/a G? % t NATIONAL LIBRARY OF MEDICINE N A T I O N A I I I B R A R Y O F M E D I C I N E NATH <& I WX I /\¥ * W\ * N 3NI3IQ3W JO 1IVHI1 IVNOIIVN 3NOI0JW JO L»»HM l»NOU»N 3 N I 3 E NATIONAL LIBRARY OF MEDICINE NATIONAL LIBRARY OF MEDICINE NAT I IE NATIONAL LIBRARY OF MEDICINE NATIONAL LIBRARY OF MEDICINE NAII N 3NI3I03W JO A1VIII1 IVNOIIVN 3NI3IQ3W JO AIIV H a II IVNOIIVN 3NK m \ . \ c c. 4 i fc HI NATIONAL LIBRARY OF MEDICINE NATIONAL LIBRARY OF MEDICINE NAT IN 3NI3IQ3W JO AHVHai'l 1VN )NAL LIBRARY OF MEDICINE NATIONAL LIBRARY OF MEDICINE NATIONAL LIB r each half ounce. " cayenne pepper, ) . Mix, and add Flour, Wine of galls, Each, a quantity sufficient to form a poultice. Let the plaster, thus prepared, be made hot, and applied to the region of the stomach. -Another Form. Take of Pulverized ginger, 1 table-spoonful. " cloves, 1 " " allspice, I " " cinnamon, 1 " Bruised mustard, 1 tea-spoonful. Bread crumbs, 3 table-spoonsful Add diluted spirits, a sufficient quantity to form a poultice. The mustard may be omitted if advisable. This plaster should be applied warm, and continued as long as the patient can bear it, and renewed as occa- sion may require. Bark Jacket. Take of Peruvian bark, l ounce. Sprinkle it over a piece of thick muslin, of the re- PREPARATION OF DIET AND DRINKS. 67 quired size; take another piece of the same size, lay it over the bark and quilt them together, to keep the bark to its place ; moisten it with brandy or vinegar. Some of the aromatics may be used in conjunction with the bark, if indicated. Let it be worn over the stomach and bowels. It has proved singularly beneficial in cases of obstinate intermittents, and debility arising therefrom. Mush poultices are sometimes ordered ; this con- stitutes an invaluable application in cases of violent pain in the stomach and bowels, such as colic, cramp, &c. It is made by simply boiling the corn meal until it attains the proper consistency; it must be spread on a cloth, and applied as warm as can be endured. We have known the most inveterate cases relieved by it in fifteen minutes. PREPARATION OF DIET AND DRINKS. The aliments of the human family are taken either from the animal or vegetable kingdom. Strictly speaking, however, they are drawn almost exclu- sively from among the vegetables, as the animals, upon whose flesh we subsist, draw their nourish- ment from vegetables, or prey upon those that do. Nevertheless, animal and vegetable, when applied to aliments, are terms generally accepted; and we shall employ them in the sense in which they are re- ceived. ' - • ■ - 68 PRINCIPLES OF NURSING. The preparing of proper diet and drinks for the patient, constitutes one of the most important duties of the nurse; and many great evils have arisen from an improper management of this department of her calling; not so much, perhaps, through wilful delin- quency, as the want of a proper knowledge of the process of digestion, and the theory of nutrition. In endeavoring to remove this difficulty, we shall not pretend to go into a minute physiological discus- sion of the subject; this would not only encroach too much upon our limits, but would be unintelligible to the general reader; unless due attention had been previously bestowed upon the study of the anatomi- cal arrangement of the parts concerned, and the phy- siological relation they bear to each other. Leaving, then, the details to be studied by the physician and physiologist, to whose province it properly belongs, we shall proceed to give as concise and explicit a view of this very interesting process as we possibly can, hoping it will not be labor spent in vain. The definition of digestion, "in physiology," given by Hooper, " is the change that food under- goes in the stomach, by which it is converted into chyme." The food is taken into the mouth, where com- mences the process of digestion by chewing or mas- ticating it; during mastication it becomes thoroughly intermixed with the saliva or spittle, after which, by the effort of swallowing, it is deposited in the sto- PREPARATION OF DIET AND DRINKS. 69 mach ; there it is acted upon by a fluid secretion of the stomach, called the gastric juice, by which it is converted, by solution, into a soft, pap-like, semi- fluid substance, bearing no resemblance to the food when first introduced. This new formed substance has been denominated chyme. The chyme, after its formation has become complete, passes out of the stomach into that part of the small intestines called the duodenum, which is also the receptacle of the bile, a bitter fluid secretion from the liver, and a liquid formed by the pancreas, called the pancreatic juice. The chyme being acted upon by these liquors? undergoes a change, by which it is separated into two distinct substances termed chyle, a white milky nutritious fluid, and excrementitious matter; the one is taken up by numerous open-mouthed vessels, abundantly supplied for the purpose, called lacteals, and carried, by appropriate apparatus, to the place of its destination, a large vein under the arm called the subclavian vein, by which it is conducted to the heart. Having thus gained admittance to the gene- ral circulation, by a process not easily explained, it becomes blood itself; and by the contractions of the heart, it is sent, with the other blood, through the circulatory system to every part of the body, impart- ing nourishment and vitality to the whole. The excremental matter, after being separated from the chyle, is propelled by the peristallic motion of 70 PRINCIPLES OF NURSING. the intestinal tube into the lower bowels, and at last thrown out of the body altogether. From this brief view of the digestive process, we have certain principles indicated which should never be lost sight of in making up our dietetic preparations for the sick. First. Select those substances that are the most so- luble, that are readily converted into chyme by the action of the gastric juice. Second. Those that experience has shown to be the most nutritious. Third. Those that contain the least amount of sti- mulus. Fourth. These to be given in quantity and fre- quency proportioned to the general strength or de- bility of the patient. By careful observation the feelings of the invalid will be found to furnish the most unequivocal evi- dence of the truth of the foregoing principles; any deviation from which will soon be attended with symptoms more or less unpleasant. In order, then, to attain the object in view, vege- table preparations, in consequence of the easiness with which they are acted upon by the gastric juice, constitute the only proper diet during the continu- ance of acute disease, and the early stage of conva- lescence ; and by being taken in a fluid or semi-fluid state, digestion is greatly accelerated, since more solid substances are obliged to be reduced to that PREPARATION OF DIET AND DRINKS. state preparatory to the formation of chyme. Hence it will be perceived, by this means the stomach will be exonerated from the more laborious part of its office, and the formation of chyme commence im- mediately on the aliment being taken into the sys- tem. Having, then, endeavored to show the process through which the food has to pass in order to sus- tain animal life, by communicating its nutritive pro- perties, and the quality necessary under circum- stances of disease, we shall now proceed to give a few directions relative to the preparation of certain articles of vegetable diet, that theory and experience have found to be not only admissible aliments, but some of them eminently beneficial, in a remedial point of view. Arrow root contains, in small bulk, a greater pro- portion of nourishment than any other farinaceous substance yet known. The powder boiled in water, forms a very pleasant transparent jelly, far superior to sago or tapioca. The jelly for use is made in the following mamier: Take of Arrow root, 1 desert spoonful. Cold water, enough to form a paste. Add boiling water, 1 pint. Stir it briskly, and boil it a few minutes, when it will become a smooth clear jelly; a little sugar and 72 PRINCIPLES OF NURSING. Sherry wine may be added for debilitated patients, but for infants a drop or two of the essence of cara- way seed or cinnamon is preferable, wine being very apt to become acid in the stomach of infants, and thus disagree with the bowels.—Hooper. Another Form. Take of Arrow root, 1 table-spoonful. Sweet milk, half a pint. Boiling water, half a pint. Boil them for a few moments over the fire.—Ellis. For very debilitated frames, and especially rickety children, this jelly, blended with animal jelly, affords a more nutritious diet than arrow root alone. Sago. Take of Sago, 2 table-spoonsful. Water, l pint. Boil gently until it thickens, frequently stirring. Wine, sugar, and nutmeg may be added, according to circumstances.—Ellis. The sago becomes soft and transparent by boiling, and forms a light and agreeable diet; it is used a great deal in fevers and consumptions, but is well adapted to all kinds of sickness. PREPARATION OF DIET AND DRINKS. 73 Tapioca Jelly. Take of Tapioca, 2 spoonsful. Water, 1 pint. Boil it gently for an hour, or until it assumes a jelly- like appearance. Add sugar, wine, and nutmeg, with lemon juice, to suit the taste of the patient, and the nature of the case.—Ellis. Boiled Flour. Take of Fine flour, 1 pound. Tie it up in a linen rag as tight as possible, and after frequently dipping it in cold water, dredge the out- side with flour till a crust is formed round it, which will prevent the water soaking into it while boiling. It is then to be boiled until it becomes a hard dry mass. Two or three spoonsful of this may be grated and prepared in the same manner as arrow root, for which it forms an excellent substitute, and can be obtained in the country, where perhaps the other cannot.—Ellis. Vegetable Soup. Take one turnip, one potato, one onion ; let them be sliced, and boiled in one quart of water for an hour; add as much salt and parsley as is agreeable, and pour the whole on a slice of toasted bread. 7 74 PRINCIPLES OF NURSING. This preparation forms an agreeable substitute for animal food, and may be given when the former would be improper. Indian Gruel. Take of Fine corn meal, 1 \ gills. Boiling water, 1 pint. Stir, while adding the meal, until they become tho- roughly mixed; boil it two hours; stir while boiling; add salt, to make it agreeable. This is an excellent preparation, where there is a disposition to costiveness. Unless it is well boiled it is apt to sour on the stomach, producing acid windy eructations, colic pains, and flatulence. Rice Gruel. Take of Ground rice, 1 ounce. Cinnamon, 1 drachm. Water, 1 quart. Boil for forty minutes, adding the aromatic near the conclusion. Strain and sweeten it. Wine may be added if necessary.—Ellis. Panado. Take of Stale wheat bread, 1 ounce. Cinnamon, 1 drachm. Water, 1 pint. Boil them until well mixed, then add a little grated ; PREPARATION OF DIET AND DRINKS. 75 nUtmeg and sugar. Wine butter, or raisins may also be added if desirable. The latter, by being boiled with the rest, gives it an additional flavor, but are themselves often inadmissible, and cannot be taken with safety. These are some of the preparations in daily use among the sick, with which every nurse should be as familiar as her alphabet. She may be well versed in culinary operations in general, yet ignorant of those peculiarly adapted to cases of disease and con- valescence. It does not follow, as a matter of course, that a good cook should be a good nurse, neither that a good nurse should be a good general cook; each acts in her own particular sphere; the province of the one is to prepare food for the healthy and vigor- ous—that of the other for the sick and weakly; hence the authority of the cook camiot be adopted as a guide to the nurse. She must acquire her informa- tion from quite a different source. In order successfully to discharge her culinary du- ties, she must first prepare herself by studying those works devoted to the subjects of digestion and as- simulation, and giving directions for preparing nour- ishment for the sick, under every variety of disease, and by scrupulously watching the effect each change of diet produces upon the invalid; if it be beneficial, a moderate indulgence in it is justifiable; but if the contrary be the result, it must be forthwith discon- tinued. 76 PRINCIPLES OF NURSING. As the case advances in convalescence, or, under any other circumstances, a change in the class of diet becomes necessary, it should be done with a great deal of caution; and a sudden transition from vege- table to animal, or from fluids to solids, should never be attempted, lest, by imposing too heavy a tax upon the stomach and other digestive organs, we impede their progress towards the resumption of their healthy functions. The advantage, then, of approaching a change, by mixing the animal with the vegetable, and the dry with the liquid substances, must be ob- vious to all; the proportion of that to which the pa- tient has been accustomed should be allowed greatly to predominate, gradually decreasing its quantity as the new article is increased, until the stomach be- comes fully accustomed to its reception. Frequently some of the varieties of fruit are craved by the pa- tient, such as peaches, apples, oranges, strawberries, blackberries, raspberries, melons, &c. In these cases the best general rule to be laid down, we con- ceive, is, for the nurse never to assume the respon- sibility of giving them, before the views of the phy- sician have been obtained relative to the propriety thereof. We will now proceed to give a few specimens of animal preparations in general use as aliments for the sick. PREPARATION OF DIET AND DRINKS. 77 Beef Tea. Take of Lean beef, cut into shreds, 1 pound. Water, 1 quart. Boil it for twenty minutes, taking off the scum as it raises; after it grows cold, strain the liquor; a little salt may be added if desirable. This preparation is more nourishing than ordinary broths, and is very palatable. It may be conveniently mixed with the vegetable soup, if necessary. Hartshorne Jelly. Take of Hartshorne shavings, 4 ounces. Water, 1 quart. Boil over a gentle fire until one pint of the water be dissipated. Strain, and add lemon juice, sugar, and wine. , This forms, either with or without the last ingre- dients, a very nourishing diet for the convalescent; and, when mixed with an equal portion of cow's milk, is very useful in the bowel complaints of chil- dren. Arrow root, sago, or tapioca jelly, when mixed with it, gives it additional nourishment. Isinglass or fish glue may be used instead of the hartshorne shavings, if preferred. Calves' Feet Jelly. Take two calves' feet and add to them one gallon 7* 78 PRINCIPLES OF NURSING. of water, which reduce, by boiling, to one quart. Strain it, and when cold skim the fat entirely off. Add to this the white of six or eight eggs, well beaten, half a pint of wine, half a pound of loaf sugar, and the juice of four lemons, and let them be well mixed. Boil the whole for a few minutes, stir- ring it constantly, and then pass it through a flannel strainer. This forms a very nutritious article of diet for the sick and convalescent. When it is desired, the wine can be omitted.—Ellis. Chicken Water. Take half a chicken, divested of all fat, and break the bones; add to this half a gallon of water, and boil for fifteen or twenty minutes. Season with salt. This was freely employed by, the late Dr. Parrish in cholera at its commencement. Taken warm it promotes vomiting, and washes out the stomach. Essence of Beef. Put into a porter bottle a sufficient quantity of lean beef, sliced, to fill up its body, cork it with a paper stopple, and place it in a pot of cold water, attaching the neck, by means of a string, to the handle of the vessel. Boil this for three-quarters of an hour, then pour off the liquor and skim it. To this preparation may be added spices, salt, PREPARATION OF DIET AND DRINKS. 79 wine, &c, according to the taste of the patient, and nature of the disease. It is greatly employed in low fevers, and therefore the physician must direct its mode of preparation. Suet Ptisan. Take of : Sheep's suet, 2 ounces. Milk, 1 pint, Starch, half an ounce. Boil slowly for ten minutes. Aromatics may be added to make it palatable. This is well adapted to cases of dysentery. As the foregoing directions are confined exclu- sively to those preparations that are either fluid or semi-fluid, it becomes necessary to say a word rela- tive to those of a more solid consistency. In the course of convalescence, then, when it becomes ex- pedient that the latter should be employed, it may be approached by commencing with a little water, or cream toast, as the case may indicate, with a small piece of boiled chicken ; we always prefer the neck at first with the skin removed, for two reasons; first, on account of the absence of fat, which is almost en- tirely removed with the skin; second, the difficulty with which the meat is detached, obviates the danger of taking too great a quantity into the mouth at once to be thoroughly masticated; a poached egg, two or three roasted or stewed oysters, or a small piece of 80 PRINCIPLES OF NURSING. rare beef steak, with a cup of weak chocolate, for breakfast; a baked potato, well mashed, with a small portion of broiled or roasted chicken, lamb, beef or venison, bread or dry toast, and a glass of water for dinner; and a slice or two of water toast, a small portion of boiled lean ham, sliced thin, or dried beef, scalded or boiled chicken, a cup of weak cocoa, and perhaps a taste of preserved peach or plum, for sup- per. This course may be pursued generally with safety and advantage. If, however, it should be found to disagree at all with the patient, it must be speedily discontinued, and her former diet resumed, until otherwise directed by the physician. All kinds of pastry must be positively withheld, as it is at best a heavy diet, requiring a vigorous constitution to di- gest it. The patient, doubtless, will require some- thing between her regular meals; this must be sup- plied with a bowl of gruel, panada, or something of the kind. Wheat flour and good sweet cream, made into a batter, and baked in small cakes on a bake iron, forms an excellent substitute for bread or toast, where the patient desires a change; they constitute a light, nutritious, and agreeable diet, which the sick gene- rally esteem as a great luxury. Connected with this part of the nurse's duty, there are two or three items which we wish particularly to urge upon her atten- tion. First. Never present to the patient a larger quantity of food, at one time, than is directed by the PREPARATION OF DIET AND DRINKS. 81 physician, or in the absence of such direction, than her judgment may deem prudent; much mischief has been done by giving too great a quantity of an article of admissible quality at once. Second. She should never prepare more at once than is sufficient for present use, as it becomes stale by standing, and when warmed up, as it is called, the second time, becomes more or less insipid, and is seldom taken with as much satisfaction as when fresh. Third. The nurse should always prepare the nour- ishment with her own hands, or have it done imme- diately under her supervision, and never leave it to the direction of another. With these remarks, relative to the preparation of diet, we now take our leave of the subject, at the same time, we would suggest to every nurse the im- portance of exerting herself in procuring all dietetic receipts, pertaining to her profession, that circum- stances may throw in her way, or experience show to be worthy of notice, and record them in her note book. She will find them to be valuable auxiliaries in suiting the varied and ever-changing appetites of those under her charge. Drinks.—We will now proceed to the consi- deration of the preparation of drinks proper for the sick. Under the title of drink is comprehended every liquid suitable to supply the watery parts, either of 82 PRINCIPLES OF NURSING. the solids or fluids, entering into the composition of animate beings. The sensation produced by the want of this supply, is that denominated thirst. Every fluid, then, capable of allaying thirst, is properly a drink. Water forms the basis of all liquids used for sus- taining the animal system of man, as well as of all others. And as experience has proved, beyond all cavil, that thirst is more readily allayed by simple, pure cold water, than in a state of mixture, it is ra- tional to infer that this spontaneous production of na- ture, so bountifully supplied by the Creator of the Universe, is the sole ingredient, in whatever combi- nation it may be employed, that accomplishes the im- portant end of allaying the suffering arising from in- tense thirst. While a few of the accessions made to it by art are valuable in cases of disease, many are highly injurious when employed as a beverage, whe- ther in sickness or health. But to go into a protracted disquisition of the sub- ject in this place, involving, as it naturally would, the odious deformity, and the destroying, murderous influence of intemperance, would be engaging in a digression from the main subject under consideration, of unwarrantable length. When the bare quenching of thirst, then, is the ob- ject in view, whether under circumstances of disease, or the full enjoyment of perfect health, the clear, cold PREPARATION OF DIET AND DRINKS. 83 water, as it gushes fresh from the crystal fountain, furnishes a far better, and, to the unperverted appe- tite, much more agreeable means, than any of the highly extolled productions of art. But when there are other objects to be attained, a combination becomes necessary, into which generally enters an acid, an alkali, a stimulus, a tonic, or some article of nourishment. Acidulated drinks are employed frequently in dis- eases of bilious origin. It is known that acids united with bile destroy its bitterness; hence, it is presumed, that it neutralizes the acrid corroding properties of vitiated bile frequently contained in the intestines, giving rise to a variety of diseases. Quite as agree- able, and perhaps as effectual an acidulated prepara- tion as any in use, is that afforded by the juice of the lemon, in the form of Lemonade. Take of Fresh lemon juice, 4 ounces. Fresh, and very thin peeled lemon, half an ounce. White sugar, 4 ounces. Boiling water, 3 pints. Let them stand until cool, then strain off for use. This, when freely taken by the patient, sometimes produces pain in the bowels. It must therefore be given with some reserve as a daily drink.—Ellis. 84 PRINCIPLES OF NURSING. Another drink is frequently employed for the same purpose, which is sometimes very grateful to the taste of the patient, and may be substituted for the foregoing when she desires a change. Apple Water. Take one tart apple of ordinary size, well baked, let it be well mashed ; pour on it one pint of boiling water; beat them well together; let it stand to cool, and strain it off for use. Add loaf sugar, if the pa- tient desire it. Or, Take of Strong vinegar, 3 ounces. Water, 1 pint. Loaf sugar, %\ ounces. Either of these are liable to produce pain in the bowels, if too freely indulged in. Care, therefore, is advisable. Cases in which alkalescent drinks are chiefly em- ployed, are those of dyspepsia, or, what is termed a sour stomach, and heart burn, arising from indi- gestion or any other cause. Acids and alkalies, be- ing incompatible substances, upon coming in contact produce an effervescence, during which the acid contained in the stomach becomes neutralized. The articles commonly employed for this purpose are some of the preparations of soda or potash. A very PREPARATION OF DIET AND DRINKS. 85 effectual combination, employed by the late Dr. Phy- sick in his own case, and which afterwards became a favorite remedy with him, is called Dyspeptic Ley. Take of Hickory ashes, 1 quart. Soot, 6 ounces. Boiling water, 1 gallon. Mix, and let them stand for twenty-four hours, fre- quently stirring the ingredients. A tea-cupful may be given of this liquor three times a-day. It should be poured off always at the end of twenty-four hours; for by standing on the materials a long time, the water acquires almost caustic properties, and may do serious injury.—Ellis. Drinks, containing any stimulating properties, are seldom necessary but in cases of extreme debility, produced by protracted illness, where they are em- ployed to arouse the sinking energies, and restore action to the languid and enervated system. Alcohol in some one or other of its various combinations, is generally employed for this purpose. It enters into the composition of Madeira, Sherry, and Port wine, in a proportion better adapted to the design of its administration, than any other form in which it exists. The superiority in these three va- rieties of wine, as a stimulus alone, when given in an uncombined state, is to be awarded in favor of 8 86 PRINCIPLES OF NURSING. Sherry, in consequence of its containing a less quan- tity of acid in proportion to its alcohol; consequently it is not so apt to sour on the stomach. But when a tonic, as well as a stimulating effect is desired, the Port is to be preferred, on account of its strengthening properties, in which it is prolific, compared with the others. Madeira is better adapted to the making of whey, owing to its greater acidity, which renders it almost unfit to be employed in any other form. Both the Port and Madeira contain more of the stimulating property than the Sherry, but the latter being a purer wine, is better adapted to the purpose for which it is employed. It must be given only as di- rected by the physician. Wine Whey. Take of Fresh cow's milk, skimmed, half a pint. White Madeira wine, 1 or 2 ounces, ac- cording to the required strength. Boil the milk, then add the wine. The draught to be regulated by the circumstances of the case, from four to ten ounces during the day. Mustard Whey. Take of Cow's milk, 1 pint. Bruised mustard seed, 1 ounce. Simmer until the curd separates, then strain it, and add White Madeira wine, 6 ounces. PREPARATION OF DIET AND DRINKS. 87 A draught of this whey may be taken every hour or two in low fevers, and cases of debilitated sto- machs.—Ellis. Tonic drinks are "exhibited directly, to correct debility or relaxation of the system." Those the nurse is more frequently called upon to prepare, are decoctions and infusions; consequently, our attention is confined wholly to them. As many of them are used, to a great extent, by persons laboring under chronic debility, whose cases are not deemed of suf- ficient importance to require constant medical atten- tion, as well as those who are debilitated through acute disease; and as such preparations, under such circumstances, are formed without much regard for accuracy, and administered with but little precision, we shall, for their especial benefit, add a few more directions than we have heretofore thought neces- sary. Decoction of Peruvian Bark. Take of Peruvian bark, bruised, 1 ounce. Cold water, 1 pint. Boil for ten minutes, and, while hot, add Virginia snake root, half an ounce. Drange peel, bruised, 2 drachms. Suffer them to infuse for half an hour near the fire, in a close vessel. A wine-glassful may be taken once every hour. 88 PRINCIPLES OF NURSING. If the bark be boiled longer than ten minutes, it becomes pale and less efficient. The last ingredients are; directed to be infused, because their aromatic properties would be dissipated by decoction. Infusion of Columba Root and Ginger. Take of Columba root, bruised, 1 ounce. Ginger, 2 drachms. Boiling water, 1 pint. Let them infuse one hour by the fire; and give of the strained liquor (cold) a wine-glassful every two hours. This infusion, when freely used, has proved suc- cessful in bowel complaint (chronic diarrhoea) of long standing. Infusion of Quassia. Take of Quassia wood, prepared, 2 ounces. Virginia snake root, 2 ounces. Orange peel, bruised, 2 ounces. Boiling water, 1 pint. Let them infuse, and when cold, give a tea-cupful three times a-day. Decoction of Peruvian Bark and Valerian. Take of Peruvian bark, bruised, l ounce. Water, 1 pint. PREPARATION OF DIET AND DRINKS. 89 Boil for ten minutes and strain; then Take of Valerian root, 1 ounce. Boiling water, 1- pint. Infuse for one hour and strain. Add the decoction of bark to this infusion, and give a tea-cupful, cold, three or four times a-day. This is chiefly employed in rheumatic headach, in which it is sometimes very serviceable. It was a favorite prescription of the late Dr. Parrish. Infusion of Camomile and Orange Peel. Take of Camomile flowers, l ounce. Orange Peel, half an ounce. Cold water, 3 pints. Macerate for twenty-four hours. Let a tea-cupful be taken four times a-day. The camomile infusion is more agreeable to the taste when made cold, and is less apt to spoil than when made of boiling water. Decoction of Wild Cherry-tree Bark. Take of Wild cherry bark, (dried and bruised,) 1 ounce. Orange peel, bruised, 2 drachms. Water. 1 pint. Boil the bark alone for half an hour, and then add S* 90 PRINCIPLES OF NURSING. the orange peel. A wine-glassful may be taken every hour or two in consumptive cases, asthma, &c. Infusion of Virginian Snake Root. Take of Snake root, half an ounce. Boiling water, 1 pint. Infuse in a covered vessel for one hour. Give a wine-glassful every hour or two. Decoction of Dogwood Bark. Take of Dogwood bark, bruised, 1 ounce. Water, 1 pint. Boil for twenty or thirty minutes and strain. A wine-glassful may be given every hour. This is a very good substitute for Peruvian bark in fever and ague. Compound Infusion of Gentian. Gentian root, half an ounce. Orange peel, bruised, 2 drachms. Cardamomum seed, half a drachm. Hot water, 1 pint. Let them infuse one hour. This will be found use- ful in debility of the digestive organs. A wine-glass- ful may be given every two or three hours. Nutritive Drinks. The nutritive drinks are employed, not only to PREPARATION OF DIET AND DRINKS. 91 allay thirst, but to supply the place of food in cases where the appetite may refuse to take it. Some one or other of the various articles of diet is combined with the water; and me great thirst of the patient frequently requiring to be satisfied, the nourishment, in this way, is made to enter the system in quantity sufficient to sustain life a long time. Decoction of Barley, or Barley water. Take of Pearl barley, 2 ounces. Boiling water, 2 quarts. Before adding the boiling water let the barley be weil washed, then boil it to one-half, and strain the liquor. A little lemon juice and sugar may be added if desirable. To be taken at liberty in inflammatory diseases.—Ellis. Rice Water. Take of Rice, 2 ounces. Let it be well washed, and add to it Water, 2 quarts. Boil it for an hour and a half, and then add sugar and nutmeg, as much as may be required. To be taken at liberty.—Ellis. Infusion of Flaxseed, or Flaxseed Tea. Take of Flaxseed, 1 ounce. Liquorice root, half an ounce. Boiling water, 2 pints. 92 PRINCIPLES OF NURSING. Macerate for two or three hours near the fire in a covered vessel; strain, and add lemon juice sufficient to make it agreeable. It may be given as a common drink in catarrh, (bad cold.)—Ellis. Mucilage of Gum Arabic. Take of Gum Arabic, 1 ounce. Hot water, 1 gill. Let it dissolve. Used in most diseases of the breast. Also in bowel complaints, &c. Decoction of Bran. Bran Tea. Take of Fresh wheat bran, 1 pint. Water, 3 quarts. Boil down one-third; strain off the liquor, and add sugar, honey, or molasses, according to the taste of the patient. Bran tea may' be made by using boiling water, and allowing the mixture to stand in a covered ves- sel for three or four hours.—Ellis. Sage Tea. Take of Dried sage leaves, half an ounce. Boiling water, 1 quart. PREPARATION OF DIET AND DRINKS. 93 Infuse for half an hour, then strain. Sugar and le- mon juice may be added in the proportion required by the patient. In the same manner may be made balm and other teas. These infusions form very agreeable and useful drinks in fevers; and their diaphoretic (sweating) powers may be increased by the addition of sweet spirits of nitre, or, what is better, antimonial wine.— Ellis. Water Gruel. Take of Oat meal, 2 ounces. Water, 1 quart. Boil for ten or fifteen minutes and strain, adding su- gar and salt to make it agreeable.—Ellis. Infusion of Malt. Take of Ground malt, 1 pint. Scalding (not quite boiling) water, 3 pints. Infuse for two hours, and strain off the liquor, to which may be added sugar or lemon juice, if re- quired. This was a favorite preparation with Dr. Parrish, and employed by him in inflammatory fevers.— Ellis. 94 PRINCIPLES OF NURSING. Mucilage of Starch. Take of Starch, 1 ounce. Powdered cinnamon, 1 drachm. " gum Arabic, 1 ounce. Boiling water, 3 pints. Boil until reduced one-third, and strain. This may be used as a common drink in dysen- tery.—Ellis. Thus we close the subject of the present section, though not so much to our satisfaction as we might have done, had our limits allowed us to have touched upon some items that we have been obliged entirely to omit, and dwell more at length upon others, at which we have but barely glanced. However, we let it pass with all its deficiencies, by subjoining this caution to the nurse; never permit the patient to take her nourishment and drinks too warm. It is our opinion, that convalescence is often impeded by inattention to this matter. Their temperature should seldom be over 100° Fahrenheit, and a few degrees below cannot be objected to. NIGHT WATCHING. A part of the nurse's duty consists in attending to the patient during the night, as well as day. It is not expected, however, that she should devote whole nights, one after another, to watching; this would TEMPERATURE AND VENTILATION. 95 be not only extremely wearisome to herself, but in- jurious to her health. When the demands of nature require her to be absent herself from the patient, it is for her to see that all things are properly arranged • that lights, and, in winter, that fuel are provided, if necessary; that a proper place be selected for the light; that the patient may not be annoyed by its shining in her face; and that the attendants are in- structed in what they have to do; that necessary nourishments are provided, both for patient and at- tendants; and every thing that would require her personal attention must be delegated to them pre- viously to her retiring. She should have her sleeping apartment adjoining that of the patient, so that if her presence should be required, she may be summoned conveniently, and without any unnecessary noise. Sometimes patients become so attached to the nurse that they are never satisfied unless she is pre- sent : under these circumstances, she would do well to give her all the attention she can, without jeopar- dizing her own health; and by watching her oppor- tunity while the patient sleeps, get what rest she can. ATTENTION TO THE TEMPERATURE AND VENTILATION OF THE ROOM. The temperature of the sick room should be kept as even as possible; and for this purpose a thermo- 96 PRINCIPLES OF NURSING. meter becomes as important an appendage to the room as any other article of use. It is a matter of less moment at what precise point of the thermometer the mercury may be allowed to stand, than any great variation from that point either above or below. If 65° F. be selected as the stan- dard temperature of the room, no ordinary emer- gency should be offered as an excuse for its rising above 70, or falling below 60. During the extreme warm weather of summer the sick are apt to suffer more or less from excessive heat; this may be obviated, to a great extent, by shutting out the light in the middle of the day, to ef- fect which, the outside shutters should be kept bowed, so as not entirely to exclude the air; and Venitian blinds, suspended inside, are better adapted to the purpose than any other variety of window curtains, as they at the same time afford free pas- sage to the air, and measurably obstruct the rays of light. During the severity of winter the room should be warmed either by heated air, or by means of an open wood fire ; the former is preferable, on account of its being less liable to sudden variations. Notwith- standing the recommendation of heated air, a fire- place is indispensable to a well constructed nursery, as a means of ventilation. In the milder seasons of spring and autumn, the open fire will be found sufficient, as the state of the TEMPERATURE AND VENTILATION. 97 atmosphere does not require so great a degree of ar- tificial heat to answer the purpose of affording the necessary warmth. The use of coal should be en- tirely excluded from the sick room, as the gas gene- rated by it while burning, is alike unpleasant and injurious to the patient. Stoves of all kinds are highly objectionable, where other means can be employed, and should never be used in the nursery but as the last resort. " Foul linen and clothes," says Dr. Kissam, "should not be allowed to remain in the room an instant longer than is necessary, for they vitiate the air. Whenever the bed pan is used this of course must be instantly removed. Before using it, a tea-spoonful of the chloride of lime, dissolved in half a pint of water, and put into the vessel, will destroy the dis- agreeable effluvia. If the physician should express a wish to examine the contents of the bed pan, the lime must be omitted, because it will destroy the color and appearance of its contents. " Plants," he continues, "should not be allowed to remain in the sick room at night, as they absorb a portion of the vital principle of the air, and give off an injurious gas. It is well to have them in the room during the day, as the case is reversed. They ab- sorb the injurious gas, and give off oxygen, the vital principle of air. For the same reason, if the house be situated near a forest, and the wind is blowing 9 98 PRINCIPLES OF NURSING. from it towards the house, the windows had better be closed. " The same injurious gas is given off when char- coal is burning; for this reason, it should always be ignited in the open air, or in the chimney corner." CHAPTER III. ON NURSING IN PARTICULAR. A knowledge of the Proper Management of the Infant during the month, including Food, quality and quan- tity—Dress, quality and quantity—Crying, Sleep— Handling the Infant, <$fc. tyc. — The Age of the Nurse—A knowledge of the Proper Management of the Mother during the month, including the Bed, Pro- per Diet—General Management of the Patient, in- cluding Premature Exertion, Exposure, Exercise — Even State of Mind, Locia—Temperature and Venti- lation of the Room, <$fc. tyc. QUALIFICATIONS OF THE NURSE IN PARTICULAR. In addition to the qualifications of the nurse in general, there are others here requiring notice, that will be found essential to the successful management of that particular branch of her profession now under consideration. This department of her calling frequently embraces not only all the duties we have dwelt upon in the 100 PRINCIPLES OF NURSING. preceding chapter, but at the same time involves other duties equally important and interesting. When called upon to discharge the double duties pertaining to the nursery, of conducting the mother through the perilous period of her confinement, and contributing materially to the formation of the phy- sical, if not the moral constitution of the new being committed to her charge, she cannot attach too much importance to her station; and to be able to acquit herself in a manner best calculated to enhance the welfare of both mother and child, and with a dignity commanding that respect for her profession that its importance so justly merits, cannot but be a deside- ratum of the first magnitude. In order, then, to attain this desirable end, a pre- paratory course of reading, reflection and observa- tion, becomes as indispensable to the nurse, as a si- milar course does to an accomplished physician, law- yer, or divine. The works we would recommend for preparatory study, as being prolific in sound, practical information, are "Dewees on Children," "Eberle on Children," "The Young Mother," "The Young Mother's Guide, and Nurse's Manual." The two latter are particularly adapted to the practice of nursing. The "Young Mother" is exclusively de- voted to the management of children; though with the author's theoretical views we cannot unite in all points, yet, taken upon the whole, it is a valuable production, and should be in possession of every QUALIFICATIONS OF THE NURSE. 101 nurse. The "Manual" we have noticed before; it is a neat little volume, embracing practical directions for the management of both mother and child, and would be found a valuable assistant to every nurse, it matters not what may be her experience or skill. "The Nurse's Guide," by Dr. Warrington, is also worthy the careful perusal of every inexperienced nurse. The works of Dewees and Eberle are more vo- luminous, and consequently of a higher price, but the expense is a consideration of small moment, compared with the amount of interesting and im- portant matter they contain; they abound in sub- stantial practical information, and should be tho- roughly studied as the basis of this branch of her profession. It must be extremely humiliating and perplexing to the nurse, in the onset of her career, to be required to officiate in a capacity, the very rudiments of which experience will soon teach her she is en- tirely ignorant; she finds herself on every side beset with difficulties, from which she is unable to extri- cate herself, and every effort to procure relief from her embarrassments merges her into others, equally difficult to be overcome, and disagreeable to endure. But, where the mind is thoroughly stored with in- formation, drawn from reason and the experience of others, these difficulties are rarely to be apprehended, and her path, instead of being beset at every step 9* 102 PRINCIPLES OF NURSING. with asperities, and the poison thorns of disappoint- ment, becomes smooth and pleasant, and the mind, in- stead of being harrassed with a variety of discordant emotions, will, throughout her whole career, retain a delightful equilibrium; indeed, it might almost be said, to her well qualified for discharging the duties of her profession, that "its ways are ways of plea- santness, and all its paths are peace." Too much time and labor cannot, then, be devoted to the acquirement of qualifications so absolutely es- sential to the successful performance of her fre- quently arduous, and at all times anxious and highly interesting duties. And while prosecuting her stu- dies, she can enjoy the enviable satisfaction of re- flecting that every hour thus spent is devoted to the cause of suffering humanity, and the alleviation of human misery. We will now proceed with some of the qualifica- tions we deem most essential for the nurse, in the particular branch now under consideration. Those necessary for the general nurse are also adapted to the management of the mother, in her confinement; there are others, however, to be considered under our present head, that her condition will frequently call into requisition, which will be taken up in due order. Those qualifications necessary for the suc- cessful management of the infant during the first four weeks of its existence, shall occupy our present attention. PROPER MANAGEMENT OF THE INFANT. 103 A KNOWLEDGE OF THE PROPER MANAGEMENT OF THE INFANT. "The infant's death is argument of guilt." The want of a knowledge of the proper manage- ment of children during the month, we hesitate not to say, is the fruitful cause of the great mortality among the infants of our country; not those who die within the time specified, exclusively, but those who are permitted to survive a year, and perhaps longer, and at an age when they should be most in- teresting, they begin to pine away, and finally die of shocks they received through the ignorance or carelessness of her who had charge of them, at a time when the most scrupulous regard for their wel- fare should have constituted one of her religious du- ties. The importance, then, of this qualification can- not be too strongly insisted upon. The food, qual- ity and quantity—quantity and quality of dress; cry- ing, the circumstances under which it takes place; sleep, the manner in which it is procured, and hand- ling the infant, are all matters of the first importance, each claiming a share of consideration. Food.—Since food (with the exception of air) is first in contributing to the support of animal life, we shall place it first for examination in our plan of the management of early infancy. The path pointed out by nature is the true and 104 PRINCIPLES OF NURSING. only one that can be followed with safety in admi- nistering to the wants of the new born babe; and the " Book of Nature" should not fail of being tho- roughly studied, that we may be able to read the meaning of those instinctive signs to which the help- less little being, from time to time, continues to call our attention, from the very moment it first breathes the vital air, until it acquires age and knowledge sufficient to make known its wishes, desires, and in- clinations, through the medium of speech. Perhaps in no one particular, connected with the manage- ment of infants, is an ignorance of, or inattention to those signs, productive of more injury, than in pre- paring and administering food. Almost the first cries of the infant are looked upon by the kind-hearted attendants upon the occasion as a demand of hunger; and the more vehement the cries, the more imperious is the demand considered. And no sooner is the process of washing and dress- ing completed, than the nurse, if present, is zealously importuned to prepare for the "poor little thing" some nourishment; and she, too frequently sur- charged with solicitude, lest starvation will, during the first hour of its existence, deprive the " poor thing" of life, bustles about, in order, if possible, to prevent, by a timely meal, so fatal a catastrophe. Accordingly, out of a variety of preparations, such as paps, panadas, gruels, &c, one is selected for the purpose, either of which, to be serious, is highly im- PROPER MANAGEMENT OF THE INFANT. 105 proper in point of quality. There generally enters into their composition some one or more of the spices, with a drop or two of wine, and "other nice things," calculated much more to deprave the appetite, and impede the process of digestion, than to produce any beneficial result. Even admitting they are harmless, we cannot see the necessity or propriety of introduc- ing them into the food of the infant. What does the new-born babe, with pure, unperverted appetite, know about such delicacies ? It is those perverted by habit, that luxuriate in mixtures containing wines, spices, and other stimulating ingredients, but never that of an infant. By forcing upon them thus early such articles, and continuing their use during the period of infancy, we can do little other than incor- porate with their very existence a desire for them— which desire grows and strengthens as age advances, until the individual thus trained, perhaps before he acquires the age of manhood, if he so long survive? is swallowed up in the vortex of intemperance and dissipation. If there were no physical injuries to be appre- hended, the moral obligations we owe the little be- ing should raise a bar against such a course of pro- cedure. In addition to the violence done to the little sto- mach of the child, by the articles with which its food is enriched, the food itself, when it consists of the preparations above mentioned, is no less objectiona- 106 PRINCIPLES OF NURSING ble, and subject to like condemnation. How can it be otherwise than mischievous, to force upon the un- confirmed stomach of the infant a thick, tenacious paste, (for little better than this is the most delicate preparations ordinarily used,) that would require the efforts of a stomach much longer inured to the recep- tion of food, and more strengthened by age and ex- ercise to digest it ? The substance of which this variety of diet is ge- nerally composed, is crackers, bread, or flour in some other form, boiled with water and sweetened; and no sooner is it received into the stomach, than com- mences the process of fermentation—for all " farina- cious substances, in a state of fluid mixture, are liable to ferment when heated by a temperature lower than that of the human body." The gas that is evolved during this process, is confined within the stomach and bowels, producing what is called wind colic, sour eructations, (belching,) swelling of the lower belly, and convulsions. Digestion is otherwise de- ranged, and frequently to a fatal extent. Infants fed upon these unnatural articles, are affected more or less with green watery stools, griping pains, fre- quently throwing up milk strongly curdled, emacia- tion, &c, followed by death. Having thus endeavored briefly to show the entire unfitness, in point of quality, of the food generally given to the infant, we shall now proceed to state what, in our opinion, approaches much nearer the PROPER MANAGEMENT OF THE INFANT. 107 intentions of nature, and consequently better suited to the infantile organs of digestion and assimilation; and while we can glean from our own experience abundant testimony confirmatory of our views, we shall not fail to adduce that of others, whose exten- sive observations have led them to adopt similar ones. We would, then, remark, that the milk, as it rises spontaneously in the breast of the mother, is nature's own food, prepared for the sustenance of the new- born being; and if all things, during the first two or three days of the child's existence be propitious, art can in no wise be employed but with disadvantage, if not danger. But, should the breasts be tardy in performing their functions, or the mother, from any cause whatever, be incapacitated from discharging the delightful duty of suckling her child, art must then be resorted to as the secondary means of sus- taining the infant. We say secondary, because it is our settled conviction, based upon the experience of years, that no means can be instituted as primary, save that so bountifully supplied through nature by Nature's God; and where this can be attained, no pretence, however broad, can screen an opposite course from the imputation of dangerous interfer- ence. The first important step to be taken, when circum- stances forbid the application of the child to the breast, is the removal from the bowels of the meco- 108 PRINCIPLES OF NURSING. nium, a substance familiar to every nurse, of a deep bottle-green color, that constitutes the first discharges; a little warm molasses and water, given in quantities of two or three tea-spoonsful from time to time, will mostly answer the purpose; if, however, this should prove insufficient to produce an active operation, a tea-spoonful of sweet oil, or the oil of butter, may be administered; we have known cases so obstinate as to require castor oil, in quantity of a tea-spoon three parts full, repeated at intervals of an hour or two, to produce the desired effect. When the breast affords a full supply from the first, it is unnecessary, in most instances, to resort to any other means, even for the purpose of attaining this important end, as the first secretions of this won- derful organ is nature's own physic, designed to ac- complish the object in view. But in cases of disease, or under any other unpropitious circumstances, where this is found ineffectual, the co-operation of either of the above preparations may be advanta- geously solicited. Perhaps it will be well here to observe, that we deem a moderately brisk purge, within the first twelve or eighteen hours after birth, a matter of no small moment, provided the health and vigor of the child will permit of it; if not, as soon as practicable. Most infants who have been fed on improper diet, affected with colicy pains, evinced by distressing cries, restlessness, early jaun- dice, costiveness, &c, owe the cause of their suffer- PROPER MANAGEMENT OF THE INFANT. 109 ing to not having the meconium thoroughly re- moved. The nurse, in her solicitude to have this timely achieved, may do a great deal of mischief by em- ploying means entirely too harsh; aloes, infusion of senna, and other drastic articles have been injudi- ciously resorted to for this purpose, "to the decided inconvenience, if not to the manifest injury of the child." If, then, she fail to produce the desired effect by the means above directed, the nurse would evince more prudence, by acquainting the attending physician with the condition of the little patient, than by.longer depending upon her own judgment, and perhaps persevering in ill-judged and inappro- priate means. Though the subject of the present digression is of vastly more importance than we have been led to think it is generally considered, we shall not indulge in the deviation from the main tenor of our remarks on food, further than to state that it is not expected, where there is a protracted delay in removing the meconium, the child shall not be permitted to take any nourishment; not so, but, on the contrary, it should from time to time be allowed a reasonable supply of proper diet. It has been observed that the proper nourishment for the newly born infant, under all circumstances, when it can be procured, is the milk from the breast of the mother, and no other can be substituted, pos. 10 110 PRINCIPLES OF NURSING. sessing the least claims to superiority. As well might the ingenuity of man array itself against the wisdom of his Maker, with a view of giving eclat to his works, as to attempt to devise a means for the fulfilment of this important design, other than that which his benificence has so amply bestowed. But when circumstances render this natural pro- vision unavailable, the assistance of art becomes an indispensable auxiliary to the sustenance of the child. What, then, can be substituted for the mo- ther's milk, that approaches nearest to it in point of quality and nourishment? A preparation formed of cow's milk and water, with a little loaf sugar, in the following proportions, supplies the deside- ratum. Take of Fresh cow's milk, 1 table-spoonful. Hot water, 2 table-spoonsful. Loaf sugar, as much as may be agreeable. Some authors recommend a preparation consisting of two parts milk, and one of water; this, in our opinion, is too great a deviation from nature; the proportions we here direct form a compound, ap- proximating nearer to that the child would want to draw from its legitimate source than any other that has yet received the sanction of successful experi- ment. In this view we are sustained by chemical PROPER MANAGEMENT OF THE INFANT. Ill analysis, which shows that in equal quantities of cow's and woman's milk the latter contains a much smaller quantity of curd, which must be attributed to the great quantity of water with which it is di- luted ; and further, to show that water enters more largely into its composition than in that of the for- mer, we will quote from Dr. Gregory, who says, "When allowed to remain at rest a sufficient time, a cream gathers on its surface. After it is separated the milk is exceeding thin, and has the appearance rather of whey, with a bluish-white color, than of creamed milk." From this we would be led to infer, that water enters more largely into the milk of the human fe- male, as a constituent, than any composition, differ- ing materially from the one we have adopted, would proportionally admit of. Dr. Ellis, in speaking of this mixture, says, " The object is to make a diet as near the qualities of the maternal milk as possible." Inasmuch as the mother's milk does, or ought to constitute the only diet for the child when available, so, also, ought this substitute to be employed, as much to the exclusion of every other article as the mother's milk itself. We have heard this system of treating infants objected to, and the objection urged has been, "the child is obliged to take so great a quantity of water, in order to get adequate nourish- ment." To this objection we would reply, if there be a fault in the infantile organization requiring a 112 PRINCIPLES OF NURSING. diet so simple, the fault is not ours; that a diet simi- larly proportioned is required, we have convincing testimony in the fact that almost simultaneously with the birth of the child commences its spontaneous flow, warm from its legitimate source—the breast of the mother. Dr. Dewees, in treating of this subject, speaks thus: " Many of the preparations in use as nourishment for young children cannot be too strongly condemned, such as crackers and water boiled together and sweetened, or bread, water and sugar, than which nothing can be more ungenial to the infant stomach— for these masses begin to ferment the instant they are received into the stomach." While we were receiving instructions from the lips of this illustrious teacher, we came to the settled determination to set our face with rigid pertinacity against the unnatural and preposterous practice of many nurses in this department of the management of early infancy, and pursue a course more in con- formity with our views of propriety. This course we have just been prescribing; it is the one with which we commenced at the onset of our profes- sional career, and every day's experience convinces us the more of the geniality of its influence on the health and well-being of the infant; so much so, that we are almost ready to assert as a maxim, that a fret- ful, troublesome child, is the result of wanton mis- management, while a contrary course almost inva- PROPER MANAGEMENT OF THE INFANT. 113 riably ensures to the little charge a state of comfort- able composure, and to the mother and nurse days of enjoyment, and nights of comparative quiet and unconcern. As our object is to convince the mind of the nurse, rather than enforce obedience without conviction, we have endeavored to expose the danger of forcing upon the child an unnatural and decidedly injurious diet; and also to urge the necessity of employing na- ture's own provision exclusively, and when circum- stances withhold this, we have offered an appropriate substitute, with a view of drawing the attention of the nurse to the pointings of that ever-faithful and never-varying instructress—Nature, in her naked simplicity. Neither can the physician or nurse en- tertain a well grounded hope of success, unless every effort in practice be exerted in conformity to her mild and unerring laws. Quantity.—Should the nurse, after she has pre- pared the "ample bowl" for the child, pause for one moment, and reflect on the dimensions alone of the little organ destined to receive its contents, she could not fail to conceive the idea that it is but a little larger than her thumb; then let the thought that it is incapacitated by the tenderness of its organization and feebleness of age, from digesting and converting into proper nourishment any considerable quantity of ever so fit an article, enter her mind, and she, if pos- sessed of common humanity, would shudder at the 10* 114 PRINCIPLES OF NURSING. evil she was about to inflict upon the hapless little creature. Indeed, so great and manifold are the evils arising from a disregard of these two items in the in- fant economy, that it is really surprising that so many outlive the period of infancy as do. Within the last six years, no less than two instances have come under our observation, in which the little suf- ferers died, one within twelve, and the other twenty- four hours after its birth from excessive feeding, not- withstanding our strong injunctions to the nurse to pursue a contrary course. In the former case, upon inquiring of the nurse whether or no the babe had taken any nourishment, we were replied to after this wise: " Oh laws! yes, it ate half a tea-cupful of boiled crackers and water at once." Did you feed it more than once ? " Yes, sir, it ate hearty four times." Here, then, we have at least near two tea- cupsful of boiled crackers and water crammed into a cavity so small as scarcely to admit your thumb, in the space of twelve hours. What else but death could be anticipated as the result ? The latter, we were informed, ate largely of a similar preparation in the evening, and died in convulsions before morning. We will, in passing, observe that both of the children thus destroyed were remarkably fine, vigorous, and, to every appearance, healthy at birth. Let us see what that great man Dr. Dewees says, in relation to over feeding; and none, who is not con- PROPER MANAGEMENT OF THE INFANT. 115 sumately ignorant or criminally perverse, will pre- sume to gainsay his authority concerning the manage- ment of infants. " The mother very rarely has her breasts furnished with milk at the birth of the child; for the most part, there is an interval of several days before it is supplied in sufficient quantity to sustain the infant,—it is, therefore, supposed, that the child would suffer severely, did it not receive nourishment by other means, until the mother is enabled to provide for it. Accordingly, an ample bowl is prepared by the nurse, and the stomach is crammed to regurgita- tion with a tenacious paste, called pap or panada. This is repeated with such mischievous industry as to throw the poor infant into violent agony, unless the stomach revolt at the unmerciful invasion, and re- ject it by a violent effort, and thus avert the im- pending mischief. Nature seems to have endowed the stomachs of children with a discriminating power upon such occasions ; and most happy it is for them that she has been thus kind, for were it otherwise, many would die in a few hours after birth from absolute repletion. " It appears that the kind nurse has but one rule by which she regulates the feeding of a newly-born child, which is, to pour food down its throat until its stomach can hold no more ; it is then permitted to rest a short time. But the delightful task of cram- ming is again resumed, especially if the poor babe cry ; it is now imagined to be again hungry, and 116 PRINCIPLES OF NURSING. again its feeble powers of digestion are unmercifully taxed. This addition of food, to the great surprise of the anxious nurse, does not quiet its complaining. and its uneasiness is now attributed to 'wind,' and the unfortunate child is next obliged to swallow some stimulating tea, ox liquor, until further distention, and perhaps intoxication, are added to the already almost bursting stomach. It is then rudely jolted on the knee, until kind vomiting comes to its relief, or until the bowels rapidly and profusely discharge their con- tents." While we are penning the remarks of our author, we are aware that many of them, as well as some of our own observations, will sound harsh and unplea- sant to the ear of the careless and unconcerned ; and be received as an unsavory repast by the perverted moral appetite of the guilty. Yet many an anxious and devoted parent will, we opine, confer upon them their 'decided approval. Be it so or not, our duty re- quires us faithfully to represent the claims, upon our protection, of the helpless little being who is entirely dependant, for its existence and comfort, on the management of others, regardless of the frowns of the one, or the approving smiles of the other. To it, and our God, do we owe our allegiance, and to them alone do we hold ourself accountable. There are objections to the practice, against which we have been remonstrating, other than the immedi- ate evils which are likely to result: such as plant- PROPER MANAGEMENT OF THE INFANT. 117 ing the seeds of future ill health, creating an unnatu- ral demand for food, forming habits of gluttony, &c, each of which might afford an instructive disquisition, but we are admonished by our limits to forbear. An instance comes to mind, however, illustrating the ef- fects mismanagement, in this particular, has on the future health and longevity of its victim, which we beg leave to mention. We once had occasion to re- monstrate with a kind, and in every respect most in- dulgent nurse, against the propriety of pursuing a course counter to our directions, both with regard to the quality and quantity of the child's diet, previous to the formation of the mother's milk;—she very pleasantly remarked, "you direct from theory and I practice from experience," and added, "I have been the mother of eight children, and pursued a similar course with them all." We inquired how many of them are now living? She replied, "but two, and they are weakly." We addressed the mother, and asked her if she wished her babe (it being her first,) to share the same fate of the other six? She felt the force of the interrogatory, and united her exertions with ours in prevailing upon the nurse to accommodate her prac- tice to our theory,—and she soon discovered that the notions of starvation and death, which she had formed in anticipation of our meager fare, were unfounded, as the little creature throve finely, and has since grown to be a remarkably clever boy. The fate of the unfortunate six and the shattered constitution 118 PRINCIPLES OF NURSING. of the remaining two, constitute the moral of the story. The receipt given, while considering the quality of diet applicable to early infancy, contains a sufficient quantity to be given at one meal; this should be re- peated at intervals of not less than two or over three hours through the day, and less frequently through the night, provided the child give signs of hunger. These consist in a whining, nustling noise, restless- ness, throwing the hands about, &c, but seldom loud crying. In fact, almost every other means is em- ployed to make known its wants in this respect, be- fore this is resorted to, and when it does cry aloud for food, it is a demonstration of hunger of no ordinary intensity. Three table-spoonsful, then repeated as occasion may require,—not as ignorance may dictate, or a mis- chievous custom sanction,—will be sufficient to answer the requirements of nature until the mother shall be able to furnish the necessary supply. If, however, the circumstances of the case be such as to render an attempt to rear the child by hand un- avoidable, it will be necessary to continue this fare for the space of two or three weeks without much alteration; perhaps a little augmentation in quantity the third week, may not be amiss. It is not expected that the use of the spoon shall be continued after a decision on the expediency of raising the child by hand has been made ; but a means of feeding it of much greater convenience may be employed, viz: PROPER MANAGEMENT OF THE INFANT. 119 the " sucking bottle." As this instrument is so fami- liar to every nurse, and so generally employed in die nursery, it is unnecessary here either to go into its description or to urge the propriety of its use. Dr. Kissam, however, recommends the "German Co- logne Bottles" as preferable, and says, "they are of an equal thickness, thin, and consequently not so lia- ble to break in cold weather as those bottles prepared for the purpose : besides, the expense will be found to be much less. The shape of the latter is most convenient. A silver tube fastened in a cork is the best adapted for suction." The circumstances which render an attempt to rear the child by artificial means expedient, place the nurse also in a situation peculiarly responsible; and she cannot be too cautious in her procedure, as she is now about to form the habits of the child with re- gard to its diet ; and a more important duty seldom crosses her pathway. And to be qualified to dis- charge it in a manner best calculated to secure to it future health and comfort, should awaken her liveli- est concern. The great cause of so many deaths among infants thus unfortunately circumstanced, is, in our opinion, not so much the want of the breast as a want of habits formed more in conformity with the actual requirements of nature. We have seen in- fants scarcely two months old, take from the bottle, with apparent avidity, the enormous quantity of one pint at a meal, and this repeated at short intervals 120 PRINCIPLES OF NURSING. through the day and night; and the mothers, instead of looking upon the achievement as a melancholy event, gave it their approval, and enjoyed it as a demonstra- tion of good health, rather than that of a lamentable perversion of nature. All demanded by the actual necessities of a child at that age does not exceed one half the quantity. The stomach being a muscular organ, and render- ed, by the tenderness of age, very susceptible of im- pressions, becomes greatly increased beyond its na- tural dimensions by this early over-feeding. And as the child is more comfortable when its stomach is mo- derately distended by food, than when it is empty, an increased supply each time becomes necessary to sa- tisfy its demands; this augments the evil which in turn demands a further increase of food, until very much larger quantities are received into the stomach than is required for the purposes of digestion and nu- trition ; and all above this is converted into the ele- ments of disease. Hence the great mortality among children thus situated: and hence the common remark, that such "have a poor chance for their lives." Dr. Cadogan, an eminent English physician, who wrote near a century ago on the management of infancy, made some excellent remarks in regard to our pre- sent topic, a few of which we will here transcribe, and from them the reader will perceive that he, who promulgated doctrines a century ago that will, at this day, scarcely be received as or thodox,must have figured PROPER MANAGEMENT OF THE INFANT. 121 greatly in advance of his age ; he "wrote against the same evils in his day of which we still complain; a circumstance demonstrative of the humiliating fact, that the profession of nursing has advanced but very little, if any, for the last hundred years; while every other occupation, subject to human agency, has, within that time, made mighty strides in improve- ment, and many of them to an extent almost incredi- ble. Is it not time to begin to inquire into the cause of this supineness in regard to one of the most impor- tant relations in which man can stand to his fellow? Can it be that human life is considered of less conse- quence than many other subjects that claim our at- tention? Or is it, that ignorance, bigotry, and wan- ton perverseness constitute the prevailing character- istics of too many of those to whose care the manage- ment of early infancy is committed ? Or is it to be attributed to a shameful recklessness on the part of that class who assume to be the guardians of the pub- lic health, and who have it greatly in their power to remedy the evil? To one or the other of these three causes, or to a conbination of the whole, must be- long the delinquency complained of, and no physi- cian or nurse can faithfully discharge the duty he or she owes to the community without exerting their united influence in opposition to the prevailing cus- toms of the day, with respect to the management of infancy. But to proceed with our quotations, "Look over 11 122 PRINCIPLKS OF NURSING. the bills of mortality. Almost half of those that fill up that black list die under five years of age; so that half the people that come into the world go out of it again before they become of the least use to it or to themselves. To me this seems to deserve serious consideration. "It is ridiculous to charge it upon nature, and to suppose that infants are more subject to disease and death than grown persons; on the contrary, they bear pain and disease much better—fevers espe- cially—-and for the same reason that a twig is less hurt by a storm than an oak. "In all the other productions of nature, we see the greatest vigor and luxuriancy of health, the nearer they are to the egg or bud. When was there a lamb, a bird, or a tree that died because it was young? These are under the immediate nursing of unerring nature, and they thrive accordingly. "Ought it not, therefore, to be the care of every nurse and every parent, not only to protect their nurslings from injury, but to be well assured that their own officious services be not the greatest evils the helpless creature can suffer? "In the lower classes of mankind, especially in the country, disease and mortality are not so frequent, either among adults or their children. Health and prosperity are the portions of the poor—I mean the laborious. The want of superfluity confines them more within the limits of nature; hence they enjoy PROPER MANAGEMENT OF THE INFANT. 123 the blessings they feel not, and are ignorant of their cause. " In the course of my practice, I have had frequent occasions to be fully satisfied of this; and have often heard a mother anxiously say, 'the child has not been well ever since it has done puking and cry- ing.' "These complaints, though not attended to, point very plainly to the cause. Is it not very evident that when a child rids its stomach of its contents several times a day, it has been overloaded? While the na- tural strength lasts (for every child is born with more health and strength than is generally imagined,) it cries at or rejects the superfluous load, and thrives apace : that is, grows very fat, bloated, and distend- ed beyond measure, like a house lamb. "But in time, the same oppressive causes continu- ing, the natural powers are overcome, being no long- er able to throw off the unequal weight. The child, now unable to cry any more, languishes and is quiet. "The misfortune is, that these complaints are not understood. The child is swaddled and crammed on till, after gripes, purging, &c. it sinks under both bur- dens into a convulsion fit, and escapes further torture. This would be the case with the lamb were it not killed when full fat. "That the present mode of nursing is wrong, one would think needed no other proof than the frequent 124 PRINCIPLES OF NURSING. miscarriages attending it, the death of many, and the ill health of those that survive." These remarks are just as applicable to American customs in 1840, as they were to English in 1750 ; the same evils ex- ist now, in regard to feeding children, as were repre- hended then. We have been thus lengthy in our observations on food, in order to bring fully to bear upon the under- standing of the nurse an array of eminent medical testimony, reason, and facts, in hopes of convincing her of the importance of a reformation in this depart- ment of her profession, whereby the great amount of infantile suffering and mortality maybe lessened; and by adopting a course of procedure more conformably to the requisitions of nature, render the business of rearing children one of enjoyment and pleasure, in- stead of a task painful, anxious, and perplexing, "for," says Dr. Cadogan, "if we follow nature in- stead of leading or driving her, we cannot err. In the business of nursing, as well as physic, art, if it do not exactly copy the original, is ever destruc- tive." Now, in conclusion, we will remark to the nurse, that the infant will really require but a very little, if any deviation from the directions we have given, during her administration in the nursery ; and what is to follow after the mother shall have assumed the charge of her babe, we reserve for future considera- tion. PROPER MANAGEMENT OF THE INFANT. 12^ DRESS. " Such rearing 'mong the rich has thinned their house In early life, and laid in silent ranks, Successive with the dead, their infant race." Were it possible for an inhabitant of another sphere to visit the nurseries of some belonging to our fa- shionable circles, he would, in view of the embroid- ered lace, worked ruffles, and stiffly starched linen scratching and chaffing the tender skin of the infant, with some important regions of the body entirely un- clothed and exposed, and others superabundantly clad, become impressed with the idea, that the re- quirements of idle fashion, or the gratification of empty pride, constituted, at least, one of the cardinal objects in the making and arrangement of the child's dress; and that its health and comfort were least of all consulted. Such, at this time, appears to be the order of things, and that, too, in what is styled the higher ranks of society, where opportunities favorable to the acquisition of correct information are so nu- merous, and the resources of knowledge so available; while, on the contrary, a course nearly opposite is pursued by those filling the humbler walks of life, whose means are not adequate to the ever varying demands of inconstant fashion, and who have the satisfaction of seeing their offspring enjoying almost uninterrupted health and vigor of constitution, by pursuing a course from which their circumstances 11* 126 PRINCIPLES OF NURSING. will not readily permit them to deviate ; hence, mea- surably, the common observation that health is, in particular, the blessing of the poor, while the wealthy are more the subjects of affliction. Fortunately, however, for the little charge, the ad- vancement of intelligence in this country is about re- cording among the things of the past a most prepos- terous and cruel practice—one which was once con- sidered almost as essential to the healthy existence of the child as food itself; and so far as form, symmetry, and regularity of growth is concerned, it was deemed indispensable; we allude to swaddling or swathing the body and limbs of the child, a process vieing in torture with inquisitorial infliction. Buffon says, "with us" (in France) "an infant has hardly enjoyed the liberty of moving and stretching its limbs, than it is clapped again into confinement. It is swathed, its head is fixed, its legs are stretched out at full length, and its arms placed straight down by the side of its body. In this manner it is bound tight with clothes and bandages, so that it cannot stir a limb; indeed, it is fortunate that the poor thing is not muf- fled up so as to be unable to breathe, or if so much precaution be taken as to lay it on its side, in order that the fluid excretions voided at the mouth, may descend of themselves; for the helpless infant is not at liberty to turn its head to facilitate the dis- charges." We give this quotation as a specimen of what was PROPER MANAGEMENT OF THE INFANT. 127 once esteemed, and is yet, to a greater or less extent, practised as an essential matter in the management of infancy; and in hopes it may have an influence in accelerating the barbarous custom in its downward course towards annihilation. Dr. Gregory says "the fillets, rollers, and bandages of the nursery are not only useless merely, but, beyond measure, dangerous. They are to be laid aside as implements of torture and destruction." Notwithstanding the remark of Professor Alcott, that '*' the good sense of the community nowhere per- mits us to transform a beautiful babe into an Egyp- tian mummy," there are errors in the child's dress in this country, and in this age, not differing so much in effect from that we have just been considering, as (judging from the general intelligence of the commu- nity) we might be led to suppose. Tne evils of which we complain is, bandaging the body entirely too tight, and confining the limbs, by the wrapping blanket and other means, so as to prevent their free motion. Every article of the child's dress should be so made and arranged, as to be subservient to its health and comfort. This will be found to consist, l. In guarding against the variations of external tempera- ture ; 2. In preserving a genial warmth for the main- tenance of the various functions; 3. In protecting the body and limbs against external injuries. The means for attaining these important ends may be ar- 128 PRINCIPLES OF NURSING. ranged according to the dictates of fancy, provided the object pursued is not thereby interrupted ; pride and fashion must always be made to subserve more important considerations, if we set any value on the life of the child; this, however, unfortunately, is too frequently not the case. THE QUALITY OF CLOTHING BEST SUITED TO THE SITUATION OF THE INFANT. Flannel is, perhaps, more extensively and advan- tageously used as an ingredient, of which clothing for children is made, than any other material. Pub- lic sentiment, as much as it is perverted on many subjects connected with the management of infants, appears to be right on this. The superiority of flannel to other substances used, consists, 1. "In its protecting power against sudden reduction of temperature ;" i. e. its non-conducting power prevents the natural heat from escaping from the surface of the body when the surrounding tem- perature is materially lower; wool being a better non-conductor of caloric than flax or cotton, is con- sequently better adapted to the purposes of wearing in cold or variable weather. 2. In guarding the body against the cooling effects of evaporation. When the surface of the body is bedewed with perspiration, the flannel prevents too rapid an escape of the warmth from the body—and as it does pass off gra- CLOTHING FOR THE INFANT. 129 dually the moisture is absorbed by the flannel, whence it evaporates to the body imperceptibly. Thus, it is perceived, that the temperature of the body can be but little affected during the process of " drying up of the sweat," as it is called, which must be otherwise, were linen or muslin employed in its stead, because they conduct off the heat much more rapidly, and absorb the moisture with less facility. hence, a cold dampness must of course pervade the surface of the body during the drying process, and hence the advantage of flannel next to the skin. 3. In producing over the surface of the body a health- ful and " agreeable irritation," by means of which insensible perspiration is advantageously promoted— a function indispensable to the health of the child; its use, in this respect, approaches in effect that of the flesh brush, by producing this grateful action upon the skin, it equallizes the circulation ; the blood is being constantly invited to the surface, which les- sens the liability to congestion of the internal organs, by its being thrown upon them in too great abun- dance. From these considerations it is evident, that flan- nel next to the skin, in cold and variable seasons, not only adds to the comfort, but also exerts a salutary influence on the health of the child, so much so, that its adoption cannot but be considered an important if not an indispensable item in the successful man- agement of the infant. Though flannel is of so much 130 PRINCIPLES OF NURSING. utility in a large majority of instances, it is not, ne- vertheless, of universal applicability. It is a fact, of which every observer is aware, that many persons perspire much more easily than others; this difference exists to as great an extent among infants as adults. In those cases where it is disco- vered that the infant perspires with great profusion, it is better to remove the flannel, and substitute in its place muslin or linen. Though the flannel, as it has been observed, absorbs the moisture with much greater rapidity than either of the other ingredients, it, at the same time, promotes the perspiration to an extent disproportionable to its absorbent powers; hence it not only becomes the fruitful source of the evil it was designed to obviate, but is deeply impli- cated in producing a dangerous debility and emacia- tion through excessive sweating. We occasionally, too, meet with infants whose skin is exceedingly irritable, so much so, that flannel, be it ever so fine and soft, cannot be worn next to it without producing a great deal of uneasiness; and sometimes an efflorescence or redness, extending over the whole or greater part of the body, all of which disappear immediately upon removing the flannel. During the existence of a feverish state of the sys- tem, when it becomes necessary to lower the temper- ature of the skin, with a view to reduce the force and severity of the exacerbation, the use of flannel next to the skin should be discontinued for the time being, CLOTHING FOR THE INFANT. 131 but resumed immediately after the paroxysm shall have subsided. The liability of the child to take cold may be urged as an objection to this expedient. This, however, cannot be received as valid, since, at this time, the medium through which cold is contract- ed, viz. perspiration, either sensible or insensible, is suspended; an event which constitutes one of the principal agents in producing that phenomenon called fever. But as this matter partakes more of the na- ture of a remedial means than an item, proper in the general management of infants, and belongs to the jurisdiction of the physician rather than the province of the nurse, we would recommend her to consult him relative to the propriety of adopting the mea- sure, instead of proceeding in it without such counsel and thereby incurring unnecessary responsibility. "The flannel should always be of the white kind, where the circumstances of the parents will permft it—not that the first cost of the white need be greater than that of the coloured, but because it will, for the sake of the eye, require to be more frequently changed, as it will more readily show any dirt that may attach to it; but, for this very reason it should be employed, whenever it be practicable. Another reason may also be assigned: the white'can always be procured of a finer quality, which sometimes," we would say always "is desirable." "There is a very common error upon the subject of flannel which deserves to be corrected: namely, 132 PRINCIPLES OF NURSING. that it can remain longer dirty without doing mischief by its filth than any other substance; but in this there is no truth,—flannel, from its very texture, is capable of absorbing a great deal of fluid, which it will retain so long, if permitted, as to allow a fermen- tative process to go on, and give rise to the extrica- tion of some deleterious gases; therefore flannel should not be worn even so long, on this very account, as linen substances."—Dewees. WHAT CONSTITUTES A NECESSARY SUIT DURING THE MONTH. The quantity of clothing necessary for a child during the month, cannot, in a climate so un- steady and variable as ours, be readily prescribed. This should be regulated according to circumstances: which are, 1st. The state of the weather and sea- son of the year. 2d. The advantageous or disadvan- tageous locality of the apartment employed as the nursery, with regard to its exposure to the influences of 'the atmospheric variations. As a general rule, however,—making exceptions for vicissitudes,—we would say, that the belly band, a flannel shirt, dia- per, flannel petticoat, frock, cap, and socks, properly applied, constitute all that is necessary, and nothing superfluous, in a well arranged and comfortable suit. Belly band.—This valuable constituent of the in- CLOTHING DURING THE MONTHS. 133 fantile suit derives its consequence from the import- ant ends it designed to answer, viz. to give a ge- neral support to the abdomen, and a particular one to the navel, and at the same time contribute its quota towards preserving a proper temperature of the body. It should consist of a strip of white soft flannel, cut bias, and between five and six inches wide, and about five-eighths of a yard in length. The advan- tages to be derived from cutting it diagonally with the threads, or bias, are—1st. The elasticity thus given it, enables it to accommodate itself to the child's body, during the various changes of position to which it is subject in being handled, without binding too tightly on one part and being relaxed on another. 2d. It also yields more readily to the impulses given to the abdomen by the efforts of sneezing, crying, straining, &c, thereby obviating, in a great measure, those dangerous, and sometimes lasting injuries, as rupture in the navel, groin, &c, that not unfre- quently arise from an ill management of this import- ant appendage. 3d. This elastic property enables it to set with greater uniformity and ease to the child, thereby preventing a great deal of restlessness and pain, to which it, under the ordinary arrangement, is doomed to suffer. The band is much improved by having two or three small pleats in the lower edge, perhaps still more, by being slightly gathered in that part, so as to produce a fulness in the middle corres- 12 134 PRINCIPLES OF NURSING. ponding to the shape of the child's belly; this provi- sion will prevent its tendency to slip up, an occur- rence which too frequently happens, leaving the parts it was designed to guard wholly unprotected, thus entirely defeating the object of its application, to the decided detriment of the child's present, and, perhaps, future welfare. If, however, this should be found insufficient for the full attainment of the object in view, it should be provided with a small appendage, or "tag," at the lower edge, by means of which it should be secured by the large pin to the diaper, the one being sufficient for both purposes, viz. fastening down the band and securing the diaper. It should also be provided with tape strings, to be used in the place of pins for the purpose of fastening; the latter being highly objectionable on account of their liability to scratch and puncture the skin; instances are re- corded of protracted ill health arising from accidents occurring from the use of pointed instruments about the child's dress. We are aware, that an almost uni- versally established custom may be urged against this caution. But this pretext is not sufficient to warrant the jeopardizing of the infant's health, and comfort unnecessarily. Pins and needles, then, should not be employed under any circumstances where other means can be substituted. The Shirt—With respect to this garment we have but little to say, further than to repeat, that it should be made of soft white flannel, unless it is designed to CLOTHING DURING THE MONTH. 135 be worn in the months of July and August, when fine muslin or linen may be substituted; the practice of rendering the shirt stiff with starch, and decorating the sleeves, shoulders, &c, with ruffles and embroidery, should be immediately dispensed with, as they can in no possible way contribute to the child's comfort, but on the contrary, are the source of a great deal of uneasiness, from their roughness and harshness. This garment should, of all others, be the clearest of every thing of the kind; it should be as soft and pliable as it could be made, that the skin may not suffer from its ap- plication, and the comfort of the infant be sacrificed to a foolish regard for finery. The Diaper.—Even in getting up this humble por- tion of dress, pride seems to have been required to act, at least, as a partial director. Who, after a moment's reflection, cannot see the entire unfitness of the mate- rial of which it is (if the means of those concerned will admit it) generally made, viz.: new linen, harsh and rough of itself, but rendered more so by the fancy work bestowed upon it; an article known as "diaper linen" is generally employed, less on account of its fitness, than the fine figures with which it is deco- rated. Oh shame to our boasted civilization ! When the little helpless creature is to be tortured and har- rassed, its tender skin fretted and abrasedby a garment, made not accidentally, but intentionally unfit; and for what ? Why, the bare gratification of a surviving relic of savage gaudery. 136 PRINCIPLES OF NURSING. The ingredient that we should recommend as best suited to the purpose, is linen made soft by previous use. Diapers made of old linen sheets, or some ma- terial of similar quality, approaches much nearer, in our view, to what is substantially useful, and least prejudicial to the well being of the infant, than any other we have ever seen applied. The Petticoat.—The petticoat should be made of the same variety of flannel as has been recommended for the other parts of the dress, and for the same rea- son. The body should consist of fine soft muslin or linen, six inches wide, and of a length corresponding to that of the belly band, and like the latter, it should be provided with strings for the purpose of fastening; its length should be sufficient to come considerably below the feet, so as to double well upon them, and form a protection to them against cold, &c. The Frock.—Dr. Dewees says, " The principal ar- ticles of clothing are to be made of fine flannel; they generally are called the under clothes; fashion, ca- price, or fortune may regulate the rest, provided the garments for the feet and legs be excepted." We would go farther with our exception, and include the frock and cap. We cannot consent to leave to so fickle advisers the regulation of these important items. For the frock, then, which is the exterior, and of course most exposed to the eye of criticising and destroying fashion, and which is sometimes desired to be made in conformity with her wayward requisitions, we CLOTHING DURING THE MONTH. 137 would recommend as a suitable ingredient for these "high day" occasions, a soft fine figured flannel, of a colour most agreeable to the fancy of those concerned, and for ordinary use any suitable woolen fabrick may be selected. This should be employed during the va- riable seasons of Autumn, Winter, and Spring. But during the milder and more settled months of Sum- mer, a less substantial and more fanciful material may be used. The former we would recommend, in its appropriate season, for two reasons, mainly, 1st. It is less liable to ignite when accidentally coming in con- tact with fire. 2d. It affords a more efficient security against the influences of cold and dampness. This ob- ject, however, cannot be fully attained, so long as the present preposterous style influences the making of children's dresses, viz. of leaving the whole of the upper part of the chest, and the little arms nearly to the shoulder, entirely bare. However urgent may be the demands of prevailing custom, no conscien- tious nurse can give her sanction to a whim that lays the ruined health of its innocent victim a bleeding sa- crifice on the odious altar of incorrigible folly. The softest terms that this treatment towards the tender infant deserves, is monstrous inhumanity. What nurse or mother would be willing to endure the suf- fering that is thus wantonly inflicted upon the child? Or who could go even about the nursery (which is averred to be comfortably warm) in those inclement seasons, thus partially clad, without contracting se- 12* 138 PRINCIPLES OF NURSING. vere, and, perhaps, fatal colds ? Yet the tender and uninured infant is expected to endure it all with im- punity. In vain may the physician prescribe his carmina- tives and cordials, and the nurse administer her drops and teas, while the infant remains thus exposed. Its distressing cries may be quieted by an anodyne, or it may be jolted into repose, but this relief is only tem- porary : it awakes but to renew its cries of suffering, and again to be lulled by similar means. Where every pains has been taken to regulate the diet, and other matters, (the present excepted,) relative to the management of the infant, we, as well as every prac- titioner must have seen catarrhal affections, disor- dered bowels, colicky pains, and much suffering con- sequent upon this kind of exposure, all of which timely disappeared upon remedying the evil that produced them. Dr. Eberle, in speaking of this cus- tom, says, it "ought to be abandoned as one of de- cidedly injurious tendency, more especially during cold and variable seasons. It is generally supposed that the usual mode of dressing children is calculated to inure them to the impressions of cold, and to obvi- ate the liability to disease from this cause. Doubtless it may be the result with those who survive the ex- periment, but before the system is thus inured the child is very liable to be carried off by some inflam- matory affection, produced by such exposure. It is certainly a most inconsistent practice to expose the CLOTHING DURING THE MONTH. 139 breast and arms during the weak and tender age of childhood, and yet to deem it necessary to Keep these parts carefully covered after the system has acquired firmness, and its full powers of vital resistance by a more mature age." In order, then, to preserve a uniform warmth over the whole of the body and limbs, as a legitimate means of insuring health and comfort to the child, it is evident to every one, who is not blindly "wedded by prejudice to old rules and forms," that this gar- ment should by all means be provided with sleeves of length fully sufficient to cover the arms entirely to the hand, and that it should be cut in such a manner as to allow it to fit completely around the neck, there- by thoroughly protecting the breast against surround- ing influences. We are confident, that if more atten- tion were bestowed on the real necessities of the child, in this particular, and less given to the demands of "Wild wasting fashion, which never should enter here," the poignancy of infantile suffering would be greatly mitigated, and its amount proportionally diminished ; to say nothing of the long list of chronic ailments by which it is to be tortured in after years, and its whole life doomed to wretchedness and misery. The Cap.—In advocating the use of this article of dress, we are aware that we will be obliged to run counter, not only to the influence of existing fashion, but also to the views of most writers on the subject 140 PRINCIPLES OF NURSING. at the present day. Th^ principal reasons, and the only ones worthy of notice, urged by the favourites of this new-fangled, and, in our view, positively inju- rious doctrine, are, 1st. That the cap increases the liability to disease, by its tendency to augment the heat, an undue degree of which, it is said, the head is preternaturally disposed to in consequence of the rapidity of the infantile circulation. 2d. That nature has provided a sufficient covering for this part, and " furnishes it just about as fast as a covering is re- quired, and the child's safety will permit." First. If we admit the premises in this case the conclusion is indisputable: because, whatever tends either to in- crease or diminish the animal temperature, or pro- duce any other material deviation from nature, must affect the health in a corresponding ratio. But we are not prepared to admit the presumption that there is a natural undue determination of blood to that part from the circumstance alluded to, where the child is subject to proper management. There can be no doubt but that there is very frequently a determina- tion to the head during the period of infancy; and it is only surprising that it is not more destructive in its effects than it really is; but we are very far from agreeing that it is a natural result. This, we take it, would be committing a sin, not differing materially from that committed by those who, by their folly and depravity, make their own troubles, and then charge the fault on Providence, something savouring too CLOTHING DURING THE MONTH. 141 strongly of ingratitude to receive any countenance from us. It is a question we are unable to solve, why nature, whose operations are so perfect and uniform, and whose laws so equal and unerring, should be so unmindful of her duty in this respect, as not only to withhold her protection or power of re- sistance against aggression, but herself to become the fruitful source of disease. Or why she should exert her guardian care over the young of inferior animals, and seek by her own efforts the destruction of the in- fant. Acknowledging our inability to account for this conduct of the Old Dame, we leave it for wiser heads. We would, however, attempt to exonerate her against any unfair imputation, by charging the fault upon the management to which the child is too often subject. The exposing of the arms and breast; allowing it to remain wet a long time, during which it is doubly liable to impressions from atmospheric irre- gularities, all of which tend to drive the blood from the surface to the internal organs: this, together with the unmerciful feeding to which the infant is often subject, cannot but throw the blood in undue quantities to the head. Thus nature, by too great officiousness, is robbed of her dominion, her laws sub- verted, and her operations deranged, and then to cap the climax of absurdity and injustice, charge the ef- fect of this untowardness to a neglect of duty on her part. With respect to the activity of the infantile circula- 142 PRINCIPLES OF NURSING. tion, being the cause of these frequent miscarriages on the part of nature, we are equally skeptical; for we are told that "during the period of early infancy, as in all the other productions of nature, the nearer they are to the egg or seed, the greatest, vigour and luxu- riance of vitality exist." That this is the case no one will deny, in view of the surprising tenacity with which the infant, even in disease, clings to life. The same principal is apparent in the grass, or grain, fresh shooting from the bosom of the earth, at which time it may be trampled down, or even eaten off by cattle close to the ground, and the instant the destroy- ing agent is removed, it again springs forth in all its pristine vigour. This exuberance of vital principal belongs only to the young, for its disappearance is commensurate with an approach to maturity,—and violence may be inflicted at this period with almost impunity, which, in after time, would greatly endan- ger life. It may now be asked, whence is this prin- cipal derived, and how sustained ? It has its origin in the constitution of the infant economy. And in the absence of voluntary motion, (an organic delin- quency peculiar to the infant,) and consequently of that exercise, and its concomitant attendants, which are so efficient in promoting the developement and strength of the vital organs, it is sustained by a wise arrangement of nature, viz. a corresponding activity in the circulation of the fluids, and in the process of respiration, by means of which the oxygen of the atmos- CLOTHING DURING THE MONTH. 143 phere received into the lungs, at each successive in- spiration, is carried with rapidity to the great vital organs, and also to the remotest parts of the system, dispensing life and sustenance to the whole. The blood returning to the heart, and thence to the lungs, with equal rapidity, and there ridding itself of its im- purities, to be thrown off by expiration, it again re- ceives its portion of oxygen to be again rapidly dis- tributed throughout the system. Now, if it were not for this provision, this accelerated circulation and re- spiration, the infant, instead of thriving and growing, would, as a natural consequence, dwindle away and die of emaciation in a very short time after birth. Thus, it will be perceived, that during the absence of voluntary motion, which continues through the first, and to a great extent through the second months, the equilibrium, in function, is preserved, and the health and growth of the child promoted by this wise regulation. But as this motion increases, exer- cise becomes a pleasure, and it is indulged in, which gives the system more strength and firmness, and as age advances, the above described arrangement be- comes less and less useful until it entirely subsides in adult age. Now, we cannot see how the head can receive more than its quota of blood, if the other parts of the body continue to receive theirs; true, there is a great- er quantity of blood actually sent to the head than to many other parts of the body, but no more in pro- 144 PRINCIPLES OF NURSING. portion to its demands than to the lungs, stomach, liver, or even the foot, and we can see no good rea- son why any one of these organs should not be equally liable to disease from the same cause, as each re- ceives its full quota of blood; and the head, if all other things be properly conducted, can receive no more without disturbing the equilibrium of the whole, an event which very few, indeed, would be able to survive any great length of time; and nature, which is considered the guardian and protector of the in- fant's health and well-being, would be busy in adopt- ing means for its destruction,—a crime of which we? as one, are ready to acquit her. If, then, the opera- tions of nature are uniform, and each part or organ separately are combined objects of her especial care, we cannot coincide with the opinion that the in- creased circulation in the infant predisposes in the least to disease; but, on the contrary, look upon it as the legitimate source from which, mainly, its health and animation are derived; and the new-born child, when placed in the hands of the nurse, should be esteemed a gift of Providence,—a model alike of innocence and perfection, and not as a new thing, carrying within it the seeds of its own destruction, destined only for an hour's existence. • If, then, the conclusion be correct, that at birth there is in the infant necessarily no predisposition to disease, (with the ordinary exceptions incident to every general rule,) is not one part equally liable with CLOTHING DURING THE MONTH. 145 another to disease, from the application of a covering? Is there not danger of creating too great a degree of heat in the regions of the lungs, heart, stomach, liver, or kidneys, by having these parts so warmly clad? The answer is no. Then, we would ask, why so apprehensive of danger from having the head co- veredby a thin cap? Why, in the second place, we are told that nature furnishes an appropriate covering, and at the proper time. Now, whether nature intended the hair fcr a sufficient protection against the effects of cold, or for an ornament, or for some other purpose, we have not been satisfactorily informed. If, how- ever, the first was the object she had in view, we are constrained to charge her with partiality, since, in some instances, she is so prodigal in her gift, and in others so sparing. We would suppose if the hair was designed to answer this important end, nature would have been more uniform in bestowing it. But perhaps this disparity maybe attributable to some ca- price of the old vixen, and the profusion we some- times see be the effect of a frolicksome humour, while the scantiness is that of a more sullen mood. If this is the cause of so many cases of delin- quency, and we cannot readily ascribe it to any other, we are inclined to the belief that the donor is labour- ing under that species of imbecility incident to great age, that consequently the infant is no longer safe in such hands, and that the danger of its situation be- speaks for it protection from another quarter. 13 146 PRINCIPLES OF NURSING. But if the hair is not designed by nature as the ex- clusive covering for the head, it then follows that this part, in common with the rest of the body, be- comes the subject of our regard and protection. So far we have endeavoured to show the promin- ent objections urged against the use of caps, to be in themselves futile and at variance with truth, and that the head incurs no more danger from being properly clothed than any other part of the body. An affirma- tive view of the subject now remains to be taken, wherein it will be seen that the head is more liable to disease where the cap is rejected, than otherwise; and for the same reason that other great vital organs, of like organization, become deranged from the same cause (viz. exposure.) Those authors who go for rejecting all coveringof the head, urge, with commen- dable earnestness, the necessity of keeping the upper part of the chest comfortably clad, as an efficient means of protecting the lungs and their appendages from attacks of inflammation, which attacks are in- curred mainly from exposure to atmospheric influ- ences. But they have not seen fit to inform us why this viscus, protected as it is from the circumstances of locality, by the sternum anteriorly, ribs laterally, the spinal column posteriorly, and these overlaid by thick muscular coverings, is more susceptible of in- flammatory attacks than the brain and its append- ages. The latter, from the nature of its organizationt is equally susceptible of like attacks from the same cause, while its natural situation is infinitely more CLOTHING DURING THE MONTH. 147 exposed, having no other protection against the ef- fects of cold and dampness than the thin and delicate scalp skin, the bones of the head at this period being but very imperfectly formed. Dr. Eberle, in speaking of the exposure of the chest as consequent upon the present mode of dress- ing children, very properly observes, that" croup, in- flammation of the lungs, catarrh, and general fever, are, doubtless, frequently the consequences of this ir- rational custom; and it is not improbable that the foundation of pulmonary consumption is often thus laid during the first few years of life;" and in the very next paragraph gravely teaches that " the universal custom of covering the infant's head with a cap is of very doubtful propriety." Now that the brain and its membranous coverings are equally, nay, more susceptible to disease from ex- posure than the lungs, bronchial tubes, air cells, or pleura, is a truth too evident to require argumenta- tion to prove; we are, then, free to acknowledge our want of perception to discover the philosophy of a theory that requires one organ, that is by nature won- derfully protected against certain injurious influences, to be further protected by the contributions of art, while another, equally liable to injuries from the same cause, with but very slight natural protection, should be wholly deprived of that kindly proffered by this munificent contributor to human comfort. But waiving, for the present, all theoretical no- tions of the prqpriety or impropriety of the use of the 148 PRINCIPLES OF NURSING. portion of dress, we will pause for a moment to in- quire what is the result of experience in the matter. One of the strongest practical arguments that can be urged in favour of the cap is, that many, if not most of those who esteem themselves the better part of so- ciety, who were first to reject it, and after having thoroughly satisfied themselves relative to the effect of the new scheme upon the health of their offspring, and supped freely of the bitter cup of sorrow for their folly, are now first to return to the path of safety by resuming its use. This fact of itself might be sufficient to convince the warmest stickler for the no-cap system of the falseness and danger of his position, had we no others to offer. By reference to the reports of the Philadelphia Board of Health, it will be perceived (after making ample allowance for increase of population,) that a greatly increased proportion of infantile mortality, from diseases of the brain, has occurred during the prevalence of the no-cap mania within the last twelve years. By Dr. Richardson, for two years a resident physi- cian of the Philadelphia Alms House, we were re- cently informed that " there are no caps employed in this institution, and the children are continually dying of brain diseases." Nor have we been an inattentive «bserver of the progress of mortality among infants whose parents CLOTHING DURING THE MONTH. 149 and nurses have been so far influenced by this caprice of fashion, as to offer them as sacrifices upon her un- holy altar. Indeed, in a community where quite a small proportion of infants were subjected to this mis- chievous manoeuvre, a large proportion of those who have died within the last six or eight years of dropsy on the brain, and other diseases of that organ, are found to be amongst those who were thus unfortu- nately situated. Though a few isolated cases may be cited where the project has been attended with no visibly injurious consequences, yet taking large num- bers together, in the aggregate it will appear that the bills of mortality are augmented from amongst those who have had no attention paid to their head dress. We have thus endeavored to show, by physiologi- cal and analogical reasoning, and we trust by suffi- cient experience, that a head dress for the infant, so far from being a source of disease, is, on the contra- ry, a matter of the first importance in preserving its health and well-being. The next inquiry that presents itself is, what is the necessary quantity and proper quality of this portion of dress? "Customs," says Dr. Warrington, "run rapidly into opposite extremes." This really appears to be more or less the case in most instances, but it is especially so in the present, for we are told that our worthy predecessors considered a thick quilted hood no more than sufficient to protect this vital part against the evil effects of a variable atmosphere, 13* 150 PRINCIPLES OF NURSING. but the superlative wisdom of the present age de- nounces even the most flimsy possible covering as a means of destruction. Here we have two extremes of management for the tender infant as wide from each other as the poles, and both having adherents, though at different periods equally zealous in promot- ing and vindicating their favorite dogmas. Now, our convictions influence us in the belief, that the one of these extremes is equally as prejudi- cial to the health of the infant as the other, and we are irresistibly led to observe a course differing somewhat from midway between them, as the one best calculated to enhance the present and future welfare of the little charge. While we esteem a thick heavy tiara, or ponder- ous Persian turban for the babe, an effectual instru. ment of disease and death, we cannot help depre- cating the other extreme as equally prolific with evil. That which strikes us as the proper medium to be observed, is the use of a cap, made of a soft, fine, smooth and moderately thin material; that designed for summer may be light, but the winter cap should consist of a more substantial fabric, both of which should by all means be entirely free from embroidery and all kinds of knotted work. " Lace or embroid- ered caps may be very beautiful, and well adapted to gratify the parent's pride of dress, but is an improper covering for an infant's head. The roughness and CLOTHING DURING THE MONTH. 151 harshness of its surface is calculated to fret and irri- tate the delicate skin with which it comes in contact, and if not productive of eruptions and sores, cannot fail to occasion some degree of pain or uneasiness to the wearer."* And the growth of the hair, moreover, is very of- ten greatly impeded by the application of an illy ar- ranged cap. By the rough embroidery it is continu- ally being worn off as fast as it puts out, so much so, that we have seen children of three months pld with much less hair than at birth. This, we are aware, is used as at argument against all caps, while it is only, in reality, applicable to the ingredient of which they are made. The cap should be so constructed as " never to be allowed to conine the ears," so that by " improperly compressing them against the sides of the head, pain and inflammation of those organs, or a disgusting and sometimes dangerous soreness and running behind t*>e external ears," may be occasioned. Before taking eave of this article, already protract- ed to an unreasonable extent, we crave a moment's further indulgence to state our objections to an item of management in this department which we consider of highly injurious tendency, viz. the cus- tom of placing upon the child's head at night, when it is too frequently to be immersed in a warm feather bed, and often covered with a supera- • Journal of Health. 152 PRINCIPLES OF NURSING. bundance of bed clothes, a thick warm cap, by means of which perspiration is liable to be promoted to too great an extent, attended with languor and de- bility, which exert upon the tender system of the in- fant a decidedly mischievous influence, especially when the child is permitted to go through the day with a very thin cap, or, as is now commonly the case, with none at all. Through the day the child is more or less exposed to a cooler atmosphere, to draughts or currents of air from windows, doors, &c, with the head but slightly clad, or entirely bare. And at night, when it is abundantly protected against these influences by be- ing placed in bed and warmly covered,! it becomes necessary, in the opinion of the good nurse, to add still further to the protection by the spplication of a thick, substantial, warm night-cap. The change that the infant is thus obliged to experience is too material to be long borne with impunity. Irain disease, in some form or other, must, almost as a consequent, to a greater or less extent, ensue. If there is one cir- cumstance connected with the management of infants that would justify its going without the cap, or any time more favourable than another, it is when covered up warm in bed at night. We would not, however, wish to be understood as advising the rejection of the cap even at night; but we can see nothing but mischief in making so greata change as is almost universally observed. If unifor- CLOTHING DURING THE MONTH. 153 mity in the temperature of the head, an important desideratum in the successful management of the in- fant, is desirable, the night-cap should not differ ma- terially in point of texture and warmth from that worn through the day. Socks.—These are designed to cover the feet and ankles, and protect them against atmospheric impres- sions. They should be sufficiently long to extend near half way to the knee; especially in the winter, they are to be secured to the foot by the application of a ribbon or tape, at least half an inch broad, around the ankle, and tied. They should be made of the finest wool, soft, and entirely free from rib work or any thing of the kind, as this is liable to produce pain- ful indentations of the skin; and were this not the case, the roughness thus unnecessarily given to the garment cannot but occasion a great deal of uneasi- ness by its continual friction upon the delicate skin of the wearer. THE WRAPPER. Having gone through with our observations on the necessary dress of the infant during the month, while it is presumed it is to remain mostly within the nursery, we will now state our objections to an ap- pendage that is almost universally employed during this period, which we consider not only unnecessary, but decidedly detrimental to the child's well-being, viz. the wrapper, that in which it is enveloped im- 154 PRINCIPLES OF NURSING. mediately after being dressed. Where each garment is made with a view exclusively to answer the ends of usefulness, the thick shawl or blanket prepared for this extra service becomes a mischievous supernu- merary, inasmuch as the necessary suit, if properly arranged, affords ample protection against the inju- rious impressions of surrounding agents. The child usually, when considered abundantly clad, is required to endure the encumbrance of the wrapper about it upon being placed in bed, in consequence of which it becomes oppressively warm, perspiration flows pro- fusely, producing feebleness and enervation; and when taken up, the wrapper must necessarily be re- moved to a greater or less extent while being changed, &c, and very frequently it is entirely thrown off im- mediately upon being taken from the bed, by means of which, while reeking with perspiration, with arms and breast bare, and thrown into an atmosphere of decidedly lower temperature than that of the bed, it is very liable to incur severe colds; indeed, if it escape these it should be considered more the work of miracle than of good management. If, on the contrary, every caution be observed to prevent the removal of the wrapper, and to keep it close about the child during its abode in the nursery, its limbs must necessarily suffer from a want of that instinc- tive exercise which is ever grateful to the little being, and in which it should by all means be permitted freely to indulge, which cannot be the case so long THE WRAPPER. 155 as the little limbs are bound down by this infamous contrivance. The practice of confining the limbs by this means approaches in effect that of the mur- derous, though, fortunately, almost obsolete custom of swaddling practised to so great an extent in former times. The effect of that was to confine the upper limbs close down by the side of the body, and so re- strain the lower ones as almost to prevent any mo- tion, and this does very little less. A full develope- ment of the parts, and a corresponding muscular vigour, cannot be expected without the adequate portion of exercise, and any custom that tends in the least to impede this should be discountenanced by every one interested in the important duties of rear- ing children, as ruinous and destructive. " In surplus robes They vest their babe, and surfeit cram of pills And powdered venom, which not brace the frame But native vigour sap, and hasten death." Let us not be understood, however, as condemning all over covering and at all times. This we are very far from doing. When the infant is taken out of the nursery for the purpose of airing, or from any any other consideration it be required to become ex- posed to the open air, when the weather is thought uncomfortably cool, an extra garb may be advanta- geously employed. An extra covering for the head, also, during these excursions, such as a light bonnet or hat, cannot be objected to. 156 PRINCIPLES OF NURSING. CRYING. Loud and energetic cries are almost the first of the infant's efforts upon being ushered into its new and independent state of existence. It is these for which the female anxiously hearkens at that important mo- ment, when she is about to claim the honorable rela- tion of mother. The satisfaction they produce by falling upon the listening ear, is of a far more perfect charactert han that she was ever wont to ex- perience either in the halcyon retreats of contempla- tion, in the social circle, the cotilion or the soiree. They afford her an enjoyment that amply rewards her for her anxiety, suffering and pain. Because they are the cries of her own babe, they are indeed mu- sic to the soul, they sooth its turbulence, and cheer the drooping spirits when ready'to sink beneath an almost insupportable load. Crying is an important exercise to the infant. By it most of the muscles of the chest and abdomen are put into immediate action; if it be intense, nearly the whole of the larger muscles of these regions are more or less implicated. By the act of crying, the blood is propelled with a beneficial impetus through the lungs, and made to traverse channels never coursed before. The air cells are by it expanded, giving a more ex- tensive surface to the action of the air taken in, and enabling the blood to become thoroughly oxygenized, CRYING. 157 by means of which "the dark coloured impure blood of the veins is changed at once into pure blood, and thus rendered fit to nourish the system and sustain life." Crying is also important in ridding the lungs and throat of a mucous accumulation that always ex- ists in a greater or less degree in the new-born infant, frequently interfering with the respiration to an alarm- ing extent. These are some of the advantages of the infant's first cries. Occasionally through the month, and in- deed throughout the whole period of infancy, mode- erate crying should be viewed in no other light than that of an healthful exercise. But the circumstances under which it takes place, and the causes by which it is produced, should be taken into account when we aver it to be an health- ful exercise. When severe crying takes place, after the child has lain along time in one position, it should not be permitted to continue in it any length of time, as it is then the language of distress eloquently appeal- ing to the sympathiesof the nurse for relief. By chang- ing its position it will generally cease crying imme- diately; this will be universally the result if there exist no other cause of complaint. Professor Alcott observes, that " all the inconveniences of crying ought to be borne cheerfully, for the sake of having the lit- tle sufferer remind us when nature demands a change of position. No child ought to be permitted to re- main in one position longer than two hours; even 14 158 PRI\CIPLES OF NURSING. while sleeping, nor half that time while awake; and if nurses and mothers will overlook this matter, as they often do, it is a favorable circumstance that the child should remind them of it." Crying, when induced by the infliction of torture, by the existence of continued pain, from excessive hunger, &c, and permitted to continue until the child, overcome by fatigue and exhaustion, sinks into profound sleep, as we have often witnessed, becomes extremely injurious. Important as we may esteem this species of exer- cise to the infant's well-being, we cannot conceive of any consideration, under ordinary circumstances, that can justify the employment of any means for its production, other than those by which it is naturally surrounded, and with which it must unavoidably come in contact. At the moment of its birth, " a multitude of new and highly important relations are established between its tender and uninured organi- zation, and the countless objects of external nature. Functions and operations which, up to this period, lay passive and dormant, are now suddenly called into action, and the whole machinery of its system starts forth in the performances of the harmonious series of vital actions. The air, for the first time, comes in contact with its body—it rushes into the cells of the lungs, and respiration is established—the current of the circulation finds new channels, and abandons those which were previously the principal CRYING. 159 conduits of the vital fluid. The senses are awakened— light strikes the eyes—sound, the ears—and its taste is delighted with the simple nourishment formed for it in the maternal bosom; the sense of touch is acute; it feels the variations of temperature, and is keenly susceptible of pain from injurious impressions,'and gratification from soothing and agreeable influences. The stomach begins to exercise its instinctive calls for nourishment; urine is secreted; the bowels be- gin to act, and to eliminate their foecal contents, and the various secretions subservient to digestion are established. When we contemplate this remarkable transition of a most helpless and feeble being from a state of repose, and almost total exemption from ex- ternal impressions, to a mode of existence which subjects its tender and uninured organization to the ceaseless influences of a vast multitude of varying agencies, it does not appear at all surprising that it should be attended with loud and vehement cries. This sudden transition, and its unavoidable conse- quences, then, being the cause of the infant's first cries, and the after-inevitable vicissitudes to which it is ever being exposed, abundantly supplying causes for all necessary subsequent ones, we can conceive of no consideration that can justify the infliction of torture for their production, though we have more than once known it to be resorted to by anxious mo- thers and ignorant nurses. Indeed, so great have we known the mother's alarm to become, in conse- 160 PRINCIPLES OF NURSING. quence of the infant's silence, that medical advice was thought indispensable; and we have frequently been summoned to infants where the only ailment was sound and perfect health, evinced by a natural, sweet, refreshing sleep. Equally unjustifiable is the odious and filthy prac- tice of leaving the child a long time wet or un- changed, with a view to produce crying. When it is occasioned by any species of neglect whatever, it should be discontinued immediately, and the child not made to endure suffering, undet the pretence of being benefitted thereby. From observation we are led to believe, that this is a policy often pursued by nurses, with a view to favor an inclination to idle- ness, or to promote some other selfish ends. SLEEP. "Sweet sleep is tired nature's wholesome balm; Such sleep as infants know, refreshed and free From pains and cares." "New-born children," says Dr. Dewees, "may be said to sleep constantly : their waking moments fur- nish but exceptions to the rule." This state of existence, midway as it is, between that to which the child has been accustomed, and the more "busy scenes of active life" with which it is destined subsequently to mingle, affords a most SLEEP. 161 happy means of transition from the one to the other. Accustomed, previously to birth, to a state of almost entire quiescence; to the senses laying dormant, and the whole animal system being dependant imme- diately upon other means of existence than its own inherent powers of vitality; removed from this sub- junctive state and thrown at once into another, dis- joined and independent, one that calls forth every latent principle into instantaneous action, and sub- jects the uninured organization to a thousand sur- rounding influences, all strange and unexperienced before. This transition would be too sudden and too great to be long endured, but for the kind interposi- tion of sleep—a wise provision, during which the system is acquiring from day to day firmness and strength, adequate to the demands of its new state of existence, just as fast as safety will permit, or nature require. This passive condition is also peculiarly favorable to the healthy development of the organic system, the effectual establishment of the various functions necessary to life, as digestion, secretion, &c, and to the perfect growth and expansion of every part of the infant's body; for those children whose early sleep is least disturbed by any cause, are they who thrive with the least interruption; while, on the contrary, those whose sleep is broken by some derangement of the nervous system, as evinced by too frequent crying and watchfulness, or any other permanent cause, not only cease to grow, but be- 14* 162 PRINCIPLES OF NURSING. come more or less emaciated and sickly, in propor- tion to the degree of disturbance, j " Calm and long continued sleep," says Macnish, " is a favourable symptom, and ought to be cherished rather than prevented during the whole period of in- fancy." In order for the full attainment of the ob- ject in view, the quality of the infant's sleep, with regard to its being natural or artificial, healthy or un- healthy, the manner in which it is produced, the po- sition in which it sleeps, and the place of its repose, become important items of inquiry, worthy of the serious consideration of every nurse who desires the advancement and prosperity of her little charge. A natural healthy sleep is that ^only in which the child can be permitted to indulge with a view of de- riving that amount of benefit required by nature for all the purposes of the infant economy; this is mark- ed by a sound, sweet, free, undisturbed repose; by the entire absence of all nervous commotions, as a jerking of jthe limbs, or a sudden starting, attended with loud cries, as in a fright; or a low, moaning noise, evincing the presence of pain. Unhealthy or artificial sleep is most frequently marked by some, or most, or perhaps all of the foregoing symptoms, which at once demonstrate that all is not right, and that an investigation into the matter is required. Upon inquiring into the cause of the infant's im- perfect sleep, it will be found, perhaps not always, but generally, to grow out of the misdoings of some SLEEP. 163 of those to whose charge it had been consigned. A very apparently trifling error in diet or dress, or slight exposure, may induce colicky pains, &c, when it too often occurs that a worse evil, viz., the laudanum or Godfrey's cordial bottle is resorted to, to correct the existing one. This course, from bad to worse, is con- tinued until very little, if any, natural sleep can be enjoyed by the infant. The habit of flying to these poisons and destructive drugs upon every slight appearance of pain or unea- siness in the child, is one, if persisted in, fraught with consequences ruinous in the extreme. Several in- stances have we known of infanticide, and many more of destroyed health and shortened life, from the continuance of this most unnatural and murderous custom, our often repeated remonstrances to the con- trary notwithstanding. With these;; devastating ef- fects full in view, there are many, who assume this important charge, possessing so little moral sensibility that they do not hesitate to persevere in their wonted wickedness, until the child becomes stupified in con- sequence, and its healthy existence changed into a state of unnatural dulness, which is seized by the nurse, and artfully imposed upon the unsuspecting mother, as an evidence of her superior skill in her pro- fession, frequently remarking, that " I never have any cross children." This dangerous deception is prac- tised among nurses to an extent greater than most persons are aware. When there is no laudanum, 164 PRINCIPLES OF NURSING. Godfrey's cordial, paregoric, or any thing of the kind about the house, the nurse will secretly procure it, and, if there occurs no opportunity, to escape the observation of the mother, to administer it, she will pretend thechild does not get sufficient nourishment; a bowl of victuals is next prepared, in which she puts the drops; a "sugar teet" is a very convenient means of their secret administration ; the mother's sleeping moments are often employed by the nurse to effect her vile purpose. When the child sleeps too con- stantly, especially towards the third or fourth week, or if it does not become more wakeful by this time than at first, it may rationally be suspected that all is not right; and a great deal of vigilance becomes ne- cessary to detect the wrong. The deception is often not detected until after the nurse has taken her de- parture, and not always then, for the mother, in her embarrassment to discover why her child is more fret- ful and restless now than while in charge of the nurse, too readily attributes it to her superior skill in managing the infant, instead of ascribing it to the proper cause. As it has already been observed, under another head, the child should not be allowed to sleep long in any one position, and for several reasons; 1st, the parts upon which it reclines will beeome greatly fa- tigued, in consequence of which the sleep becomes more or less disturbed; 2d, the long coutinuance in some postures would impede some of the important SLEEP. 165 functional operations, as digestion, respiration, circu- lation, &c.; 3d, the habit might readily be contracted of sleeping in but the one position only, which would be injurious in the particulars just stated. If any one posture is more favourable to health than another, it is that of laying the child on its right side, with its head a little elevated, not enough, however, to produce a sudden crook in the neck; in this there would be too great danger of causing pressure of thelarge blood vessels in that region, and thereby interrupt the free cir- culation of the vital fluid. The body below the neck should retain a position as nearly as possible horizontal. But even this should not be continued over two hours at farthest. The place of the infant's repose is a matter, perhaps, in most instances, not sufficiently regarded to secure to it all the benefit sleep is designed to afford. When asleep, as well as when awake, the child should be al- lowed a plentiful supply of pure air; it should be kept neither too warm nor too cool. A custom now preva- lent that requires the child's head to be covered, and its body immersed in a warm feather bed while it sleeps, prevents the free admission of fresh air, where- by it is obliged to breathe the same foul, unwholesome air several times over, until, near suffocation, it fortu- nately awakes. This, however, is not always the case. Many instances are on record of children having been entirely smothered by having the head carelessly co- vered while asleep, and one or two cases of the kind 166 PRINCIPLES OF NURSING. have come under our own observation. The child should not, especially during the warm weather of sum- mer, be allowed to sleep on a feather bed; it keeps it, in the first instance, quite too warm, and in the second, renders the immediate surrounding air, that which the child is obliged to breathe, vitiated and impure, and unfit for use. A bed made of straw, hair, or corn- husks, is far better adapted to health and comfort than feathers, and should always be employed. The cra- dle, provided with a warm feather bed, is frequently used as the place of the infant's slumbers, which, with a view to prevent its sleep from being disturbed by the flies, or the rays of light, is closely covered by some thick dark material, which almost entirely obstructs the admission of air. This plan is thought to be pre- ferable to covering the head closely in bed, perhaps there is less danger of immediate suffocation, but so far as breathing impure air and too great a degree of warmth are concerned, it is equally prejudicial to the child's health with the former, and alike reprehensi- ble. The child's bed and bed-clothes, whether it be in a cradle or a cribb or upon bed-steads, should be kept strictly dry, clean, and well aired. When allowed to go any length of time neglected they become unfit for use, emitting a very unpleasant and unwholesome scent, arising from absorbed urine, &c. This is a mat- ter not sufficiently attended to in many nurseries. We have frequently seen the cradle-bed, after having been SLEEP. 167 saturated with urine, and but partially dried, employed again and again, and this filthy practice continued over and over, until it had become almost intolerable to our olfactories, and the poor babe still obliged to endure its loathsomeness, the silent pleadings of its chafes and sores for better quarters notwithstanding. Strict attention to the child's sleeping clothes is as in- dispensable to its health and comfort as like attention to its bed and bedding. Had we no other reasons to urge against the custom of permitting the infant to go to sleep wet or filthy, or to continue in this condition after its discovery, its foulness would be sufficient to secure to the little sufferer at the hands of the nurse, who had the least regard for tidiness, better treatment. But when suffered to pass its sleeping hours without at- tention being paid to this particular, extensive excori- ations of the groins and creases, and odious trouble- some sores are the consequences, the suffering from which cannot but render its sleep disturbed, unrefresh- ing, and consequently unprofitable. This observation may, by some, be thought uncalled for, as no nurse can be so neglectful of her duty as to suffer the infant to get in a situation demanding such a remark. But there are those, nevertheless, who are remarkably squeamish about the appearance of the child when awake, but when asleep, unobserved, do not hesitate to oblige it to endure the loathsome situation com- plained of, until the disagreeable and painful conse- quences just stated are incurred. The child then 168 PRINCIPLES OF NURSING. should be perfectly dry and clean, upon going to sleep, and during its slumbers it should be frequently exam- ined, and upon discovering its situation to require changing, it should be done speedily. It is better, and far more consistent with decency, to subject it to the slight disturbance of changing than to allow it to remain for hours thus uncomfortably situated. During the child's sleep, it is better from the first not to be too particular, with regard to the occurrence of slight noises, or'the presence of a reasonable por- tion of light in its apartment; for children trained up to sleep where these are carefully excluded, become very much disturbed, and their sleep rendered unnatu- ral and unrefreshing, where circumstances make their presence unavoidable; an event by no means of rare oc- currence throughout the whole period of infancy. Such a habit may be prevented from becoming established by accustoming the child not to sleep exclusively in silence and darkness. HANDLING THE INFANT. This subject, though of great importance, does not admit of a very lengthened examination; all that is ne- cessary to be dwelt upon can be despatched in a very few words. The infant should not, within the month, behandled more than is absolutely necessary for the purposes of putting it to the breast, washing, dressing, changing its SLEEP. 169 position, airing, &c, and as soon as these duties to- wards it are discharged, it should be laid immediately in bed, and not permitted to lay upon the nurse's lap or jolted about in her arms. So far as exercise is con- cerned, the infant of this age requires but very little; its constant inclination to sleep indicates that a state of repose, as uninterrupted as possible, is best suited to its nature. That exercise, consequent upon the una- voidable changes to which the child's body is subject during the discharge of her various duties towards it by the nurse, and the unrestrained involuntary mo- tion of its limbs, are, in our view, sufficient to answer all the purposes of the present state of organization. The preposterous and dangerous practice of tossing the child into the air and catching it as it descends, with a view of exercising it, is one, of all other evils attending the improper management of infants, the most unnatural and mischievous, and of course most reprehensible. The reasons we would offer for handling the child as little as possible, unnecessarily, within the month, are: First, it very soon acquires the habit of being handled, after which it is difficult to get it to sleep, or lay quiet any where but in the arms of the nurse or mother. Secondly, its sleep is unavoidably more disturbed while lying on the lap. Thirdly, the habit thus acquired by the child gives the nurse a great deal of unnecessary trouble, which is desirable to be avoided. 15 170 PRINCIPLES OF NURSING. When it becomes necessary to take the child from the bed for any purpose, it should be done with a great deal of care; great and lasting injuries have been done to children by the carelessness in handling of those to whose charge they have been entrusted. The many instances of curved spines, or crooked backs, that are daily seen, are mostly attributable to this cause. When the young child is taken from the bed, and during the whole time it remains in the hands of the attendant, its back should be carefully supported by letting it lay upon the arm, while the hand of the same arm is left at liberty to support its head, which we often see "rolling about loosely, as if it hardly belonged to the same body," (Alcott,) greatly endan- gering the spinal marrow, any material injury of which must be productive of "alarming and perhaps fatal consequences." Attempts to make the child sit in the erect posture should never be made; this, however, is frequently done by nurses, upon occasions when it is to be ex- hibited, and is generally looked upon by them as feats of expertncss, both in themselves, and the little being thus wantonly subjected to the peril of injury. Some nurses also view it as an act of superior skill to seize the infant rudely, by an arm or leg, and obliging all its weight to be suspended by one of these while being moved from one place to another. QUALIFICATIONS OF THE NURSE. 171 Infants are frequently rendered cripples for life by this base and uncalled for demonstration of ignor- ance. It is a habit with some nurses, when the child is taken from the bed, for the purpose of being dressed or changed, to rub its little back and limbs with her open hand; this is very grateful to the little being, and is enjoyed by it with much satisfaction. In fact, protracted restlesness, or severe crying, may frequently be quieted by this simple though efficient means. QUALIFICATIONS OF THE NURSE NECESSARY FOR THE SUCCESSFUL DISCHARGE OF HER DUTIES TO THE # MOTHER. Having concluded our observations on the various subjects constituting the essential qualifications of the nurse for the successful management of the in- fant, we now proceed, in accordance to a previous promise, to the consideration of those, an acquaint- ance with which will qualify her the better to dis- charge her many duties towards the mother. Before entering, however, upon the main subject of this division of the present chapter, we shall pause to say a word on the age to which the nurse should have attained, (with all other necessary qualifications,) most likely to render her efficient, 172 PRINCIPLES OF NURSING. and, of course, to secure to her confidence and pa- tronage. THE AGE OF THE NURSE. An age near midway in life is the one, under every circumstance of the case, best calculated to inspire con- fidence in the public, and thereby secure to her who is about to enlist in this responsible vocation, a liberal share of support. At this time in life, it is expected that the system has attained its zenith of perfection; and while the health and constitution retain all the vigor of youth, they have become inured to most of the vicissitudes incident to life, and consequently enabled to resist, with better effect, the various exposures attendant upon this sometimes arduous and always important calling, better than in early or far advanced life. The mind, too, at this age, if trained to reflection and ob- servation, is less apt to be disturbed by either real or imaginary deviations from the ordinary course of things, than at either of the other just mentioned pe- riods, and consequently, better enabled to retain its self-possession in unlooked-for emergencies—a desi- deratum always important to the nurse. It is presumed, also, that a middle aged woman, even though having had no actual experience herself in administering to the necessities of the puerperal female, has had better opportunity of acquiring this THE AGE OF THE NURSE. 173 species of knowledge from the experience of others than is generally afforded those in earlier life. The allurements of society have a less influence upon the mind of one who has arrived at this age, than of more youthful years. But, nevertheless, we would not wish to infer that there are none, besides those who have advanced thus far in life, that are competent to take charge of the lying-in apartment; so far from this being the case, we are free to admit that we have frequently seen the management of the room, and the various duties connected with it, better conducted, and more in season, by the Miss in her teens, than by a ma- tron of fifty. Though the young nurse labors under many unavoidable disadvantages, such as less ability to resist the influences of exposure, more readily fa- tigued by exertion, more easily overcome by sleep, a natural fondness for society, &c. &c.; yet she possesses redeeming qualities, such as a greater willingness to take counsel, obedience to directions, has less self- estimation, is less presuming and bigoted, and less dictatorial; qualities, unfortunately, too seldom found among the characteristics of her elder sisters. The infirmities incident to an age advanced much beyond that above specified, are entire disqualifica- tions to the nurse. At this time in life, the sight, the hearing, and the free use of the limbs are very likely to become more or less impaired; and the individual is less able, from the general failure of the constitu- 15* 174 PRINCIPLES OF NURSING. tion, to undergo the necessary loss of sleep, fatigue, &c; and the patient, if a sensitive, feeling lady, would rather endure many privations than require her aged attendant to exert herself to remedy them. A KNOWLEDGE OF THE PROPER MANAGEMENT OF THE MOTHER DURING THE MONTH. As it is not our intention to make any observations on the duties the nurse is required to perform at the time of labor, (if present,) and during the first visit of the medical attendant, we shall say nothing of the qualifications essential to their discharge, but leave these matters for him to regulate, according to his own views of propriety; upon him rests the respon- sibility, and to him we leave the direction; our busi- ness is to qualify the nurse for the various duties per- taining to her station, that she will be called upon to perform during the physician's absence, and over which he can have no immediate control. This consists in acquainting her with the kind of bed to be employed, proper diet to be used by the patient at different periods during the month; the general management of the patient, temperature and ventila- tion of the room, &c. THE BED. Of all the materials of which beds are composed, THE BED. 175 that most generally used, viz., feathers, is, with but few exceptions, the most objectionable. They ab- sorb with great facility, and retain a length of time the exhalations from the body, until they become more or less offensive, communicating their pesti- ferous influence to the surrounding atmosphere; hence, in a great measure, that disagreeable effluvium so intolerable, that is often encountered upon going out of the free air, in the morning, into a room where persons had been sleeping on feather beds during the night. Feathers are decidedly too warm, especially during the warmer seasons; from this cause they frequently operate to the serious disadvantage of the patient, by producing inordinate perspiration, at- tended with relaxation, and debility of the sys- tem—evils ever to be avoided both by patient and nurse. Beds made of cut straw, chaff, hair, or, what is still better, the husks of Indian corn, are free from the foregoing objections; straw or chaff, however, is not to be employed where husks can be obtained, since they become very dusty by being used, and thereby render the surrounding air impure, and unfit for respiration. Husks make a cool, clean and comfortable bed, and are, consequently, best adapted to the purposes of the lying-in chamber; they are preferable to fea- thers, even in winter, on account of their inability 176 PRINCIPLES OF NURSING. to absorb the noxious matter that is being continu- ally thrown off from the body by exhalation. Soft beds, made of any material, are much inferior, in point of healthfulness, to hard ones during the warm weather of summer; the body must be more or less enveloped while lying upon them, by which means its natural heat is prevented from pass- ing off freely; hence an undue degree of warmth must be endured; consequently, hard beds, mat- trasses, or even a sacking bottom is abundantly pre- ferable. Of air beds we can say nothing from observation. Macnish objects to them as "the very worst that can be employed." The woman, generally, (her circumstances admit- ting,) in anticipation of the event that is to confine her to her room, has her bed ornamented with cur- tains, her room hung with drapery, her toilet deco- rated in the best style, and every thing about the apartment made subservient to display and pomp, with, too often, but little regard to convenience or comfort. So far as the bed curtains are concerned, physi- cians regard them, almost without exception, as highly injurious, and more especially so, when drawn close around the bed; they constitute an effectual means of preventing the free circulation of air; when two or three persons occupy the same bed, viz., the mother, child and nurse, as is often the case, THE BED. 177 the air becomes extremely foul and unwholesome, in consequence of its being inhaled over and over a great number of times; it becomes almost entirely deprived of oxygen, the vital principle of the atmos- phere, and extensively charged with carbonic acid gas, approaching very near to that state of the air frequently found in the bottom of wells, or of deep pits. Curtains that are employed merely as an orna- ment, and are left open, so as to admit of a free pas- sage of the air, are less objectionable in point of healthfulness, but they are, at best, an expensive su- perfluity, and of no benefit whatever. The bedsteads used in these days, and sanctioned by existing fashion, are but illy adapted to the pur- poses of the lying-in room; they are entirely too high for convenience or safety. It is absolutely ridiculous to see a lady, in this situation, ascending a flight of stairs in getting from her room floor to bed. It is hardly possible to imagine what sacrifices of comfort and health many are ready to make for the glory of yielding submissively to the imperious mandates of despotic fashion. The bedsteads designed to be employed upon this interesting and critical occasion, should be neither too high nor too low, but so regulated as to be most con- venient in getting in and out of bed with as little ex- ertion as possible. This evil, so much complained of by accoucheurs, 178 PRINCIPLES OF NURSING. might readily be remedied, were a few respectable, fashionable ladies, to set their faces against it, by do- ing which, they would be conferring a decided bene- fit upon their sex universally. PROPER DIET. There is an impression entertained by the gene- rality of nurses, and favored by many others in the community, who are not professedly care-takers of the sick, which is as erroneous as it is general, that the female, after having passed through the painful and fatiguing operation of parturition, labors under extreme, nay, even dangerous debility, requiring the most nutritious and stimulating diet to enable her to overcome it. That such debility does supervene the parturient effort to a greater or less extent, all will admit, but the means advised for its removal are erroneous in the extreme, and highly condem- nable. Who is there, that is at all acquainted with the scenes of the lying-in chamber, that has not seen some, or most, or, perhaps, all of the evils, entering into the "catalogue" given by Dr. Warrington, "of bloody noses, child-bed fever, miliary eruption, and milk abscesses on the part of the mother, and the nu- merous instances of inflammatory, apoplectic, or con- vulsive diseases to which the children were inci- dent, under" the use of "hot gruels, made oily PROPER DIET. 179 with butter, and intoxicating with wine," rich ani- mal broths, and similar dishes, "freely adminis- tered?" That debility, about which the kind nurse is so so- licitous, is the effect of a sudden change wrought upon the whole animal system, by an irresistibly powerful, nervous, and muscular effort, which, like that experienced in a community where every exer- tion, civil and military, had been at once called into immediate action to resist the invader, left weak and feeble, requiring time and proper means to effect a resuscitation. This state is also attended with extreme nervous irritability, rendering the system susceptible of in- flammatory attacks, frequently from the slightest causes. Hence the danger of employing other than the lightest and simplest diet. We frequently hear nurses boasting Of their hero- ism in disregarding the directions of the physician, and, with an air of self-consequence, tell with what success they can administer a bowl of well seasoned soup, a beefsteak, mutton chop, or plate of pork and cabbage; and in order to prove that such food may be given, if not with advantage, with impunity at least, we were not long since assured by a midwife nurse, of great experience, that she once ate a large dish of cucumbers and vinegar, on the day after she was put to bed, without experiencing any injury from it whatever. 180 PRINCIPLES OF NURSING. If some females do possess constitutions of iron, invulnerable to the attacks of every injurious influ- ence, it is not the case with all; and those who are thus blessed are guilty of the crime of ingratitude, at least, for thus enormously taxing, and expending with such unwarrantable prodigality, and, in fact, jeopardizing that which a kind Providence has given them for higher and better purposes. Such feats we look upon as demonstrations of consummate ignor- ance, and a perfect recklesness of human life, merit- ing the condemnation of all, of whatever caste or dis- tinction. And those who accomplish them are un- worthy of public confidence, and illy deserving the countenance of heathen, much less that of civilized communities. The only food that is proper, and can be taken by the mother with entire safety, during the first three days after the birth of her child, consists of the sim- plest preparations, such as tapioca, sago, or arrow- root gruel; flour, oat meal, or Indian gruel; or bread or crackers boiled in water, and sweetened, panada, &c, either of which must, by all means, be wholly free from butter, and every variety of stimulating liquor, and all heating condiments, as nutmeg, cinna- mon, allspice, &c. &c. If the patient have a good appetite, and manifest a strong desire for nourish- ment, a bowl of either the above preparations may be allowed her at intervals of every two and a half or three hours. PROPER DIET. 181 We direct this species of diet at this time for two reasons, mainly first; because it is less liable to ex- cite fever or other unpleasant symptoms; and se- condly, the secretion of the milk is facilitated by the use of fluids, or semi-fluids, while the use of dry food tends to produce an opposite effect. On the fourth, fifth, aiid sixth days, all things be- ing favourable, we allow a slice of cream toast and a cup of sweetened milk and water; or weak cocoa or chocolate, with the white of a poached egg, for break- fast ; the soft end of half a dozen oysters, with a bowl of soup made of them, and a couple of crackers, for dinner; and a bowl of gruel in the interim ; her af- ternoon lunch and evening meal to consist of a bowl of panada or rice gruel. From the sixth to the tenth day her fare may be enriched in variety and nourish- ment by the addition of beef, chicken, or lamb tea, or weak broth, mush and milk, a little bread and butter, &c, occasionally. After the tenth day, (" nothing forbidding,") she may be permitted to partake, mo- derately, of almost any thing her appetite may soli- cit. If this course, or a similar one, were strictly persisted in by the nurse, we are confident there would be fewer instances of bad getting up as it is called, less distressing sensations, and much more comfort experienced by the patient than falls to the lot of most women in their confinement, where a dif- ferent course is pursued. We are fully aware that it is a severe tax upon the resolution to passively fore- 16 182 PRINCIPLES OF NURSING. go the cravings of a voracious appetite, and quietly submit to directions enforcing restrictions so limited ; but, by addressing arguments to the understanding of the patient, and placing the matter in its proper light before her, we rarely fail in convincing her that it is much better to endure those minor privations a few days than risk weeks of painful illness, and per- haps her life, by indulging in gratifications but mo- mentary at best. The use of tea and coffee, from their evident stimu- lating and narcotic effects, should not only be dis- countenanced by her who has charge of the lying-in- room, but at once banished from it, as destructive to the physical and mental vigour of the patient; the in- fusion of the one, or the decoction of the other, is alike detrimental to the health of its votary. John- son, while he quaffed his " copious potations of tea," endured " the direst fantasies of a mind struggling against the darkest and most painful melancholy;" and Voltaire, while he enjoyed " the supreme bliss of sipping his coffee," dragged out the fevered life of a yellow, shrivelled, walking skeleton, "witty, profli- gate, and thin." In fact, there are but few, in any condition of life, who indulge freely in these popular draughts, that do not eventually experience extreme despondency of mind, mental depression, and incorri- gible emiui; or, what is equally distressing, violent attacks of sick headach, giddiness, vertigo, and ner- vous tremors. The employment, then, by one whose GENERAL MANAGEMENT OF THE PATIENT. 183 nervous system must, in the very nature of things, be in a state of great irritability, of so ruinous and destructive a beverage, can be viewed in no other light than that of culpable remissness. Entertaining such opinions, and daily observation brings renewed and irresistible proof of their accuracy, we cannot but place our unequivocal reprobation upon such in- dulgences within the nursery, under any circum- stances, except expressly directed by the physician. GENERAL MANAGEMENT OF THE PATIENT. Under this head belongs the consideration of those matters pertaining to the immediate safety and com- fort of the mother, during the whole period of her confinement, over which the nurse is expected to ex- ercise a careful supervision; they are, premature exertion, exposure, exercise, even state of mind, lo- cia, &c. Premature exertion.—An imprudence either on the part of the patient or nurse, fraught with more immediate danger than most into which she may in- advertently slide, is that of the patient exerting her- self too early after delivery; we have witnessed in- stances of excessive flooding supervene even very slight exertion, such as coughing, sneezing, changing her position, or turning in bed. A case of fatal flood- ing occurred in our practice a few months ago, under the following circumstances: A coloured woman 184 PRINCIPLES OF NURSING. was delivered of a very small child and two fleshy formations, (a substance known by the familiar name of " false conception,") one weighing nearly a pound, and the other about half that weight. During the course of labor, nothing occurred worthy of remark, and, after delievery, the uterus " contracted well, and all things appeared as favorable" as usual; in three- quarters of an hour after we left the house, with a view of returning in about an hour; we failed not in enjoining upon those in attendance the necessity of letting the patient remain quiet until our return; but we had not been gone more than half an hour, before an attempt was made to put her to bed; she was placed in the sitting posture upon the bed, which she did not retain long before she fainted and fell over across the bed, the position in which we found her upon our return at the appointed time, for the attend- ants, either through alarm or mortification at the re- sult of their disobedience or consummate stupidity, neglected to have us sent for, though we were but a short distance off. What was our surprise upon ar- riving? instead of finding the woman resuscitated from the fatiguing process through which she had passed, according to our expectation, and ready to be placed in a more comfortable position, to find her al- most floating in blood warm from her own veins, with cloths1, coverlets, and bed fully saturated, and the vital fluid streaming through the whole on to the floor beneath; and she, with hands and feet cold, GENERAL MANAGEMENT OF THE PATIENT. 185 hrribs rendered motionless by the rigidity of death, eyes glaring open and immovably fixed, all sensation gone, and gasping her last. Such we found to be the case; we tried every means in our power to re- vive the vital spark, but it had become too far ex- tinguished ; she expired in a few minutes. It may be said of this case, that it occurred in the lower orders of society, and that little else than such mishaps can be expected where ignorance is the pre- dominant characteristic; but let it be remembered that similar occurrences may take place even in the highest ranks, where like motives, viz., a desire to "cheat the doctor," influence the actions of those concerned. The following case, quoted by Dr. Warrington from Dr. Meigs' work " On Practical Midwifery," shows a perfect recklessness, on the part of the pa- tient, of her own safety, notwithstanding both the in- junctions of her physician, and the expostulations of her nurse. " In conversation with my late venerable friend, Professor James, on this subject, (of flooding after delivery,) he informed me that he delivered a lady a few years since, after an easy, natural labor. The uterus contracted well, and all things seemed as fa- vorable as possible. As the accouchement took place early in the morning, he was, subsequent to that event, invited to breakfast down stairs, whither he proceeded, after having given strict caution to the 16* 186 PRINCIPLES OF NURSING. lady on the subject of getting up. While the persons at breakfast were conversing cheerfully, and exchang- ing felicitations upon the fortunate issue of affairs in the lying-in-room, the nurse was heard screaming from the TOp of the stairs,' doctor, doctor, for God's sake come up.' He hastened to the apartment, and the lady was lying across the bed quite dead. It was found that soon after the doctor went below, the lady said to the nurse, ' I want to get up.' ' But you must not get up, madam; the doctor gave a very strict charge against it,' said the nurse. ' I do not care what the doctor says,' rejoined the patient; and thereupon arose, and, throwing her feet out of bed, she sat on its side a few minutes, reeled, and fell back in a fainting fit. The remarks of Dr. James, as he related the occurrence to me, have made on my mind a deep impression of the vast consequence of careful and well-timed instruction of nurses ; who, if they could have the dangers of mismanagement fully ex- posed to them, would surely avoid some accidents, that are every now and then attended with very shocking results." " As an instance of temerity on the part of the nurse, which had been nearly fatal to the patient/' says Dr. Warrington, " we take also the following from the same work:" " I left a woman half an hour after the birth of her child. She was as well as could be desired. I gave the usual directions. In a short time her husband GENERAL MANAGEMENT OF THE PATIENT. 187 came running to me in the street, where he met me, and said his wife was dying. Upon hastening to the house I found her, in fact, pulseless, pale, and com- pletely delirious, with a constant muttering of inco- herent phrases. Upon inquiry, the following occur- rences were fqund to have taken place. She felt some desire tq pass the urine. The nurse told her to get up. ' The doctor says I must not get up/ ' Oh, never mind what the doctor says, it wont hurt you? get up.5 A chamber vessel was placed in bed, and Mrs. F. was lifted upon it, in the sitting posture. She fainted in the woman's arms, was held up a short while, and then laid down; the vessel was discovered to be half full of blood. She had nearly died; and did suffer long and severely in consequence of this imprudent disregard of orders." Dr. Warrington very justly observes, " a perusal of, and reflection upon, the above statement, may be sufficient to make a lasting impression upon the mind of any woman who has a just sense of her accounta- bility ; if she have not, let her speedily relinquish the profession of nurse." In a letter of our very respected friend Dr. Haines, on this subject, he says: " By imprudence either in the nurse or patient have I frequently known faint- ings, with the loss of much blood, to occur within an hour after delivery, and never could I find language too strong in condemnation of such reprobate con- duct." 188 PRINCIPLES OF NURSING. After having been made acquainted with the im- minent danger to which the woman is exposed, by requiring her to stand upon her feet, as has been, and is yet too much the custom in some sections of the country, or even sit up in bed soon after delivery, the reader will agree with us that comment is unnecessa- ry, further than to observe, that she who would still wickedly persist in this murderous practice, regardless of her better knowledge, whether patient, assistant, or nurse, may escape conviction before the courts of civil law; but, if carried to a fatal extent, as has been shown it too often is, she cannot but stand charged with the guilt of homicide before the court of high heaven. Exposure.—Not unfrequently the slightest devia- tion from prudence, with regard to the patient's ex- posure, results in protracted and painful illness. Pro- fessor Huston ranks " exposure to cold, andjespecially a damp or humid atmosphere, or the putting on of ill-dried clothes, during the irritable condition of the female system which attends the puerperal state," second among the probable causes of that distressing malady,phlegmasia dolens, (milk leg.) And Lieu- taud places " cold carelessly treceived," first on the list of causes producing a suppression of the locia, an event bearing in its train a frightful catalogue of se- vere and dangerous symptoms, such as swelling and tenderness of the abdomen, inflammation of the breasts, very violent pain of the immediate parts, and GENERAL MANAGEMENT OF THE PATIENT. 189 groins, agonizing throes, excruciating nervous colic, sometimes attended with severe vomiting; scarlet, miliary, or inflammatory fever; dreadful hysteric fits; terrible pain and distress in the head, delirium, con- vulsions, apoplexy, suffocation, cold sweats, syncope, &c. &c. " Congestions are also formed, or stagna- tions of milk or pus, which ought to be considered as forerunners of death." In fact, there are but few unpleasant symptoms assailing the system while in this delicate and interesting state, that do not grow out of the suppression of this important flow; how desirable, then, it is, that every pains should be ta- ken to prevent so unfortunate an occurrence. Under ordinary circumstances, where there is no constitutional difficulty, it might be safely said, that a large majority of the obstacles that interpose to prevent the speedy and uninterrupted recovery of the puerperal female, originate in exposure, owing to im- prudence either on the part of the patient herself or nurse. And it too often occurs, mainly from this cause, that the woman is doomed to pain and misery, and the confinement to her room for many months, when a little care timely administered and duly ap- preciated, might have prevented so melancholy a cir- cumstance. Exercise.—Well-timed and appropriate exercise is a valuable auxiliary to the patient's recovery, and should never be overlooked in her general treatment; but great caution is necessary, lest, by unwisely in- 190 PRINCIPLES OF NURSING. dulging in ill-judged adventures, she take cold, and more harm than good be the result. In the general way, we have found the following course to answer the purpose designed, with a very little danger of incurring injury. During the first three days after delivery, the wo- man continues in the recumbent posture; on the fourth day, " nothing forbidding," she may be allow- ed to sit up in bed; this is not to be indulged in to an extent producing fatigue ; though she is not permit- ted to leave the bed, great relief is experienced by this change of position; by it a new set of muscles are called into action, and the parts which sustained the weight of the body while lying are relieved. This species of exercise may be continued until the pa- tient feels inclined to resume her former posture, and repeated as often as her strength will permit, and her inclination solicit. On the fifth day, all things being favorable, she is allowed* to leave the bed, while it is made; she may, upon these occasions, sit up an hour or two if desirable ; she can also leave the bed after the fourth day for the purpose of obeying the calls of nature, previous to which the bed pan must be used. On the sixth day she is permitted to walk about the room a little, and beguile the time by a light piece of needle-work, or employ her mind with occasional light reading. On the tenth day, if the weather be not uncomfortably cold or damp, she may go into an adjoining room for an hour or two, which GENERAL MANAGEMENT OF THE PATIENT. 191 time should be seized upon by the nurse to have her room thoroughly aired, swept, and dusted ; this pro- cess should be daily followed, nothing interfering, henceforward during the month. On the fourteenth day she can, if desirable, assume the charge of her babe, and attend to the lighter duties abut the room. Between the third and fourth week, if the day se- lected be fine, and she continue to improve, she may ride out a mile or two in an easy carriage; but not unless the weather is mild and clear; this exercise may be continued in daily, each day increasing the distance; at this period she need not be prevented from going about through the house, and occasional- ly taking a short walk in the open air, always ob- serving the caution against exposure to a damp and cold atmosphere. Upon leaving her room for any purpose, she must be amply protected by clothes; her feet, in particular, should be perfectly secured against the effects of cold and dampness. We again repeat, with a view of having it perfectly understood, what we have so often enjoined, that no attempt at out-door exercise is to be made unless every circum- stance, both as regards the patient and the weather, be decidedly favourable; neither can we assent to her leaving her room, to visit other parts of the house, unless every circumstance be propitious; she had much better forego these grateful indulgences than to risk the direful consequences of taking cold. Even state of mind.—All sudden mental emo- 192 PRINCIPLES OF NURSING. tions, such as excessive joy, grief, fear, anger, sur- prise, &c, should be strictly avoided by the patient, and the cause of such disturbances at once discoun- tenanced by the nurse ; and the recital of all marvel- lous and melancholy stories should be spurned from the lying-in-room, as agents detrimental to that speedy recovery (all other matters being favourable) that at- tends a uniformly composed state of mind, where no such mischievous influences are permitted to exist to render it otherwise. In speaking of joy, Dr. Rush tells us that " this emotion is attended sometimes with pain in the re- gion of the heart, a change in the voice, tears, syn- cope, and death." And he further adds, " there are many instances upon record of death being induced by a sudden paroxysm of joy. The son of the fa- mous Leibnitz died from this cause upon his opening an old chest and unexpectedly finding in it a large quantity of gold. Pope Leo the Tenth died of joy in consequence of hearing of a great calamity that had befallen the French nation. And, it is well known, the door-keeper of Congress died of an apo- plexy, from joy, upon hearing the news of the cap- ture of Lord Comwallis and his army during the American revolutionary war." And, upon hearing of the same glorious event, Mr. Dick, father to the late Janitor of the University of Pennsylvania, died in consequence of a rupture of the heart, caused by a sudden rush of blood to that organ. Professor Chap- GENERAL MANAGEMENT OF THE PATIENT. 193 man, in relating the circumstance in his lecture, ob- serves, " the paroxysm of joy was so great that it actually burst his patriotic heart." " The symptoms of grief," says Dr. Rush, " are acute and chronic. The former are, insensibility, syncope, asphyxia, and apoplexy ; the latter are, fe- ver, wakefulness, sighing, with and without tears, dyspepsia, hypochondriasis, loss of memory, gray hairs, marks of premature old age in the countenance, catalepsy, and madness." In speaking of fear, the same illustrious author ob- serves, " the effects of fear, when it acts suddenly upon the system, are tremors, quick pulse and respi- ration, globus hystericus, a discharge of pale urine, diarrhoea, and sometimes an involuntary discharge of feces, aphonia, fever, convulsions, syncope, mania, epilepsy, asphyxia, and death." Of anger, he remarks, " A morbid paroxysm of an- ger appears in a preternatural determination of blood to the brain, a turgescence of the blood vessels of the face, a redness of the eyes, an increased secretion of saliva, which is discharged by foaming at the mouth, great volubility or a total suppression of speech, agi- tations of the fists, stamping of the feet, uncommon bodily strength, convulsions, hysteria, bleeding at the nose, apoplexy, and death." And who has not experienced violent palpitations of the heart, followed by nervous tremors, and great debility, upon receiving a shock of sudden surprise ? 17 194 PRINCIPLES OF NURSING. Now, with this array of the ruinous consequences of mental disturbance fully in view, let the nurse reflect one moment upon the irritability of the patient's sys- tem, as consequent upon the cause of her confine- ment, and she cannot but readily perceive the vast utility of guarding strictly against any occurrence, at this time especially, that will tend,- in the leastj to disturb that equanimity so essential, not only to her present safety and comfort, but also to her future health and happiness. Locia is the name given to that discharge familiar to every nurse that takes place from the mother im- mediately upon delivery, and continues to flow dur- ing the first several days after. A knowledge of the cause, nature, use, and proper duration of this discharge, is of the first importance to the nurse. A great deal of consequence, we are aware, is almost every where attached to it, and it is right it should be so; but it is also necessary, for the safety of the patient, that this regard for it should be the result of correct knowledge, and not of ignorance and superstitious fear, as is too often the case. It proceeds immediately from the blood vessels of the womb, left open by the separation from it of the placenta, or after-birth, from which the blood flows directly, making "the locia," until prevented by a closing of the vessels from the complete contraction of that organ. The quantity of the discharge is pro- portioned to the extent of the inner surface of the GENERAL MANAGEMENT OF THE PATIENT. 195 womb, previously covered by the placenta, as the greater the surface the greater the number of vessels left open, and consequently the greater the discharge. The following, on the nature of the locia, by Ma- dame Boivin, for eleven years connected with a ly- ing-in Hospital, "in which upwards of two thousand deliveries occur annually," we take from "The Nurse's Guide.5' "The lochial discharge during the two first days is almost pure blood. From the se- cond to the third day it has a yellowish-red hue. From the third to the fourth day it has a greenish tinge, and half putrid odour. From the fourth to the fifth day it is puriform or milky; that is to say, resembling pus (the matter from an abscess) or milk. After this period it usually becomes thinner, small in quantity, when all things are perfectly natural. Sometimes the discharge is suspended as the milk be- gins to flow, but becomes more abundant after- wards." During the existence of the child in utero, it draws its support from the blood of the mother, sent there for its sustenance; but after its birth, other maternal organs furnish the supply of nutriment, and the quantum of blood previously required for sustaining it is divided, a part flowing to the breasts, and a part continuing in its accustomed channels,—the former contributing to the formation of milk, and the latter constituting the locia. Were it not for this wise pro- vision on the part of nature, the blood would be sent 196 PRINCIPLES OF NURSING. suddenly in too great a quantity to the breasts, caus- ing inflammation of those organs, an event that is known often to occur, upon a suppression of discharge from cold or other causes. But as soon as the secre- tion of milk becomes established, and an increased supply of blood becomes necessary, for the purposes of carrying on this interesting function, it gradually abandons its wonted course, (as is evinced by the gradual disappearance of the locia,) and commences the performance of its new duties. The extent of duration observed by this discharge varies from a week to a month, or even longer. "A mere show of light or slightly pink-coloured fluid is observed usually after the first week.55 Its total cessa- tion at a period even earlier than this, when it is the effect of contraction, which may be known by the su- pervention of no unpleasant symptoms, should not alarm either patient or nurse, as it is evidence of a healthy state of the womb, but should any unfavora- ble symptoms supervene the occurrence, such as a feverish state of the system, headach, pain and swelling of the breast, &c, the nurse may suspect that all is not right, and the physician should be forth- with apprised of the fact. If the discharge should continue to any extent after the tenth day, he should also be made acquainted with the circumstance, and his directions strictly observed. From what has been said it will readily be per- ceived that the locia observes no uniform rules, as TEMPERATURE AND VENTILATION. 197 regards its quantity or duration, but is liable to vary in different persons, and at different times in the same individual. Hence, all the evil prophecies and ominous tokens that we hear from the good old gos- sips, upon each fancied variation from what they con- sider established rules, in relation to the locia, are en- titled to no other regard than is generally shown in an ordinary ghost or witch story, or any other supersti- tious emanation. TEMPERATURE AND VENTILATION OF THE ROOM. This part of her duty the nurse should never suffer to pass unattended to. For a further consideration of it, see preceding chapter, page 95. 1 There are various other matters connected with the lying-in room besides those here designated, though of not so great moment, yet an acquaintance with which is indispensable to the successful manage- ment of this department of her calling, and with which the nurse should spare no pains to thoroughly acquaint herself. 17* CHAPTER IV. Duties of the Nurse towards the Child, including Wash- ing, Dressing, Feeding, Changing, Exercising, Changing its Position, and Bathing of the Child— Observations on the Diseases of Infancy—Duties of the Nurse towards the Mother—Duties at the time of Engagement—A visit to the Lady previous to being called for—Duties of the Nurse during Labor—Du- ties of the Nurse after Delivery, including Attention to the Bandage, Attention to Cleanliness, State of the Locia, and Attention to the Breasts and Nipples. DUTIES OF THE NURSE IN PARTICULAR. The nurse who is thoroughly qualified for the sta- tion she has assumed, will find the duties connected with this department few, simple, and easily per- formed ; while to her less competent, they will be proportionably intricate, arduous, and perplexing. In the preceding chapter, upon this branch we en- deavored to lay down a course of instruction as plain and intelligible as the nature of the various subjects treated of would permit, and in as concise a manner DUTIES TOWARDS THE CHILD. 199 as practicable; showing, to the best of our ability, the mischievous tendency of ill-judged and misap- plied interference with the regular and uniform ope- rations of nature, and the advantage of strictly obey- ing her wise and unerring laws. It now remains to apply those instructions to practice in administering to the wants of those under charge. While the infant, from the helplessness of its situa- tion, immediately upon being ushered into its new state of being, requires the care of others for a con- tinuance of its existence, is the first to receive atten- tion at this auspicious moment; the mother, who, previous to its appearance, had monopolized the whole regard of the nurse and attendants, now be- comes a secondary object of concern, unless some unpropitious circumstance should render her case otherwise. The infant, then, being first to receive attention, we shall proceed, in accordance with the arrangement adopted in the foregoing chapter, to the considerations of THE DUTIES OF THE NURSE TOWARDS THE CHILD. " Nature's wants are few, and easily satisfied." Though the healthy infant requires but very little actual labor of the nurse to satisfy its little wants, yet it is necessary that she should pay strict attention to all its calls, and always be ready to respond to 200 PRINCIPLES OF NURSING. them, by doing those things that nature and cleanli- ness require for its advancement; further than this is superfluous, and tends rather to its injury than be- nefit. Washing, dressing, feeding, changing, exercising, changing its position, and bathing, constitutes most that is actually required of the nurse by the infant. Whateyer more she may choose to do, by way of indulgence, as holding it in the lap, &c, tends, as we have before observed, to the formation of habits, troublesome alike to the mother and nurse, and de- cidedly injurious to the child itself. Previously to having the new-born infant placed into her hands, the nurse should, in anticipation of that event, see that she has a supply of warm water, a little lard, a cake of Castile soap, a fine linen or flannel rag, or, what is still better, a fine sponge, at hand; she should also have selected out and prepared, what clothes the child is first to wear, and have all Other things in readiness that may be required, upon the little stranger5s ingress into the world, so that all bustle and confusion that attends such occasions, where matters are not previously well arranged, may be avoided. Washing the Child.-r-^o time should be lost by the nurse, after she has received the child into her charge, in idly sauntering about the room, or in light and nonsensical conversation, before proceeding to the discharge of her duty. The child is often co- DUTIES TOWARDS THE CHILD. 201 vered to a greater or less extent with a fatty caseous substance, which adheres with great tenacity to the skin, rendering a separation extremely difficult, where soap suds and cloth alone are employed for the pur- pose. By permitting the child to remain, after its birth, any length of time unwashed, this substance becomes dry, increasing greatly the difficulty of re- moving it, thereby causing additional exertion on the part of the nurse, and consequently a proportionate inconvenience and fatigue to the child: hence the ne- cessity of immediate action. After having provided herself with a low stool or chair, and selected a place to sit, where she may be " screened from the scorching heat of the fire, and protected from any current of air,55 and prepared and placed close by her the clothes first to be put on the child, she must proceed to the discharge of this im- portant duty by first rubbing the skin over with a lit- tle soft lard, sufficiently well to dissolve and loosen the caseous coat, just spoken of, and then the suds of fine Castile soap, made something warmer than the hand, applied with a fine sponge or flannel rag, will readily remove it without excessive rubbing, which would be required were the lard not employed. If, however, there should be any left remaining, let the same process be again repeated, taking care that the head, arm-pits, groins and folds of the skin in the neck, elbows, &c, are entirely cleansed. This is important, because extensive sores are apt to follow a neglect of 202 PRINCIPLES OF NURSING. these parts. But more especially should the eyes be thoroughly washed. We once had the misfortune to witness a case of virulent ophthalmia, that resisted the most active and decisive treatment, and which terminated in the destruction of both eyes, leaving the poor child to grow up in entire blindness, to arise from a neglect on the part of the nurse to have the eyes thoroughly cleansed. After the washing is com- pleted, the child is to be wiped quite dry, and imme- diately dressed. The washing process should be repeated daily, during the stay of the nurse, and afterwards by the mother. It contributes greatly to both the health and comfort of the little being. It effectually pre- vents the occurrence of those painful and protracted sores with which children are afflicted where due at- tention is not paid to cleanliness. The preposterous practice of immersing or washing the child in cold water, under the foolish pretext of hardening it is, in intelligent communities, rapidly ap- proximating that vortex of annihilation in which is engulphed the follies that have been but are no more. And it is right it should be so. Dr. Kissam, in speak- ing on this subject, observes, " I am aware it is often said that the savages in all cases immerse their child- ren in cold water, immediately after birth ; and that the mother generally does it. Perhaps we may find an apology for this act in the ignorance of a savage. Why should we be bound to receive domestic in- DUTIES TOWARDS THE CHILD. 203 struction from them rather than instruction in the arts and sciences? for the cases are parallel.5' He continues : " Should adults be willing to sleep on the ground, in the open air, because savages do so, and acquire a degree of health and vigor ? If men and women recoil from this process of harden- ing, why should a similar one be imposed upon the tender infant?" It is said of those who subject their infants to this savage manoeuvre, "that they thereby rear a hardy race." Which sentiment has been fully met by the pertinent reply, "that all the feeble ones are killed by the process, while the more athletic survive."—A po- licy well suited to uncivilized life, where the infirm constitute a burthen to the healthy and vigorous members of the tribe, while in civilized and Christian Communities the weak and sickly are objects of com- miseration and especial regard. It is a custom with many nurses to make use of spirits in washing the child. They either mix it with the water, or rub the child all over with it after washing; and where neither of these plans of using it is adopted, its free application to the child's head is considered indispensable to its safety. Now, we cannot discharge our duty to the child nor acquit our- self of the obligation we owe to the public, without uniting with most, if not all our contemporaries in condemning in unqualified terms the use of this arti- cle by the nurse (unless prescribed by the physician) 204 PRINCIPLES OF NURSING. in the lying-in room as decidedly injurious to its in- mates. The following, from the Medical Inquirer, we extract from the Health Journal. " The applica- tion of brandy to the head and surface of the body, even of an adult, has been known to occasion the most serious inflammatory attacks, either of the brain, lungs or bowel; the evaporation producing such a degree of cold as completely to check respiration. In infants it is frequently followed by inflammation either of the bowels, lungs, or of the membrane lining the nostrils, producing what nurses call snuffles." We again repeat, that pure soft warm water and fine Castile soap (with the assistance of a little lard at the first washing) are the very best means under every circumstance of cleansing the child, and no other can be adopted with a view of assisting this process or contributing to its health or comfort that possesses the least claims to superiority in this parti- cular. Dressing the Infant.—After the babe has been washed perfectly clean, and wiped quite dry, the nurse must proceed without any delay to putting on its clothes. That which is first to require her atten- tion is the umbilcus, (naval) and, as it is presumed the physician will see that that is properly dispensed with, we pass it by, and proceed with directions re- lative to the adjustment of the next important por- tion of the child's dress. After the navel has been properly dressed, the next step to be taken by the DUTIES TOWARDS THE CHILD. nurse is to put on the belly-band. This is done by applying the middle of it immediately over the navel, with the pleated edge, or that to which the tag is ap- pended, downwards. Then lay one hand upon it im- mediately over the dressings of the navel, so as to prevent their displacement, and with the other hand turn the child, so as to lay face downwards across the knee of the nurse, then carefully withdraw the hand; see that the navel dressings remain smooth and proceed to fasten it with the strings, with which it should be provided. In case, however, pins are used, they should be of the larger kind, and, when in, should have their points well sticking out, so as to be least likely to puncture the child. Great care must be taken lest this article of dress be too tightly ap- plied, and, as has been elsewhere stated, the child, in consequence thereof, be subjected to a great deal of pain, if not to serious and permanent injury. It should never be fastened so tight as not freely to ad- mit beneath it one or two fingers. The putting on of the rest of the clothes is perfectly familiar to every nurse, so much so, that detailed di- rections are here entirely unnecessary. It is, how- ever, not to be forgotten, that every part of the in- fant's dress is to be so applied as to subserve its con- venience and comfort; and every other considera- tion should be waived, that in the least tends to de- feat this object. We would also here observe, that both the wash- 18 206 PRINCIPLES OF NURSING. ing and dressing of the infant should be performed in as expeditious a manner as the circumstances of the case will permit; but in her anxiety to have them speedily accomplished, the nurse should not forget that the little being in charge is of extremely tender and delicate organization, requiring the ut- most care in being handled. Dr. Warrington says: " The child, of course, will require the gentlest mo- tion, consistent with the necessary attentions to its ablutions, dressing, &c. We have too often seen the child handled as if it were a boot in the hand of a shoe-black, seized by its neck and heels, and plunged into a basin of hot or cold water, after having been scratched over with coarse brown and strongly alka- line soap, not to know the unnecessary pain, and shall we say absolute danger of injury, to which the tender being is exposed." Feeding the Child—Where there is a full supply of milk in the maternal breasts from the first, as is sometimes the case, there can be no other means of sustaining the child adopted with more advantage, than immediately applying it to this munificent source. In some countries, amongst what are styled the higher ranks of society, prevails the imnatural cus- tom of consigning the infant exclusively to the care of a wet-nurse, a class of women whose trade it is to furnish milk to the infants of ladies of rank and DUTIES TOWARDS THE CHILD. 207 fashion. They cannot, from the very nature of the case, feel, upon looking on their little charge, "That pure unearthly bliss which mothers only may." Hence, as they gain their livelihood from the con- tents of their dugs, they can rarely be influenced by any higher motive than interest,—sordid, selfish in- terest. And as their necessities require they should be out of employment as little as possible, they are obliged to resort to every means that art can suggest, or moral depravity sanction, to perpetuate to the greatest possible duration the time of their lactation. Therefore, stimulating drinks and diet, and various other excesses are freely indulged in, in order to ob- tain the object they have in view; consequently, their milk, frequently scanty, where such means are employed, is at all times utterly unfit to be re- ceived into the delicately organized stomach of the new-born infant. - Let queens and princesses, then, dash from their bosoms their tender offspring, and compel them to draw their subsistence from breasts supplied with more ignoble blood, and deprive them of those God has made for their use, and which are " With life and nutriment so copious bless'd ;" But the American mother, with a proper sense of true dignity, can never refuse to yield to her babe 208 PRINCIPLES OF NURSING. that rich, nectareous fluid, formed in the maternal bosom for its especial use. They may pride themselves upon the superior breed of a lap dog, or the agility of a pet monkey, but she finds substantial happiness in early com- mencing the physical and moral education of the little being with which Providence has blessed her. After the child is washed and dressed, and the mother in a good degree recovered from the effects of the parturient effort, the nurse must proceed to discharge this very interesting part of her duty. But in case the breasts fail to yield the necessary supply, she must prepare a little warm molasses and water, in the following proportions: Take of Good molasses, 1 tea-spoonful. Warm water, 3 table-spoonsful. This may be given as directed in the preceding chap- ter, page 108, letting the child suck it from the spoon, instead of pouring it into its mouth, which is less apt to produce strangling. After two or three free evacuations have passed the bowels, the diet must be changed, and that directed at page 110 be adopted and continued until a supply is furnished by the mother. In preparing food for the child, the nurse must be careful not to have it too warm or too cool; the proper temperature may be readily ascer- tained by touching the lips with it before she com- DUTIES TOWARDS THE CHILD. 209 mences feeding. The abominable practice of some nurses, of receiving into their own mouths every spoonful of food, before it is allowed to enter the mouth of the child, is one, the loathsomeness of which would, if but a few years old, drive the child in disgust from the presence of her who would thus so wantonly impose upon it. Dr. Dewees, in speaking of the unfitness of the food frequently given to the young child, and this system of tempering it for use, says: "This is a hor- rible practice, and cannot be too severely reprobated. The child is thus obliged to take into its ill-con- firmed stomach food, not only improper in itself, but which has the addition of a rank saliva from the nurse's mouth. "Much care, we grant, must be taken in warm- ing the food of the child, lest it be overheated, and its mouth made to pay the forfeit of the nurse's care- lessness; but this can be done without any previous mouthing.55 For the sake of convenience, every nurse should provide herself with an apparatus known by the name of "the nursery lamp;55 this fixture answers the double purpose of lighting the room, and keeping the food at a proper temperature for immediate use. It consumes no more oil than an ordinary lamp, and can be so regulated as to make a bright or dim light, as may be convenient or desirable. Where it be- 18* 210 PRINCIPLES OF NURSING. comes necessary to rear the child by hand, this lamp is indispensable. Changing the Child.—In consequence of our fre- quent advertence, in the preceding chapter, to the importance of keeping the child5s clothes perfectly clean as a means of promoting its well-being, our ob- servations here must, necessarily, be few; we never- theless recur again to the subject, in hopes it may have an influence in calling the attention of nurses, generally, more to the point in question. It really appears, with some, a matter of but little consequence whether the child is kept clean or other- wise; and others are extremely particular, with re- gard to its external appearance, while its under clothes are but very little attended to; and others, again, esteem it unimportant that it should be changed at night, and, by acting accordingly, permit the infant to wear during the night the same suit worn through the day—a most filthy and slovenly practice, to say the least of it. In order to get all the benefit cleanliness is capable of affording, the chikPs clothing should be changed daily. They should be thoroughly dry and well aired at each change before being put on. This the nurse should esteem as imperious as any part of her duty, and it should never be suffered to go unper- formed. The diaper should, by all means, be changed as often as required, without regard to time or cir- cumstance. DUTIES TOWARDS THE CHILD. 211 With respect to changing this portion of dress, Dr. Dewees observes: "But it should be well under- stood, when we speak of keeping the child clean, we do not consider the repeated reapplication of the same diaper, because it has been hung in the air, or before a fire and dried, as coming within our direc- tion. There can be but two reasons for this filthy practice—laziness and poverty. The first should never be considered as a valid excuse for employing the same diaper several times, nor will it perhaps ever be urged as one, in direct terms,55 &c. "If the second reason exist, and the child have not a suffi- cient change, it were much better to do without a diaper, from time to time, than have those returned to it stiffened with salts, and reeking with offensive odor.55 The diaper should never be applied over the se- cond time unwashed. Exercising.—For observations on exercising the infant, see "Handling the Infant," page 168. Changing its Position.—See articles on " Crying and Sleep,55 pages 156 and 160. Bathing the Child. " This is the purest exercise of health." ****** " Even from the body's purity, the mind Receives a secret sympathetic aid." Thomson's Seasons, 212 PRINCIPLES OF NURSING. Perspiration, both sensible and insensible, is a function of the skin, more deeply concerned in pre- serving a healthy state of the system, than of which most] persons, perhaps, are aware, notwithstanding it is generally admitted to exert a beneficial influence. In fact, there is scarcely an organ entering into the ani- mal economy, that is not more or less deranged in function, in consequence of a want of order in this particular one; but, on the contrary, while this re- mains undisturbed in its operations, the body will mostly be found in the full enjoyment of health and comfort. A consideration of the means calculated properly to promote this desirable object, then, is a matter of no small moment. Frequent allusions have been made to cleanliness as a means of pre- serving health, &c.; it effects that important end, by removing all obstructions from the pores of the skin, so as to leave them free for the escape of perspirable matter. Now, while bathing acts most beneficially in this particular, it also tends in other respects to preserve a healthy action of the skin by giving tone and vigor to the capillaries, for want of which cutaneous erup- tions and protracted troublesome sores are apt to arise. There are various kinds of baths in use; the cold, the tepid, or warm, and the hot, however, are most commonly employed. The first of these is where the water employed is of the natural temperature, with- DUTIES TOWARDS THE CHILD. 213 out being augmented by artificial means. The second is that where the temperature is between 62° and 98° Fahrenheit's thermometer (Dewees;) and the third is where the temperature is above 98°, or the natural heat of the body. As the first and last are remedial agents, only to be employed as directed by the physician in cases of disease, we shall take no further notice of them, but pass on to the consideration of the warm or tepid baths. The following, on the warm bath, we take from the Journal of Health. " It is a common, but erro- neous opinion, that the warm bath is enfeebling, and renders the person using it more liable to take cold. In times of remote antiquity it was considered the so- lace of toil, and resorted to with a view to renovate vigor exhausted by exertion. To conduct the stran- ger guest to a warm bath, and anoint him with fra- grant ungents, previously to offering him food, formed a part of the rites of hospitality. " We can readily understand why, during the de- cline of the Roman Empire, when luxurious indul- gences of all kinds were carried to excess, the warm bath should have been thought debilitating to per- sons, such as citizens of distinction, who were in the habit of bathing four, five, and eight times a day. Another cause of the disrepute into which the prac- tice fell, was the very high heat of the water; and hence the ready occurrence of debility and disease from the operation of such a violent stimulus. 214 PRINCIPLES OF NURSING. "Now, the warm bath, so far from heating and ir- ritating the body, has a most soothing and tranquil- izing effect. This is more especially obtained by a bath at from 90° to 95° Fahrenheit. The pulse, on immersion in it, is rendered slower, and the respira- tion more equable. If the kheat be above 98, we may then look for accelerated pulse, flushed cheeks, and after a while a copious perspiration bedewing the head and face. "With regard to the temperature of the bath, a very good rule is laid down by Professor Alcott, which should be always observed: i. e. " never to have the temperature of the bath below that of the room. If the thermometer show the latter to be 70°, the bath should be something like 80°; perhaps with feeble children rather more.55 In our observations on washing the infant, we di- rected the process to be continued daily during the stay of the nurse. This has allusion more particu- larly to cases where the bathing is rejected; where it is instituted, the nurse5s attention to washing may be allowed to abate, in proportion to its being more and more devoted to bathing. (Alcot.) If simple submersion be not sufficient to answer the purposes of cleanliness, a little fine soap may be added to the water, which will readily dissolve what. ever particles may adhere to the skin, and render their removal easily effected by wiping. Spirits mixed with the water, has no tendency towards ren- DUTIES TOWARDS THE CHILD. 215 dering it superior to clear, warm water, and should never be used for that purpose. The bathing should commence as soon as the dressings of the navel are dispensed with, and the parts healed entirely sound; previous to this, ablu- tions had better be practised in its stead. The length of time the infant should continue in the bath must be governed by circumstances. " If he is quiet,55 says Professor Alcott, " fifteen minutes can never be too long, and I should not object to twenty. If otherwise, and you are obliged to remove him in five minutes, or even three, still the bathing will be of too much service to be dispensed with." Our author, in speaking of the best time for bath- ing, observes: " The proper hour for bathing is the early part of the day, or about the middle of the forenoon. This season is selected, because the pro- cess, manage it as carefully as we may, is at first a little exhausting. As the child grows older, how- ever, and not only becomes stronger, but appears to be actually refreshed and invigorated by the bath, it will be advisable to defer it to a later and later hour. By the time the babe is three months old, particularly in the warm season^ the hour of bathing may be at sunset.55 In making use of the bath, one caution is to be ob- served : that is, never apply it immediately after the child has taken a full meal, but rather let the time be selected when his stomach is comparatively empty. 216 PRINCIPLES OF NURSING. After the child has been in the bath a sufficient length of time, it must be taken out and wiped dry with as little delay as possible. The nurse must be extremely careful not to allow the least current of air to blow upon it during the whole process, from the time it is stripped for bathing until it is again dressed. The vessel used as the bathing tub should be of such dimensions as to allow the full, free motion of all its limbs. This is important, because most chil- dren will soon delight in playing and scrambling about in the water, {Alcott) which exercise adds to the usefulness of the operation. OBSERVATIONS ON THE DISEASES OF INFANCY. It may be expected that we should, in giving di- rections relative to the duty of the nurse towards the child, say something concerning the treatment of some of the diseases peculiar to early infancy, and which popular error has decided to be ailments ne- cessary to infantile life, such as red gum, sore mouth, vomiting, &c. &c. Now, our sole object in dwelling so long on the management of early infancy, in both the preceding and present chapters, is to lay down principles and inculcate instructions which, if strictly followed, will save the child from attacks of disease, and consequently much suffering. We do not be- lieve there is a single disorder of which the child is ON THE DISEASES OF INFANCY. 217 doomed by necessity to be the subject. With respect to aphthse, or baby's sore mouth,—perhaps one of the most common affections of the young child,—we are sustained in this opinion by Dr. Dewees, who says, " This affection is thought to be altogether of a symptomatic kind. It is almost uniformly preceded by a deranged condition of the alimentary canal, and always, we believe, by some disturbance of the sto- mach itself." So if, by proper management in diet and regimen, the stomach be kept in a healthy condi- tion, and digestion good, there will be but very little to fear from this often troublesome and sometimes fatal affection. The red gum, which is considered by nurses a mark of the healthiness of the infant, is also a symp- tom of the deranged state of the alimentary canal. In speaking of this disease, Dr. Eberle observes, " A debilitated state of the digestive organs from error in diet, giving rise to acid and other irritating causes in the stomach and bowels, appears to be the ordinary source of this affection. Its occurrence is, doubtless, much favored by keeping the infant too warm,—an error which is but too frequently committed by nurses and mothers." This being the case, how preposterous the practice of cramming the little stomach of the poor child to regurgitation with catnip, saffron or other teas, with a view of giving ease to the pain oc- casioned by a disordered state of the bowels, and pro- moting the eruption: an event deemed so essential to 19 218 PRINCIPLES OF NURSING. its well-being. Indeed, it is no wonder tnatso many are hurried out of life within the month, or if permit- ted to survive beyond that period, are doomed to drag out an existence of suffering and disease. But it may be asked, if this practice, so long pur- sued by nurses, be so radically wrong, and so destruc- tive in its effects, why not lay down one more in ac- cordance with the principles of physiology ; one less empirical and more likely to effect the object desired? For not doing this we have two reasons: First, we think a " preventive infinitely better than a cure," and we are confident that if the child be properly dealt with, and the laws that govern the infant eco- nomy be duly observed and obeyed by the nurse, there will be no necessity of resorting to medical pre- scriptions as a means of restoring the impaired health of the little being. Second, giving directions for the treatment of infantile diseases, would be placing in unskilful hands dangerous weapons, which, for the want of experience in wielding them, might be productive of much injury, if not fatal consequences. We again repeat, with a view of impressing it on the mind of the reader, that a large majority of the ailments incident to early infancy, is the result of mis- management in regard to diet, dress, exposure, &c. and little else than disease, suffering, and death can be expected so long as those assuming the responsi- ble duties of giving direction to the various organiza tions of the uninured and tender infant remain igno- DUTIES TOWARDS THE MOTHER. 219 rant, and continue in the daily violation of the laws by which they are governed. DUTIES OF THE NURSE TOWARDS THE MOTHER. Fortunately for the patient, the time is rapidly passing away when the qualifications of the nurse are estimated by the number of her prescriptions, or the boldness with which she administers them. The infusion of more general intelligence through all classes of community, is exerting a most salutary in- fluence in this particular. Loud boastings of supe- rior skill, great loquacity, and unblushing self-conceit, were, even not long since, received in a nurse as re- commendations of professional excellence. Reverse qualities now find favor amongst the better informed portions of society; their confidence and patronage are conferred only on her who is modest, unassuming, intelligent and worthy. To such a one, duly inducted into the principles of her profession, the duties belonging to this branch of it will be but few, unless adverse circumstances should render them otherwise. Though few, ordi- narily, they are, nevertheless, important, and highly interesting. The nurse should always feel such a regard for pro- moting the advancement of the patient, as to render the performance of the duties due to her an agreea- ble exercise; this will contribute very materially to- 222 PRINCIPLES OF NURSING. wards diminishing the amount of labor that might otherwise tend to make her calling, in this particular, irksome and unpleasant. DUTIES AT THE TIME OF ENGAGEMENT. The nurse is generally engaged, by her who ex- pects to require her services, some weeks, or even months, previous to the appointed time of her travail; upon which occasion it becomes the nurse's duty to give all necessary information relative to the making of the child's clothes—preparing clothes to be worn by herself at the time of labor, and subsequently, the arrangement of the bed, the material of which it should be made best calculated to enhance the health and comfort of herself and infant; and, in fact, the proper disposition of every matter connected in any way with the anticipated event. It was with a view of qualifying the nurse for giv- ing such directions, that we were so particular and lengthy in dwelling upon the various topics treated of in the preceding chapter. We are fully aware that much there referred to and insisted upon, be- longs more to the province of the mother than that of the nurse; but when the opinion of the nurse is asked on any of these points, connected more or less with her vocation, we desire she may be able to give it in accordance with physiological truth, and not, as A VISIT TO THE LADY, ETC. 221 is too often the case, as ignorance may suggest or superstition direct. A VISIT TO THE LADY PREVIOUS TO BEING CALLED FOR. A few days in anticipation of her expected call, the nurse should make it her duty to pay the lady a visit, that she may have an opportunity of becoming better acquainted with her—that she may familiarise herself with the arrangement of her room, and ascer- tain where every thing can be found, that may be required upon the approaching occasion; this will enable her to pass from one thing to another in the performance of her duty, without troubling the pa- tient, at the trying moment, with inquiries concern- ing the whereabouts of what may be wanted for use, and without creating any undue bustle or confusion. The duty of paying such a visit should by no means be neglected; we have frequently known the ex hausted female exceedingly harassed, with question upcn question, from those about her, concerning mat- ters with which they should have been perfectly fa miliar at an earlier date; and hurry, bustle and con- fusion, equally annoying to the patient, have we wit. nessed as consequent upon a want of information in these particulars. 19* 222 PRINCIPLES OF NURSING. DUTIES OF THE NURSE DURING LABOR. As it is not expected that any respectable, well in- formed lady, will presume to pass this important and critical period of her existence without the attention of a judicious and thoroughly qualified accoucheur, we omit giving any instructions relative to the duties of the nurse during labor, but leave them exclusively to his direction. Upon this, as all other occasions, where the physician is present, the nurse discharges her duty by cheerfully acceding to his views relative to the Management of the patient; it is presumed his opportunities for acquiring necessary information have been superior to hers, and that, consequently, he is better qualified to act as director upon the oc- casion ; and she can find satisfaction in the reflection, that by yielding to his directions she acquits herself of all responsibility, while it rests with its whole weight upon him and her by whom he is em- ployed. DUTIES OF THE NURSE AFTER DELIVERY. After the woman has been comfortably put to bed,* and the physician taken his departure, com- *The physician is expected not to leave before this, but, by his council and aid, assist in accomplishing it; if, however, he should previously absent himself, without being constrained by DUTIES AFTER DELIVERY. 223 mences the active duties of the nurse towards the mother; not only all those necessary to be performed towards a patient in general sickness, as shown in Chapter II, are required here by the invalid, but also a number of others, belonging to this department only. For directions, then, relative to preparing the va- rious articles of diet and drink that may, from time to time, be ordered by the physician or required by the patient, and for instructions in all the duties relating to the management of the patient as a mere invalid, the reader is referred to that portion of the work that treats of " the duties of the nurse in ge- neral." Those necessary for the successful management of the newly constituted mother, as such, that can- not, from the very nature of things, be required by the ordinary invalid, shall occupy our present atten- tion. These are, attention to the bandage worn by the patient, attention to the cleanliness of the patient, with regard to her situation, attention to the state of the locia, attention to the breasts and nipples, &c. &c. imperious necessity, he becomes guilty of a neglect of duty; be- cause the patient can never be considered safe until it is per. formed, as circumstances frequently render the act of putting the patient to bed the most critical part of the whole pro- cess. 224 PRINCIPLES OF NURSING Attention to the bandage.—The bandage consti- tutes an essential portion of dress, worn by the pa- tient at the time of her confinement. It may consist of a strong towel or strip of new muslin, of length suf- ficient to reach around the body and overlap so as to allow of its being firmly fastened by means of three or four large pins, and wide enough to include in its passage around the body the whole of the abdomen. It affords a general support to that part, and when properly applied and retained in its position, tends materially to keep the contents of the abdominal ca- vity in their proper place, thereby preventing a great deal of pain and uneasiness. It also contributes largely towards reducing the distended abdomen to its natural size. In order to get the full benefit of this apparatus, it should be applied with sufficient tightness to render the wearer perfectly comfortable and easy under its operation; the nurse should from time to time exam- ine it to see that it does not become too relaxed, as the part it is designed to guard diminishes in size, to prevent which it will become necessary to tighten it as occasion may require; where this precaution is not observed, it is apt also to become displaced by slipping up, and otherwise, which cannot but defeat the object of its application. It should be worn from four to eight weeks, as the case may require. Attention to cleanliness.—The observations of DUTIES AFTER DELIVERY. 225 Dr. Warrington, in regard to this matter, are so much in point that we cannot express our views better than to give his words. "Great attention to cleanliness should be given by the nurse. On and after the se- cond day ; she should use luke-warm soap suds and a soft sponge or cloth, with which she may remove every thing which adheres to these parts of the pa- tient. By this means she will correct the disagreea- ble and unhealthy fetor which soon arises from these discharges; she will also contribute greatly to the comfort of the patient. This ablution should be con- tinued daily, or more frequently during the whole period of the nurse's attendance." The cloths used by the patient should, during the first few days, be frequently changed, and promptly removed from the room ; as their presence, after they have become much soiled, tends to vitiate the air by the elimination of their impurities. Her body and bed linen should be frequently changed; sometimes it becomes necessary to perform this duty daily, and never should they be continued in use longer than is consistent with perfect cleanli- ness. We have frequently had our olfactories as- sailed, upon entering the lying-in room, by a most disagreeable effluvia, where due attention had not been paid to cleanliness in every particular,—a state of things highly detrimental to the patient's speedy recovery, and well calculated to retard her convales- cence. 226 PRINCIPLES OF NURSING. State of the Locia.—It becomes of a part of the nurse's duty to observe the character of the locia, from day to day, with regard to its colour, quantity, consistency, &c, and faithfully report any change that may take place to the physician. The vague terms usually employed by nurses in making their commu- nication relative to these discharges, such as " there is enough, or not enough; about the common; the colour natural; all is right," &c, are very indefinite and unsatisfactory. By informing him of the size and number of cloths employed within a given time, he would be able to judge more accurately of the condition of his pa- tient ; and an exhibition of the cloth last employed would afford him more satisfactory information, con- cerning the colour and consistency of the locia, than could be obtained by any description that she can give. When the patient is doing well, and nothing of im- portance arises indicative of an unpropitious state of things, the physician will rarely consider it necessary to extend his inquiries further than to ascertain the favourableness of her situation, while the nurse should examine each cloth in order to embrace this available, and often certain means of detecting mis- chief Avhile in its incipiency, and upon the occurrence of any unusual appearance, with regard either to its colour, abundance, scantiness, &c, to communicate the fact forthwith to the physician. DUTIES AFTER DELIVERY. 227 Attention to the Breasts and Nipples.—Breasts. Quite as prolific a source of trouble, pain, and incon- venience as any that presents impediments to her re- covery, with which the nursing female may be as- sailed, is Mammillary Abscess, (gathered [ox broken breasts.) The many sleepless hours of excruciating suffering; the many tedious days of enduring pain experienced by her at this important and interesting season, are better known to herself than to any other earthly being. This affliction commonly commences not until after the patient has been abandoned by her physician, to the exclusive direction of the nurse; par- ticularly in the country where one or two visits after delivery are made to suffice. And she, frequently overcharged with solicitude, and too often uninformed with respect to the anatomical construction, the func- tional operations, or the specific action of disease on the affected part, applies, without regard to their fit- ness, her poultices and plasters, administers whatever prescriptions she may have learnt, parrot-like, by rote, of some ignorant pretender, which, as often as otherwise, do more harm than good. Thus the poor creature is, aside from the pain consequent upon the abscess, teased, tormented, and tortured by this ill- judged interference, for weeks, and sometimes months, until the curative powers of nature kindly come to her relief. Other considerations than the mere pain and incon- venience at the time, which, by the way, are not 228 PRINCIPLES OF NURSING. trifling, such as after consequences, among which are schirrus, cancer, &c, demand for those organs the most scrupulous care and attention. During the first few weeks after delivery, the breasts of the young female, with her first child par- ticularly, are peculiarly liable to attacks of inflamma- tion ; this liability arises in a great measure, if not wholly, from the great excitability of the parts, occa- sioned by the new duties they are here called upon to perform; a circumstance requiring of the physi- cian strict directions; of the patient obedience; and of the nurse unremitting care. Among the causes producing a derangement of the functions of the mammillary glands, at a time when a healthy state is most desirable, will be found the fol- lowing, viz. an impaired state of the general health, which tends to increase the irritability of the parts, and an over distension of the vessels from too great an accumulation of milk, these very frequently sow the seeds of much trouble and suffering, which re- main dormant until brought into action by some ex- citing agent, as exposure to cold and dampness, un- due bodily exertion, too free an indulgence in stimu- lating diet or drinks, severe mental emotion, as anger, joy, grief, &c. By scrupulously attending to the following pre- ventive means, the nurse may in a great measure lessen the liability to attacks of this troublesome ail- ment. She should guard the patient against the least DUTIES AFTER DELIVERY. 229 exposure to cold and dampness. The infant, as heretofore stated, should be put to the breast as soon convenient, after the mother has recovered from the fatigue of labor. The breasts should never be per- mitted to become painful from the quantity of milk; should there be more than sufficient for the child, it should be drawn by other means, and never be per- mitted to remain in the breasts. The breasts should never, during lactation, be confined by corsets or other articles of dress, but allowed room to expand freely. Should the secretion of milk be inconveniently copi- ous, dry diet should be used, and as little fluids be taken into the system as possible. Occasionally a dose of epsom salts should be administered. The bowels should be kept freely open at least once in twenty-four hours, and all fatiguing exercise avoided, if any symptoms of danger be apparent. The sys- tem should be kept comfortably cool, and moderate exercise indulged in. Should there occur a state of general feverish excitement, with swelling and ten- derness of the breast, with or without a sudden un- natural suppression of the locia, the nurse had better apprise the attending physician of the state of the case. The following remarks, on the diagnostic symptoms of the disease, we are permitted by our friend Dr. Tomlinson to extract from his inaugural thesis, a clearly written paper on Mammary Abscess. " An inflammation of the substance of the gland commences 20 230 PRINCIPLES OF NURSING. with a hardness and circumscribed tumefaction in any part of the gland, not remarkably sensitive to the touch; considerable symptomatic fever attends the advancement of the inflammation; it soon be- comes extremely painful; there is not swelling cor- responding to the violence of the symptoms; suppura- tion rarely takes place under two weeks from the commencement of the attack. When the cellular membrane* is the seat of dis- ease, quite a different state of things are observed; a chill followed by fever is the first symptom; the breast becomes greatly swollen and very tender to the touch; the swelling more general than in the other case, without tumours; the process of inflammation is more rapid, it more speedily runs on to suppuration; the appearance is much more alarming, though the pain is less severe.5' It frequently occurs that one breast is attacked with an inflammation of the gland, and the other the cellularsubstance; sometimes the gland and cellular substance are both implicated in one breast, and only one in the other. It is important to ascertain the precise seat of the inflammation, whether it be in the substance of the gland, or the cellular substance, as a different course of treatment is indicated. * A substance in which the tatty matter is deposited, and which frequently gives the appearance of enormously enlarged glands. It is also frequently called cellular substance. DUTIES AFTER DELIVERY. 231 As the treatment of this disease, in its incipiency especially, is, by common consent, made a part of the nurse's duty, we shall proceed to give a few direc- tions relative to its management, in hopes they may render her some assistance in combating so formida- ble an enemy. Should the patient be of a plethoric habit, and the approach of '.the disease attended by constitutional disturbances, such as feverish excitement, rigors, lan- guor, &c, the nurse had better at once call the phy- sician, than to attempt, herself, to arrest its pro- gress. But where no such difficulties are apparent, and the affection is altogether of a local character, the treatment may commence, (if the substance of the gland be the seat of the inflammation, which may be determined, as has been observed, by the hard cir- cumscribed knots or cakes that can be felt in the breast,) by thoroughly bathing the affected part with vinegar made as hot as can be borne; the part should be bathed and rubbed for ten or fifteen mi- nutes at least at each application; hot brandy, or di- luted alcohol, with the addition of a table-spoonful of fine salt, applied as just stated, we have known to dissipate the hardness at a single bathing, and when resorted to early, more than two or three are seldom required. But should the disease manifest any thing like ob- 232 PRINCIPLES OF NURSING. stinacy, in yielding to this treatment the co-operation of the following plaster may be solicited. Take of Alcohol and olive oil, each 4 ounces, (fluid.) Black pepper, 4 drachm. Castile soap, sufficient quantity. Simmer the three last ingredients to the proper con- sistency, and add the alcohol while cooling. This not unfrequently produces a softening of the tumor, and, by promoting insensible perspiration, proves serviceable in overcoming the inflammation. But let it be understood, that every effort to produce resolution* must prove abortive, if there be not great pains taken to remove the milk as it becomes se- creted. When the cellular substance alone is affected, quite a different course of management is to be pursued. Cold applications are then indicated, and a solution of the sugar of lead, or lead water, is among the most convenient and efficient means. Nitrate of pot- ash (saltpetre) dissolved in vinegar, and applied cold, and repeated as often as the cloths saturated with it become warm, we have known to reduce the highest grade of inflammation: one case in particu- lar, that now comes to mind, in which the right * A term expressive of the termination of inflammation with- out forming an abscess. DUTIES AFTER DELIVERY. 233 breast was enormously swollen, red, and extremely sensitive to the touch; though we had very little prospect of any thing but extensive suppuration, the remedy was directed, and, to our extreme gratifica- tion, in less than six hours the pain and inflamma- tion began to subside, and in a very few days com- plete resolution was effected. Sometimes it occurs that the swelling is so great as to cover the nipple, which seems to shrink back and bury itself in the gland, so much so, that the child is unable to take hold of it; when this is the case, a shield provided with a heifer's teat, placed over the nipple for the child to draw through, some- times answers an excellent purpose; this apparatus is also valuable in cases of excoriated nipples. Should every effort to procure resolution fail, and the inflammation threaten to run on to suppuration, soft warm emollient poultices of bread and milk, with the addition of running mallard, slippery elm bark, pulverized, or flaxseed, sufficient to render it muci- laginous, must be employed; if the pain be very se- vere, one or two tea-spoonsfuls of laudanum may be added with advantage. The following poultice we have been in the habit of employing in severe cases as a discutient* with much advantage; while it pos- sesses all the soothing properties of the foregoing, it acts beneficially as a gentle counter-irritant. * A term in surgery applied to substances that repel or soften tumors. 20* 234 PRINCIPLES OF NURSING. Take of Flaxseed, 1 gill. Black mustard seed, (bruised,) 1 table-spoonful. The yolk of 1 egg. Beat the whole well together, then pour on one quart of water, boil down to one pint, filter through flannel, and thicken the liquor with rye flour to the consistency of a poultice. The patient will find it more to her comfort to pass the most of her time in bed upon her back; if, how- ever, she prefer sitting up, the diseased part must be suspended in a sling, as the weight of the breast, in- creased by that of the poultices, would otherwise be productive of a great deal of pain and uneasiness. After the abscess has broken, and the matter mea- surably discharged, let the breast be dressed with soft warm poultices of bread and milk, or slippery elm, until the discharges have sufficiently diminished, when dressings of simple ointment will suffice. If, however, the part should continue inflamed, swelled, and painful, a plaster of red lead, fresh lard, and olive oil, each half a pound, should be spread thin on a rag, and made to cover the whole of the breast; a hole should be left opposite the opening in the skin for the escape of matter. Boil these ingredients, constantly stirring the mixture while boiling, till the whole unite and form a plaster. This, according to DUTIES AFTER DELIVERY. 235 Dr. Coxe, keeps the part moderately warm, and pro- tects it from the air—all that can be expected in these cases from any plaster. Nipples.—It is commonly not until after the fe- male has become a mother that she can fully appre- ciate all the evils resulting from having the breasts compressed, for years, by tightly drawn corsets:— aside from the murderous effects of tight lacing upon the health and constitution of the poor sallow votary of dress, the amount of mischief sustained in this particular is best judged of by her writhings and ex- cruciating sufferings during the moments that Pro- vidence intended for the happiest of life—those of giving suck to her infant. How untrue to her are the words of the poet: "The starting beverage meets the thirsty lip, 'Tis joy to yield it, as 'tis joy to sip." By thus compressing the breasts they seldom be come thoroughly developed, but, on the contrary, are absorbed, and rendered much less than nature in- tended they should be. The nipples are also much diminished in size, the ducts, for the passage of the milk, reduced, requiring a greater effort of the child to extract the milk; the nipples, for want of a full development, are made preternaturally tender; this, together with the smallness of the ducts, constitute two fruitful sources of that distressing malady, that " bane to the nursing female,55 sore nipples. And it 236 PRINCIPLES OF NURSING. is vain for females to expect exemption from penal- ties, so long as they continue to violate the laws of their organization. Every one who has been the subject of this cala- mity, is aware of the difficulty with which it is made to yield to remedial means; this does not arise from any peculiarity of the sore, nor is it consequent upon the organization of the affected part, but is kept up by the continual irritation produced by the child in its efforts at sucking. So it will be perceived that if the nipples become thus affected, nothing but trouble is to be anticipated from either side; for if the child continue to suck, they have but very little chance of healing, and if it be removed, the accumulation of milk is sure to produce inflammation, and a gathered breast is the consequence. Since, then, medical treatment, and the most adroit management, are incapable of protecting the female, to any extent, from the intense suffering consequent upon this affection, after it nas become established, it is advisable to recommend proper means for its prevention, instead of vainly hoping to effect a cure after the excoriations have taken place. Two or three weeks in anticipation of the birth of her child, the first in particular, (for sore nipples are more apt to occur in her first confinement than any subsequent one,) the female should commence hand- ling the nipples, frequently drawing upon them with a force producing moderate friction, in imitation of DUTIES AFTER DELIVERY. 237 the effort the child will exert upon them while suck- ing, and often rubbing them; this handling invites the blood to them in greater quantities, and causes them to become more fully developed; the friction to which they are thus subjected, tends to thicken and harden the delicate skin with which they are covered; the hardening is greatly aided by the frequent use of a solution of borax or alum, or some other astringent wash. Some authors recommend these washes to be used warm, and others cold; our own views favor the for- mer as being more in accordance with the tempera- ture of the subsequent applications, viz., the child5s mouth. Let the washes be employed either cold or warm, great care is necessary to have the parts wiped perfectly dry after their use; the same caution should be observed after each nursing ;of the child; these astringent washes should be continued for a week or two after the child is born. If, however, after every precaution have been ob- served to prevent the occurrence of sore nipples, they should be found to present an irritable or inflamed appearance, all that can be done by the nurse, with a view to arrest the progress of the disease, is to ap- ply some bland, cooling lotions, as the mucilage of quince, or linseed, or slippery elm bark; an article known by the name of "McClintock5s Nipple Wash55 is employed by some nurses with advantage ; the co- operation of a mild, soothing unction, as the common 238 PRINCIPLES OF NURSING. simple, the lily, or spermaceti ointment, may also be solicited; the parts must by all means be kept from the air; this is readily done by placing over the nip- ple a shield made of bees-wax. If, however, the disease should progress, in spite of her exertions to arrest it, the physician had better be called, for it will require all his skill to render the patient's lot at all tolerable. From what has been said in regard to the breasts and nipples, the nurse will perceive that the most un- remitting attention is required, and that by proper care, duly exercised, she may save the patient a great deal of intense suffering, and herself much trouble. IotITm. d. mont Ave., him P»- I.'Iii ———)jl . * NURSE'S MANUAL AN D MOTHER'S MEDICAL ADVISER, GUIDE TO THE INEXPERIENCED, BY A PRACTISING PHYSICIAN. i i ■JA ^ i P/*f I L A D E L P H l"A ." LINDSAY & BLfKlSTON, .-""■" | 1845. ■ i ( ' THE COMPLETE |. FAMILY AND PRACTICAL RECEIPT BOOK. | MISS SIK7 i% oats, THE FIFTH FOITION NOW REAOY. r TrtE UNITED STATES FAMILY & PRACTICAL RE- CEIPT BOOK, or Complete Book of Reference, containing over 3000 new and valuable Receipts, in all the Useful and Domestic Jlrts. Neaitly^five thousand copies of this book have already • been'sold since its publication a few months since. These are selected as a few only of the testimonials in its favor: "This book is all that it imports to be, and within its com- pass are gathered valuable receipts of all kinds, adapted to all the wants of life, collected-with care, and arranged so that the reference to them is easy, while the manner in which they are ex- pressed is simple, clear artd concise. As a book of reference, it is one of the most valuable publications of the season."—U. S. Oaz. " The United States Complete Practical Receipt Book, for the manufacturer, tradesman, agriculturist and housekeeper, contain- ing many thousand valuable receipts in all the useful and do- ] mestic arts, by a professed Chemist, is a very useful book, in which the author has drawn freely from the universally received Pharmacopoeias and Dictionaries of London and Edinburg."— Ledger. "This is one of the best works we have met with for a long time. Its purpose is useful. Its language plain. It contains hundred's and thousands of receipts."—Sat. Mus. "This work is all that is claimed for it by the title, and should find its way into general use. It is the result of many years of observation and research, and the receipts it presents are cullfid from the experience of various nations. Care has also been taken in its preparation to avoid the use of difficult tech- nical language, and in this way to render it strictly a volume of practical utility."-—Pe«n. " As its title indicates, this book is a perfect compendium of useful information, and its arrangement is such as to render a reference to any given subject, convenient and easy. The price is sufficiently reasonable to place it within the reach of every artisan and housekeeper, and no one should neglect providing himself with a copy."—Sat. Post. PUBLISHED BV LINDSAY & BLAKISTON, PHILADELPHIA. AND FOR SALE BV Burgess, Stringer & Co., New York; G. W. Redding ob Co., Boston; Zeiber & Co. 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