WHAT SHOULD A NURSE BE? BY DR. E. S. MCKEE, Cincinnati, Ohio. NOT only the whole Sermon on the Mount itself but also the whole mountain. "A nurse should be a nurse, not a medical man" was the original attitude of Miss Nightingale, from which she never varied. Yet she was always anxiously working to advance the standard among nurses. Ability to pass a good technical examination does not show that a woman will make a good nurse. Natural aptitude comes in for a great deal. To use a familiar axiom of late years too much criticized, a nurse is born not made. I must confess that I have seen a fifteen year old schoolgirl and a negro mammy do better nursing than some trained nurses. I have often found the fat woman of forty or fifty a more reliable nurse than the slip of twenty. She has been through the mill and her judgment is more settled. She has parted from much of that self-conceit seemingly a constant companion of youth. The Chinese have a saying: If my bones must be set let them be set by one who has had his own bones broken. The nurse should have had that noblest frailty of the mind, Love, and that other acute infectious disease of childhood, the measles. While the doctor must sometimes be cold, bold and severe, warmth, gentleness, kindness, chastity, forbearance should characterize the nurse. A nurse should be a lispenser of all good things and if possible have a pretty face, yet not use it to tempt virtue aside. She should be, if possible, one whose presence makes it both a pleasure and a good fortune to be ill. She should remember to nurse the patient, not the sickness. I once had a nurse caring for an obstetrical case. The infant had milk in its breast, which proved very persistent. In time I discovered that the nurse was nursing the breasts of the infant, knowing full well that this but protracted the complaint. Her excuse was stated frankly-that she was prolonging a good case for both of us. Florence Nightingale certainly was the model nurse. Ada, Countess of Warwick, daughter of Lord Byron, spoke of her as peaceful, placid loveliness. Whittier describes her as: "The sweetest woman ever Fate Perverse, denied a household mate." "Get leave to work in this world. 'Tis the best you can get at all," said Mrs. Browning. The average American housewife when she has sickness in the family wants a nurse who will be a help, not a hindrance, one who will brush aside not add to her burdens. The old Irish woman, when the doctor told her she was so ill that she must have a trained nurse, said: "I'd like very well to have one of thim creatures in the house but I do be that bad I don't feel able to wait on her at all." The nurse should help the patient and help make home more habitable for father, mother and children. It is not degrading to do housework. If so, the American women are the most degraded of civilized women. Many American women of means, education and refinement must work, on account of the impossibility of obtaining domestic help. Miss Nightingale always said that a nurse must be able to show how to clean up a house. I have seen instances of educated, refined housewives waiting on trained nurses who would not wait upon them. A nurse should not be expected to do all the nursing nor all the housework, but she should be able, capable and willing to do both if the necessity required. The nurse should be the typical mother. She must, indeed, be more. The mother must be sympathy, usefulness, patience to her own flesh and blood. The nurse must be all these to strangers, and often to those who through diseased minds and bodies make life a severe burden to her. Nursing is an art, one of the finest of arts; there is but one other art which equals it. Nursing is one of the most useful professions in the whole domestic economy; there is but one other as useful. Nursing is a noble calling; there is but one as noble. A nurse should have all wisdom but not consider herself a comprehension of knowledge. From this it an be readily seen that few nurses have more training than they can use, at least in the exigencies of their work, yet many have more than is needed in the great majority of cases and more than most people are able to pay for. The regular charges of the graduate nurse are beyond the reach of a large majority of the people. In some instances the nurse gets all the money the patient has and the doctor gets left. What we more particularly need at the present day is a nurse with about a year in a hospital, at least a grammar school education, one who is not afraid of work and will work for ten or fifteen dollars a week. She would be a godsend to families of limited means and doctors whose lot is cast with this class. What we also need is more charity among nurses. The medical profession I sometimes think has too much of this good thing. Florence Nightingale at the busiest time of her life, and when she was loaded down with honors and illness, never failed to keep up her deep interest in district nursing in the homes of the poor. You never yet made an artist by paying him well, yet an artist ought to be well paid. In brief, the nurse must have some higher motive than money else she has chosen the wrong calling. The nurse must not only strictly obey the physician in charge, but must work in obedience to the greatest of all masters, highest of all motives. Temperance, so wanting in the nurse of fifty years ago, is now scarcely necessary to discuss. Suffice it only to quote Don Quixote: "Inebriety never keeps a secret nor performs a promise." The nurse like the physician should approach sublimity by being always ready to sacrifice pleasure for duty. Like Cato firm, like Aristides just, like rigid Cincinnatus, noble, pure; steadfast and unmovable, vigilant, blow it rough or smooth. This may seem to be asking a great deal for $25 per week, but the nurse is like woman,—with her we may fail to be satisfied, without her we cannot fail to be miserable. We do not blame the nurse for getting the $25 when she can, but she should feel more for the poor and those in moderate circumstances. She should not be displeased with a less fee nor even disconcerted with a larger. My nurse, and she brings news-(Juliet). When you hear good of people tell it; when you hear a tale of evil quell it. Everything you possess even to your life you may give to your friend, but the secret of another is not yours to give. A once told secret is no secret at all. A secret is seldom safe with more than one person. The nurse should say to her patient concerning her secrets, as did Shakespeare: "Tis in my memory locked and you yourself shall keep the key of it." If you tell your patient's secret to a friend that friend has another friend and so without end. The nurse should be all eyes and ears and let her tongue be stilled by the wisdom of her head. Shallow streams murmur, deep ones silent flow. Though it may be but foolish to tell your own secrets it is treachery to tell others. Florence Nightingale once wrote: "A small pet animal is often excellent company for the sick, for chronic cases especially. One advantage of a dog over a nurse is that it does not talk." What is written is written. I wish nothing to extenuate nor aught set down in malice. The following are the words of the founder of the holy order of the Sisters of Charity: Your convent must be the houses of the sick; your cell the chamber of suffering; your chapel the nearest church; your cloister the streets of the city or the wards of a hospital; the promise of obedience your sole enclosure; your gate the fear of God, and womanly modesty your only veil. St. Paul must have had not only Abraham Lincoln and Florence Nightingale but also doctors and nurses in mind when he wrote: Charity suffereth long and is kind; charity envieth not; charity vaunteth not itself, is not puffed up, doth not behave itself unseemly, seeketh not her own, is not 1 easily provoked, thinketh no evil; rejoiceth not in inquity, but rejoiceth in the truth; beareth all things, believeth all things, hopeth all things, endureth all things. Charity never faileth. 19 West Seventh St. CARE OF THE SICK AND INJURED.* BY J. C. YOUNG, M.D., M.R.C.S., M.R.C.P. Cuba, N. Y. Ir is said that the sick or injured deer is abandoned by the rest of the herd. Such is the instinct of those animals. But the instinct of the human race is far different. We are told there was a time when no man was his brother's keeper. While we may still see or learn in the course of a lifetime of some few instances where a heartless indifference has been manifested toward a sick or injured human being, yet it is the instinct of the human race to go out with a deep feeling of tenderness and sympathy toward such persons. History teaches us that at all times and in all ages mankind has manifested in different ways a kindly tenderness toward the sick or injured. The natural regard felt for those who are near and dear to them in health has led to the adoption of some means or methods for their relief and safety when unable to care for themselves. A sick or injured person welcomes the flowers which bloom and fade, but how much more he welcomes the care which always saves suffering and many times saves both life and health to its possessor. This help and care is the monument he desires and welcomes most. Warriors have ambitions for the lustre of a single name, but this is always at the expense of a victory won or lost, but in recent years there have sprung up all over this land institutions of learning, and out from their doors have passed and are passing thousands who through special study have prepared themselves for a life work *Read before the Eighth District Branch of the Medical Society of the State of New York held in Buffalo, September 8 and 9, 1909. which is often far more commendable than that of warriors, and that is a work of saving life and preventing suffering. As far back as the oldest of us remember people were very apt to remark that it was as much in care as it was in the medicine. Long years ago members of the medical profession who practiced then worked very hard in nursing the sick back to health. In many instances great confusion if not serious trouble followed such efforts, as they were always unscientific and inaccurate, but it was the best we were able to do for our best friends. Now this is all changed, for we see that the means then used with the best of intentions should be abandoned as inexact and unsafe. The doctor formerly performed many of the duties which the nurse of to-day does. But the doctor could not remain with the case, as other duties were pressing upon him and still he could not help but realize how important it was to have the constant attention of a nurse. Vision and reality differ, for generally they are widely separated as to time and space, but the vision of the doctor well advanced in years and still practicing medicine, and all the best years of his life spent in the sick room and by sick beds, becomes very nearly realized now as to care of sick and injured and adds an alluring interest as he passes down the descent of life's avenues. The great advances which have taken place in medical and surgical science have created a need for new help both for the patient and medical attendant-a need which has been met to a great extent by the trained nurse, as her coming into the sick room is inspiring to physician, patient and friends. During recent years care of the sick and injured has been developed far in advance of the older methods so familiar to many of us here to-day. Since the change in the treatment of wounds and diseases the whole aspect of the question has been altered. This is certainly a decided step forward. and has a tendency to relieve the uncertainty which heretofore surrounded the case. Some brilliant results have been obtained in this way that could not be reached by any other. It is claimed that when the history of inedicine comes to be written we of the present time will be accused of endorsing almost any methods which seem to contain some new or unusual features. But this is not entirely new. Nursing is as old as the time when mothers first bore and cared for their offspring, but the trained nurse is not taking us back very far. It is only one of the means of replacing the more unsatisfactory and unsafe methods of years ago. Nursing the sick and injured has made its mark in history to remain as a very interesting page to look back upon. This world is indebted for lasting and substantial benefit to many changes and improvements which have taken place in our day. The inventors say we are most indebted to them. The chemists say to them. The pathologists say to them, and other professions say we are most indebted to them. But suffering humanity is surely indebted very much to those who from surrounding circumstances or their own inclinations and wishes have fitted themselves to save suffering and life by the care and attention they are able to give. It means much more than good intentions, which anyone could give. Good intentions count for nought. They may be positively harmful. The advance in medical science and the care which the nurse can give a sick and injured person make the great sacrifices of former times on our part needless. We are no longer expected to risk so much while we are in the pursuit of our duty. If the nurse is so helpful in the homes where wealth furnishes every comfort money can bring, of how much greater help would she be in homes where poverty is fostered in all its forms and where there is comparatively little to help the sufferer. The fact that there are a great number of sick and suffering all the time who are unable to obtain such help as the well-todo are able to obtain has repeatedly drawn the attention of the medical profession, and at times the public, to this matter. The rights of the poor form a very interesting subject. The medical profession as guar dians of the public health would naturally be looked to first in regard to this, but the subject is of so great importance that it is rather surprising that so far it has received. so little attention from the public mind. There are a class of people who get along very well in health and yet find it difficult to make the income equal the outgo, but when sickness comes it strikes a new terror into their lives and they ask what next,what in this world will happen to us next. Humanity inspires us to do all we are able to for the sick and injured no matter what their stations in life may be. Things must be arranged not on personal grounds but according to the needs of the case and nature of the disease. As human beings, each case deserves the same care and consideration. Our duty and work is to restore to health or relieve the sufferings of those who have been overtaken by disease. It should never be a question of how much or how little we can do but what ought to be done -and then we should do our best to do it. Lamentable as it may seem, disease sometimes causes death in a quiet way and takes a valuable life out of the world which might have been saved if proper care could have been given the case. While we are looking for better days yet to come to this class, yet present needs are crowding upon us and the question is: how shall we best provide for them now? Never before in the history of medicine has so much interest centered on this question as at the present time. The medical profession are deeply interested in it. And so we trust the time is near at hand when the needy poor may feel that a helping hand is waiting to clasp their own in return. Such a fellowship constitutes a bond unbroken, by time unsealed. People may have different opinions as to what it is to die rich, but all will agree that the man or woman died very rich who, after death, could ask: "When was it that I had this account placed to my credit which has been accumulating all these years?" And the answer comes: "When you saw the poor woman, the little boy or girl who were sick and in destitute circumstances and you sent a nurse there to care for them until they were relieved by art or released of their sufferings by death you had this account placed to your credit and on interest, and when you died you did not leave all your wealth in the world you left." As the old Scotchman said, this world we are passing through is God's world just as much as any we are going to. How poor people can receive the care of a nurse when sick has within recent years received marked interest at the hands of the medical profession and some others as well. It is difficult many times and in some cases, we all must admit, but difficulties make the opposite, and that is success, possible. The question comes every day to both the nurse and the doctor, What can I do and what can you do to help a sick person to get well? The well trained nurse deserves and expects to receive $25 per week in all cases. But there are camparatively few who can afford such a price for any length of time without great hardship. But there are schools both by correspondence and schools of short training where many can learn much as to how to help a sick person to get well and how to relieve suffering, who could not afford the time or expense to take full training. Such nurses could afford to give service at less than one-half the price given by others. There should always be a full distinction made between the two classes. But I think all classes are getting nearer together on this point. I am pleased. to note with the well trained three year course nurses a marked change in their views and opinions on this point. They recognize more and more that the partly trained nurse is far in advance of the nurse of no training and can furnish that care and attention which will be a great help, at a price that the full trained nurse could not afford to work for and that others could not afford to send them for. We trust the time is near when the sick poor will have something more than desire or wish but a reality. The nurse is the doctor's best assistant and very much of his treatment must be carried into effect by her. In very many cases the nurse stands ahead of any or all other measures we are able to adopt in piloting patients safely over critical periods in their lives. The doctor requests and wishes but he cannot carry out his wishes or requests. There no longer remains a doubt that the medical profession owe to nurses a debt of gratitude we can hardly repay. The most we can do is to cherish it, remember it, and acknowledge it. But we must not allow the public to feel that we wish the trained nurse simply to make our burdens lighter or our anxiety less. Show them that as much as ever we look upon our patients as sick and afflicted fellow creatures who want relief and help and that we can afford them the help they want in this way better than any other way, but no known means will be omitted or forgotten on our part. Phillips Brooks in his last days said that a minister who was up to date was in rather poor business. But give us nurses who are up to date. In the care they give the sick and injured they help us to save the father to his family, the wife and mother to her home, the child to the parents. Some people claim the world is not growing better as it grows older. They say things were not so in their day, and they wish to take us back to the days when the red cradle rocked and they would ignore the more comfortable, the more sanitary and less cumbersome methods used in the care of the infant of to-day. The true nurse says, Not so; let us not do as our forefathers did, but let us do our work in a higher, nobler and better way for the relief of suffering humanity. Is there a class that do a better work? The sun does not shine for itself alone. It is for the race. Nurses do not work for themselves alone. It is for others. The good they do is not all confined to the sick room or sick beds or to the interior of walls where their work is mostly done. When a nurse graduates some might say her work is done. No more so than the work of the steam engine just completed. It is the number of miles it |