SICK, NURSING OF—The time has gone by when, even in country communities, a sick person is expected to depend for nursing upon neigh bours who " run in and take turns " in tending the invalid, each with a different idea of what should be done, and agreeing only in a sublime disregard for the doctor. The evolution of the trained nurse has proceeded parallel with the developments of modern medicine, and especially with the tendency to rely more and more upon other means than the administration of drugs to combat disease. Almost anyone could give a pre scribed dose of medicine at a given time, hut to do skilfully, swiftly, and effectively all that the modern interpretation of the word " nursing " implies, requires not only a large fund of theoretical knowledge, hut a long and careful training and practical experience as well. Fortunately, the prejudice which at first made it seem to some devoted souls a cold-hearted thing to turn the care of their loved ones over to a stranger, has given way before the good results obtained, and they now realise that the kindest thing to do is to secure for the patient the comfort and safeguard of a care which the keenest intelligence ? and the utmost devotion cannot furnish through untrained hands.
Where it is still impossible to obtain the services of a trained nurse, as is sometimes the case, the volunteer nurse must get from the attendant physician directions as detailed as possible, and follow them implicitly.
Cleanliness is a prime requisite in nursing the sick. Every day the necessary utensils should be brought near the bed, and the patient should have hands and face bathed, mouth and nails cleaned, and hair put in order. The hands should be washed after every meal, and after every discharge from the bowels—a rule also to be followed in health. In the morning, and also after each meal, the mouth should be cleansed with a tooth-brush, or at least by rinsing it with fresh water. The development of crusts and scabs or white spots (thrush) on the lips, tongue, palate, etc., can be prevented by wiping the mouth every two or three hours with a bit of cotton wrapped around the index-finger and clipped in fresh water or in a 5 per cent. solution of borax. If the patient cannot open his mouth, entrance may be effected behind the last molar tooth, or a wooden wedge may be used.
The linen of the patient must always be clean. It should be changed whenever soiled with sweat, blood, vomitus, etc., if necessary several times a day, and in any case at least twice a week. In removing the patient's shirt, his bent arm must not be forcibly pulled through the front opening. Instead, the nurse should place one hand under the patient's neck and Lhoulders, raise him a little, slide the back part of the shirt upward, and put him down again. Then the patient's hands should be extended upward, both shirt-sleeves grasped, and the shirt pulled off over the patient's head. When dressing the patient, fresh, warmed linen should be used. In putting on the shirt, the arms should first be inserted into the sleeves, whereupon the back of the shirt should be gathered up and carefully drawn over the patient's head.
Patients who are seriously ill, and who often soil themselves, may fre quently suffer from bed-sores. Such sores are painful as well as dangerous, and their development reflects on the nurse. Whenever a blood-red point is noted in the small of the back or in any part where the skin is slightly pressed between a bone and the mattress (on the shoulder-blades, buttocks, heels, etc.), the nurse should be doubly careful in looking after the cleanliness and softness of the bed, and in seeing to it that the sheet is stretched smoothly. In order to avoid the appearance of these tender spots, the patient should every day be placed upon his side, and his back washed with cold water, and then dried. As long as the skin is not sore it is permissible also to rub it with a piece of lemon. The sheet must be changed frequently and stretched smoothly, so that it has no folds. A soft cushion, covered with chamois-skin, may sometimes give comfort. If the patient be very emaciated, an air-cushion should be placed under the small of the back (see Figs. 369 and 370). The cushion should be placed so that the tender part of the skin rests in the hollow, thus preventing contact with the bed. Very helpless patients should rest on water-cushions (see Fig. 371), and, in order to facilitate the placing of the bedpan, it is advisable to use horseshoe-shaped cushions. If bed-sores have already appeared, the physi cian's directions must be followed.