HOW TO AMUSE THE CONVALESCENT CHILD.*

BY MARY E. LEDWIDGE.

THE finest entertainment for any child, either well or convalescent, is to keep him busy. His hands and his mind as far as possible should be occupied. An interesting occupation is needed to keep the patient in that cheerful, expectant frame of mind which is a child's normal state.

We will only consider amusing the child while he is in bed or at least while he is confined to the room.

He is generally given old toys, books, and games that may be burned when he is ready to join the family circle again.

It is better to vary his amusements several times during the day and so preserve the novelty, rather than let him keep at one favorite game till he is utterly tired of it.

The nurse might plan for two games or toys during the morning and two different toys or employments for the afternoon,

Most children enjoy hearing stories told to them, but there is no need of a nurse spending long hours every day in this (to many nurses wearing) form of entertainment. Let him do something for himself. After the bath and breakfast the first part of the morning might be spent in making a pretty picture book. Take pretty colored cambric, or plain white cloth if more convenient. Cut out half a dozen pieces the size to make a nice book when folded. Sew these pieces down the middle to make the leaves.

The books sent out by the wholesale seed houses contain brilliant pictures of flowers and vegetables that the children find very attractive for cutting out and pasting. A few old magazines for colored fashion plates might also prove useful.

A pair of blunt scissors, a little bottle of mucilage or a small amount of library paste will prove sufficient material for many hours' delightful employment.

I think two hours is long enough for a

*Reprinted from the Monthly Report of the Alumnae Association of Illinois.

child to spend at this work in one morning. Put all these very interesting tools away while he takes a little lunch, even if it is only a glass of liquid diet. And give him some other form of amusement till after dinner.

Most little girls and many little boys enjoy sewing in outline on perforated cards with colored silk or bright wool; if perforated cards are not available the nurse could take white writing paper and show the patient how to fasten it to a pillow placed before him by sticking a pin straight through the four corners.

Take a picture cut from the seed book or a bird from the advertising section of a magazine, let it be much smaller than the sheet of paper, fasten picture and paper together with a pin stuck through the center and into the pillow.

Now let the patient outline the picture for himself with pin pricks. A large pin such as the banks use would be very easy for a child to play with, or a medium sized safety pin bent at a right angle could be used very comfortably.

This might easily consume two hours in a morning, when dinner probably would be the next diversion. At the corresponding hour next morning he could take colored silks-the ends of spools that collect in every household sewing basket-and outline a picture of his own making.

One I. T. S. nurse interested herself in raffia work during her last year at the training school and she claimed to have made very little progress in the art. Her first case in private duty was a little girl sick with scarlet fever, and during long weeks of convalescence her patient spent many happy hours making tennis balls and racquets of raffia, playing many interesting games of tennis while the patient was still confined to her room.

Much of this game of tennis was "make believe," but all children love "make believe."

Raffia is not very expensive and it comes in pretty colors. Weaving is so generally taught in the schools now that a child might

be given a small bundle of raffia and left to his own devices for a while, with a suggestion from the nurse that he make a surprise for her.

A child of six years could easily weave a long straight mat, then the nurse could make a surprise by setting it up like a little tent, and, of course, she could call it an Indian tent, which would be a delightful "make believe."

A lump of putty on a little tray for a modeling board would be a nice plaything. A child who had not attempted anything of this kind before could begin by moulding loaves of bread, cutting out biscuits with a thimble and pretending to bake them. Shape some bricks or marbles; the latter, with a little judicious patting by the nurse, could easily be shaped into apples.

The animals out of an inexpensive Noah's ark are easily copied in putty or clay. I suggest putty instead of clay for two reasons; first, because modeling clay might be troublesome to obtain, and ten cents' worth of putty could be had at the nearest hardware store; and, second, because a child convalescing from an eruptive disease should be guarded against cold or chilling and the clay would be cold to the patient's hands, while the putty, being softened with oil, could be warmed and easily kept at body heat.

If there is a fireplace or grate in the room take a pair of worn-out overshoes and cut out little men or dolls, no matter how crudely done, string them on a wire and fasten the wire to a couple of bricks stood on end (or in any other way that suggests itself) close enough to the fire for the rubber figures to be warmed up well and you will soon have a set of dancing darkies that would please any child. There will be no odor of burned rubber in the isolation room; it will be carried up the chimney.

Let the boy playing with picture blocks known as sliced animals or birds make the picture complete without help. When they are finished you are sure to admire them. In the same way let the little girl cut out and dress up paper dolls and then ask for your

approval. Little nursery rhymes or jingles that come back to you from your own childhood days will sometimes prove more diverting to a fretful or perhaps spoiled child than the later Father Goose rhymes of which he is already tired.

The telling of nice stories might be left till just before bedtime.

Have your book, paper or what you will and appear engrossed in it; don't sit with your hands in your lap looking at him, waiting his request to hand him things or help him play; give him a chance to entertain himself.

It seems to me that any nurse might sing little songs to her patient while he is isolated; her small audience is sure to be appreciative rather than critical. It sometimes costs a nurse a great effort to sing before any one, even a child, but such kindness is not forgotten, and what you do for him at this time may make this illness a bright spot in his memory forever.

HOSPITALS AND NURSING IN THE PHILIPPINES.*

BY MISS M. E. MCCALMONT, Superintendent, Civil Hospital, Manila, and Supervising Nurse of the Bureau of Health. (Reprinted from The British Journal of Nursing.)

It may be only from my close proximity, or it may actually be a fact, but it does seem to the writer that in no portion of the globe could there be a greater opportunity for nurses or nursing than in the Philippine Islands. Since the American occupation much has been done, especially in the last two years, or since the beginning of the Training School for Filipino Nurses in Manila; but there is still such a great field, and such large opportunities, both altruistic and financial, it seems rather a pity that the nursing profession does not know more of this far away, but most interesting, corner of the Orient.

The first American nurses who came to the Islands were, of course, the Red Cross

*Report presented to the International Council of Nurses, London, 1909.

and the army nurses, who came over during, and right after, the Spanish-American War. There were about 125 in all; but their movements and history while here are of no special moment to this report, as practically all left the Islands as soon as their immediate duty was fulfilled. A few of the Red Cross nurses went into the army, but with the adoption of Civil Government the Army Nursing Corps has been gradually reduced, until there are now possibly not more than twenty nurses in the Islands. The work of the Army and Navy Corps will always be localized, and devoted practically to the Americans; the real nursing of the Philippine Islands-the work that will reach the people will be dependent upon, and represented by, the nurses employed by the civil government, those of private institutions, and lastly, but most important, by the native trained nurses themselves.

The Bureau of Health has charge of all the civil hospitals in the Philippine Islands, with their accompanying nursing force. While this Bureau is responsible for all the medical and sanitary inspection of the islands, besides aiding many private hospitals and charitable organizations, yet it directs, controls and operates the Civil Hospital, Bilibid Hospital, and San Lazaro, all of Manila; the Baguio Civil Sanitarium of Benguet (the summer capital of the Philippines), and the Culion Leper Hospital. The Civil Hospital of Manila furnishes free medical and surgical treatment to all Insular Government employees, besides doing private and emergency work. When finally merged into the Philippine General, which will be within a year, all city cases will be cared for in its wards. The San Lazaro Hospital takes care of the cholera, smallpox, and other contagious diseases, with special departments in charge of native helpers for leprosy, insanity, victims of drug habits, etc. The Bilibid Hospital is connected with Bilibid Prison, the largest prison in the world, and is a very complete new hospital of reinforced concrete, where an American nurse is soon to be put in charge for the purpose of systematically

training the Sisters of Charity, who will ultimately carry on the work. The Baguio Sanitarium is for the sick and convalescent Insular employees, as well as for the Igorots, a semi-civilized tribe, in the heart of whose country Baguio is situated. They are a bright, friendly, tractable people, and each day the dispensary at Baguio treats and cares for a large number of them.

The Culion Leper Colony is the largest in the world. There are at present 1,700 lepers there, and several hundreds more segregated and awaiting collection. The work of collecting and caring for the lepers of the Philippines is most interesting. At Culion there is also a large, modern, reinforced concrete hospital in the course of construction, with a capacity of about sixty beds. The work is carried on by two American doctors and six French Sisters of Mercy. Thus far it has been impossible to find American nurses to undertake this work. A supervising nurse here to train the Sisters in more aseptic methods, etc., would be of greatest assistance. It does not mean lifelong isolation or anything of the sort. The four American employees, the Catholic priests and Sisters, with proper disinfecting precautions, come and go from Manila as often as they have the opportunity. It is a great field, of course, for missionary work, the children of the colony being dependent upon the overworked Sisters for their schooling, moral training, etc.

In addition to the foregoing work, which is actively and successfully under way, there are proposed new general hospitals for the various provinces, besides three great health campaigns which are just being started by the Director of the Bureau. One is the crusade for the reduction of infant mortality, another is a great hock-worm campaign, and the third, that now familiar warfare against the omnipresent tuberculosis, a plague which has attained the same appalling stature here as in other countries.

Towards the reduction of infant mortality creditable work has already been begun, chiefly by Filipino doctors and philanthro

pists; but it is a work wherein American nurses will eventually figure in the way of supervision at least, and where graduate Filipino nurses will soon be of inestimable value. With an infant mortality of 44 per cent. (of total number of deaths), what a field right here for a Visiting Nurses' Settlement !

Investigations have shown that the impaired health and weakened conditions of the Filipino people (who are not a strong or enduring race) is largely due to the prevalence of not only tuberculosis but to the hook-worm disease, which latter in its capacity to enervate and undermine the system seems to have no equal. Nurses will not figure in this work, however, the probabilities being that it will be conducted exclusively by the medical men and health inspectors of the various provinces.

The tuberculosis campaign is only just beginning, and nurses are needed. It is proposed to build a large camp on the outskirts of Manila, where all tubercular working people will be compelled by law to go at nights and sleep under proper conditions, and where they will receive instructions from trained nurses as to right living, proper diet, disposal of sputum, etc. After frem four to six weeks of instruction they will be dismissed from the camp, but it will be watched to see if they are carrying out instructions or not, whether they are improving, etc. The work is not entirely formulated, but promises to be most interesting. Exactly what form the campaign will take in the provinces has also not yet been determined; but, in the opinion of the writer it would seem most logical to begin with classes of instruction, followed up by regular visiting from home to home, giving them practical demonstrations in the matter of cooking, ventilation, hygienic, and sanitary measures, etc. I feel that the best results will be obtained from systematic instruction of the school children and Filipino school teachers, which work has already been contemplated by the Bureau of Education, but is being held back by a lack of competent teachers of nursing. As the diffi

culties of such work are colossal, and the discouragements extreme, it is useless for nurses without a missionary or philanthropic spirit to undertake it.

The balance of the nursing work done in Manila is accomplished by the University Hospital, St. Paul's, the Mary Johnson Memorial, San Juan de Dios, and Sampaloc's.

The University is an Episcopal hospital of about thirty beds, with a force of five American nurses and a training school of seven Filipino nurses. Two settlement workers are also maintained here-young, enthusiastic women, who are doing splendid work with an orphanage, the establishment of a most successful woman's exchange, neighborhood visiting, children's classes, etc. St. Paul's Hospital is a large Catholic hospital of 200 beds, conducted by French Sisters of the Order of St. Paul de Chartres. Here is a successful training school of twenty pupil nurses, conducted by two American graduates, under whom it has. been two years in existence. The French Sisters of this hospital also conduct the Sampaloc Hospital, an institution of 60 beds, supported by and maintained exclusively for the prostitutes of Manila.

San Juan de Dios is a Spanish institution conducted by Catholic Sisters for the benefit of orphans, the feeble-minded, the insane, and paupers.

There are not more than six private nurses in Manila, yet the demand for them is enormous. The regular salary is at the rate of $5 a day, but even at that price they cannot be secured. Probably this dearth is due to the fact that few people know much about the Philippines. The climate is not nearly as trying as one is led to expect from reports of tropical countries, there are comparatively no poisonous snakes or insects, and it is possible to get almost everything here that money can buy elsewhere. If it were not for mosquitoes one would have very little fault to find. Everything but fresh milk is easy to obtain; even green vegetables, fresh strawberries—and ice! I trust there will be an awakening of interest

in the work of these islands, and that nurses will be tempted to enter the field not only for the nursing opportunities, but for the opportunity of travel it affords.

I will conclude this report with a brief history of the Civil Hospital and training school for Filipino nurses.

In October, 1902, the Civil Hospital was established in Manila, with Miss Julia Betts, a former Red Cross and ex-army nurse in charge, and with a force of four trained and one untrained nurses, and two attendants for assistants. The capacity was then about forty beds, but rapidly increased to eighty beds with eighteen nurses and ten or eleven male attendants. With the development of the native training school, the force of graduates was decreased to the present number of twelve American nurses and six attendants. This hospital within the coming year will be merged into the new Philip pine General, a most modern and beautiful group of buildings of reinforced concrete with tiled roofing, the entire scheme designed to accommodate 1,000 patients. The eleven buildings are almost completed. Each pavilion has a capacity of sixty beds, while the operating pavilion boasts of two large amphitheatres. The required nursing force will probably be forty graduates as supervisors, fifty native pupil nurses, and a corresponding number of American and native male attendants.

One of the most interesting features of the work over here is the Training School for Nurses. This was started two years ago by the Bureau of Education as a specialized branch of the Philippine Normal School under Miss Mary E. Coleman, for six years Dean of Women there. Shortly after its inception the theoretical work was put in charge of Miss Charlotte Layton, graduate of Orange Memorial Hospital, N. J., who is at present carrying it on in a most able manner. The school started with sixteen scholarships, ten furnished by the Government and six by private individuals. After one year's study in the Normal School six of these nurses were sent to St. Paul's for practical work, three to the University,

and seven to the Civil Hospital. After a short time St. Paul's bought over their six scholarships, and used these nurses as a nucleus for their own training school, which now numbers twenty. The University Hospital did likewise, and now has a training school of seven, with five more to enter next year. The seven sent to the Civil Hospital remain intact as the senior class, and will be the first graduating class under the Civil Government. There are twenty-three in the next class, making thirty in all. There are to be twenty in this year's class, and for each year hereafter. These twenty scholarships are covered by a special appropriation of the Assembly, which defrays all the expenses of the girls appointed to fill them. The course is a four years' one, including the preliminary year in the Normal School. This is necessary on account of the youthfulness of the available material. But they are bright, conscientious girls, doing wonderfully good work. They are making splendid assistants in the operating room, and while they lack the initiative of the American graduates, yet they do so well under supervision that all interested feel greatly encouraged for their future. I am sending West a picture of the present large force of native nurses. It is surely a group of which to be proud, and it is a very significant fact that the original sixteen are still among them.

I regret that I have had such a short time in which to prepare this report; but I trust it has given a little idea of what is going on in this small corner of the world. Perhaps some of those who read it will be inspired to cast their lot with ours. If so, we will gladly greet them. It is a country of opportunity for nurses and all women with the right spirit. The work is entirely that of organization. We want nurses with new ideas, enthusiasm, and enterprise, not the salary-drawing variety, but the world-helping kind.

UNLESS you work with your whole heart, the work cannot be wholly done.-EDWARD EVERETT Hale.