: the nurse should be able to discriminate, and know when this moment is approaching."

2428. Diet suitable for patients will depend, in some degree, on their natural likes and dislikes, which the nurse will do well to acquaint herself with. Beef-tea is useful and relishing, but possesses little nourishment; when evaporated, it presents a teaspoonful of solid meat to a pint of water. Eggs are not equivalent to the same weight of meat. Arrowroot is less nourishing than flour. Butter is the lightest and most digestible kind of fat. Cream, in some diseases, cannot be replaced. But, to sum up with some of Miss Nightingale's useful maxims:—Observation is the nurse's best guide, and the patient's appetite the rule. Half a pint of milk is equal to a quarter of a pound of meat. Beef-tea is the least nourishing food administered to the sick; and tea and coffee, she thinks, are both too much excluded from the sick-room.

THE MONTHLY NURSE.

2429. The choice of a monthly nurse is of the utmost importance; and in the case of a young mother with her first child, it would be well for her to seek advice and counsel from her more experienced relatives in this matter. In the first place, the engaging a monthly nurse in good time is of the utmost importance, as, if she be competent and clever, her services will be sought months beforehand; a good nurse having seldom much of her time disengaged. There are some qualifications which it is evident the nurse should possess: she should be scrupulously clean and tidy in her person; honest, sober, and noiseless in her movements; should possess a natural love for children, and have a strong nerve in case of emergencies. Snuff-taking and spirit-drinking must not be included in her habits; but these are happily much less frequent than they were in former days.

2430. Receiving, as she often will, instructions from the doctor, she should bear these in mind, and carefully carry them out. In those instances where she does not feel herself sufficiently informed, she should ask advice from the medical man, and not take upon herself to administer medicines, &c., without his knowledge.

2431. A monthly nurse should be between 30 and 50 years of age, sufficiently old to have had a little experience, and yet not too old or infirm to be able to perform various duties requiring strength and bodily vigour. She should be able to wake the moment she is called,—at any hour of the night, that the mother or child may have their wants immediately attended to. Good temper, united to a kind and gentle disposition, is indispensable; and, although the nurse will frequently have much to endure from the whims and caprices of the invalid, she should make allowances for these, and command her temper, at the same time exerting her authority when it is necessary.

2432. What the nurse has to do in the way of cleaning and dusting her lady's room, depends entirely on the establishment that is kept. Where there are plenty of servants, the nurse, of course, has nothing whatever to do but attend on her patient, and ring the bell for anything she may require. Where the number of domestics is limited, she should not mind keeping her room in order; that is to say, sweeping and dusting it every morning. If fires be necessary, the housemaid should always clean the grate, and do all that is wanted in that way, as this, being rather dirty work, would soil the nurse's dress, and unfit her to approach the bed, or take the infant without soiling its clothes. In small establishments, too, the nurse should herself fetch things she may require, and not ring every time she wants anything; and she must, of course, not leave her invalid unless she sees everything is comfortable; and then only for a few minutes. When down stairs, and in company with the other servants, the nurse should not repeat what she may have heard in her lady's room, as much mischief may be done by a gossiping nurse. As in most houses the monthly nurse is usually sent for a few days before her services may be required, she should see that all is in readiness; that there be no bustle and hurry at the time the confinement takes place. She should keep two pairs of sheets thoroughly aired, as well as night-dresses, flannels, &c. &c. All the things which will be required to dress the baby the first time should be laid in the basket in readiness, in the order in which they are to be put on; as well as scissors, thread, a few pieces of soft linen rag, and two or three flannel squares. If a berceaunette is to be used immediately, the nurse should ascertain that the mattresses, pillow, &c. are all well aired; and if not already done before she arrives, she should assist in covering and trimming it, ready for the little occupant. A monthly nurse should be handy at her needle, as, if she is in the house some time before the baby is born, she will require some work of this sort; to occupy her time. She should also understand the making-up of little caps, although we can scarcely say this is one of the nurse's duties. As most children wear no caps, except out of doors, her powers in this way will not be much taxed.

2433. A nurse should endeavour to make her room as cheerful as possible, and always keep it clean and tidy. She should empty the chamber utensils as soon as used, and on no account put things under the bed. Soiled baby's napkins should be rolled up and put into a pan, when they should be washed out every morning, and hung out to dry: they are then in a fit state to send to the laundress; and should, on no account, be left dirty, but done every morning in this way. The bedroom should be kept rather dark, particularly for the first week or ten days; of a regular temperature, and as free as possible from draughts, at the same time well ventilated and free from unpleasant smells.

2434. The infant during the month must not be exposed to strong light, or much air; and in carrying it about the passages, stairs, &c., the nurse should always have its head-flannel on, to protect the eyes and ears from the currents of air. For the management of children, we must refer our readers to the following chapters; and we need only say, in conclusion, that a good nurse should understand the symptoms of various ills incident to this period, as, in all cases, prevention is better than cure. As young mothers with their first baby are very often much troubled at first with their breasts, the nurse should understand the art of emptying them by suction, or some other contrivance. If the breasts are kept well drawn, there will be but little danger of inflammation; and as the infant at first cannot take all that is necessary, something must be done to keep the inflammation down. This is one of the greatest difficulties a nurse has to contend with, and we can only advise her to be very persevering, to rub the breasts well, and to let the infant suck as soon and as often as possible, until they get in proper order.

THE WET-NURSE.

2435. We are aware that, according to the opinion of some ladies, there is no domestic theme, during a certain period of their married lives, more fraught with vexation and disquietude than that ever-fruitful source of annoyance, "the Nurse;" but, as we believe, there are thousands of excellent wives and mothers who pass through life without even a temporary embroglio in the kitchen, or suffering a state of moral hectic the whole time of a nurse's empire in the nursery or bedroom. Our own experience goes to prove, that although many unqualified persons palm themselves off on ladies as fully competent for the duties they so rashly and dishonestly undertake to perform, and thus expose themselves to ill-will and merited censure, there are still very many fully equal to the legitimate exercise of what they undertake; and if they do not in every case give entire satisfaction, some of the fault,—and sometimes a great deal of it,—may be honestly placed to the account of the ladies themselves, who, in many instances, are so impressed with the propriety of their own method of performing everything, as to insist upon the adoption of their system in preference to that of the nurse, whose plan is probably based on a comprehensive forethought, and rendered perfect in all its details by an ample experience.

2436. In all our remarks on this subject, we should remember with gentleness the order of society from which our nurses are drawn; and that those who make their duty a study, and are termed professional nurses, have much to endure from the caprice and egotism of their employers; while others are driven to the occupation from the laudable motive of feeding their own children, and who, in fulfilling that object, are too often both selfish and sensual, performing, without further interest than is consistent with their own advantage, the routine of customary duties.

2437. Properly speaking, there are two nurses,—the nurse for the mother and the nurse for the child, or, the monthly and the wet nurse. Of the former we have already spoken, and will now proceed to describe the duties of the latter, and add some suggestions as to her age, physical health, and moral conduct, subjects of the utmost importance as far as the charge intrusted to her is concerned, and therefore demanding some special remarks.

2438. When from illness, suppression of the milk, accident, or some natural process, the mother is deprived of the pleasure of rearing her infant, it becomes necessary at once to look around for a fitting substitute, so that the child may not suffer, by any needless delay, a physical loss by the deprivation of its natural food. The first consideration should be as regards age, state of health, and temper.

2439. The age, if possible, should not be less than twenty nor exceed thirty years, with the health sound in every respect, and the body free from all eruptive disease or local blemish. The best evidence of a sound state of health will be found in the woman's clear open countenance, the ruddy tone of the skin, the full, round, and elastic state of the breasts, and especially in the erectile, firm condition of the nipple, which, in all unhealthy states of the body, is pendulous, flabby, and relaxed; in which case, the milk is sure to be imperfect in its organization, and, consequently, deficient in its nutrient qualities. Appetite is another indication of health in the suckling nurse or mother; for it is impossible a woman can feed her child without having a corresponding appetite; and though inordinate craving for food is neither desirable nor necessary, a natural vigour should be experienced at meal-times, and the food taken should be anticipated and enjoyed.

2440. Besides her health, the moral state of the nurse is to be taken into account, or that mental discipline or principle of conduct which would deter the nurse from at any time gratifying her own pleasures and appetites at the cost or suffering of her infant charge.

2441. The conscientiousness and good faith that would prevent a nurse so acting are, unfortunately, very rare; and many nurses, rather than forego the enjoyment of a favourite dish, though morally certain of the effect it will have on the child, will, on the first opportunity, feed with avidity on fried meats, cabbage, cucumbers, pickles, or other crude and injurious aliments, in defiance of all orders given, or confidence reposed in their word, good sense, and humanity. And when the infant is afterwards racked with pain, and a night of disquiet alarms the mother, the doctor is sent for, and the nurse, covering her dereliction by a falsehood, the consequence of her gluttony is treated as a disease, and the poor infant is dosed for some days with medicines, that can do it but little if any good, and, in all probability, materially retard its physical development. The selfish nurse, in her ignorance, believes, too, that as long as she experiences no admonitory symptoms herself, the child cannot suffer; and satisfied that, whatever is the cause of its screams and plunges, neither she, nor what she had eaten, had anything to do with it, with this flattering assurance at her heart, she watches her opportunity, and has another luxurious feast off the proscribed dainties, till the increasing disturbance in the child's health, or treachery from the kitchen, opens the eyes of mother and doctor to the nurse's unprincipled conduct. In all such cases the infant should be spared the infliction of medicine, and, as a wholesome corrective to herself, and relief to her charge, a good sound dose administered to the nurse.

2442. Respecting the diet of the wet-nurse, the first point of importance is to fix early and definite hours for every meal; and the mother should see that no cause is ever allowed to interfere with their punctuality. The food itself should be light, easy of digestion, and simple. Boiled or roast meat, with bread and potatoes, with occasionally a piece of sago, rice, or tapioca pudding, should constitute the dinner, the only meal that requires special comment; broths, green vegetables, and all acid or salt foods, must be avoided. Fresh fish, once or twice a week, may be taken; but it is hardly sufficiently nutritious to be often used as a meal. If the dinner is taken early,—at one o'clock,—there will be no occasion for luncheon, which too often, to the injury of the child, is made the cover for a first dinner. Half a pint of stout, with a Reading biscuit, at eleven o'clock, will be abundantly sufficient between breakfast at eight and a good dinner, with a pint of porter at one o'clock. About eight o'clock in the evening, half a pint of stout, with another biscuit, may be taken; and for supper, at ten or half-past, a pint of porter, with a slice of toast or a small amount of bread and cheese, may conclude the feeding for the day.

2443. Animal food once in twenty-four hours is quite sufficient. All spirits, unless in extreme cases, should be avoided; and wine is still more seldom needed. With a due quantity of plain digestible food, and the proportion of stout and porter ordered, with early hours and regularity, the nurse will not only be strong and healthy herself, but fully capable of rearing a child in health and strength. There are two points all mothers, who are obliged to employ wet-nurses, should remember, and be on their guard against. The first is, never to allow a nurse to give medicine to the infant on her own authority: many have such an infatuated idea of the healing excellence of castor-oil, that they would administer a dose of this disgusting grease twice a week, and think they had done a meritorious service to the child. The next point is, to watch carefully, lest, to insure a night's sleep for herself, she does not dose the infant with Godfrey's cordial, syrup of poppies, or some narcotic potion, to insure tranquillity to the one and give the opportunity of sleep to the other. The fact that scores of nurses keep secret bottles of these deadly syrups, for the purpose of stilling their charges, is notorious; and that many use them to a fearful extent, is sufficiently patent to all.

2444. It therefore behoves the mother, while obliged to trust to a nurse, to use her best discretion to guard her child from the unprincipled treatment of the person she must, to a certain extent, depend upon and trust; and to remember, in all cases, rather than resort to castor-oil or sedatives, to consult a medical man for her infant in preference to following the counsel of her nurse.