Wet nursing

“ The treatment of the condition of system described as resulting from over-nursing is, if it cannot be remedied by partially feeding the infant and the use of tonics, to remove the child from the breast altogether, and either procure a wet-nurse for it, or wean it. The wet-nurse is greatly to be preferred; and the preference is the stronger, the younger the child. ”

“ That it would relieve us of all external scrubbers in the Nurses’ own rooms. Each Nurse would sweep, wet-brush and dry-brush her bed-room and day-room herself, daily, would once-a-week give a little extra wash, and would wash the wooden skirting which runs along the bottom of the walls. As the bed-room must be tiny and the day-room small (it would be better if we could keep to one room, which would take a quarter of an hour daily, and the grand weekly purification not more than one hour, even to a slow performer) a short time daily and a moderate time weekly will do it. ”

“ If the mother, either on account of sickness or failure in her breast-milk, is obliged during the summer to give up nursing, she should at once procure a wet-nurse. If she cannot, the child must be sent into the country. To wean an infant in the city in hot weather, is to expose it to almost certain death. ”

“ If the weather is so stormy or severe as to make it undesirable for her to go out from under cover, because of the danger of getting wet or chilled, she may wrap up well and take her airing on a protected porch or in a room with all of the windows wide open. ”

“ Thus, then, it will be perceived, that I place great reliance upon the shallow-bath, tepid, cool, or cold, with prolonged friction by the wet hands, the sitting-bath, the cold wet compresses, often repeated, the wet girdle, cold wet cloths upon the thighs and back, the folded packing sheet, with covering sufficient to keep the patient comfortable, tepid or cold clysters, and water-drinking, together with good nursing throughout, as a remedy for the distressing affection of which I have been treating. ”

“ At present our medical men, especially in London, are easily won upon to recommend a wet-nurse; and, in far too many cases, it is they who suggest and urge the mother’s relinquishment of her first duty to her child; so that we have reached such a pass that something must be done. We shall ere long know from the Registrar-General what proportion of infant mortality is due to this practice: and we are told by those who are likely to know, that of the children of wet-nurses not above one in twenty survives the age when weaning would be natural. ”

“ Cleanliness and fresh air from open windows with unremitting attention to the patient, are the only defence a true nurse either needs or asks.”
“The very first canon of nursing, the first and the last thing upon which a nurse’s attention must be fixed, the first essential to a patient, without which all the rest you can do for him is as nothing, with which I had almost said you may leave all the rest alone, is this: To keep the air he breathes as pure as the external air, without chilling him.” ”

“ A wet-nurse is frequently allowed to remain in bed until a late hour in the morning, and during the day to continue in the house, as if she were a fixture! How is it possible that any one, under such treatment, can continue healthy! A wet nurse ought to rise early, and, if the weather and season will permit, take a walk, which will give her an appetite for breakfast, and will make a good meal for her little charge. ”

“ A surprising amount of water may be given to the sleeping or unconscious patient by dropping it into her mouth from the point of a teaspoon, taking care to give it only at those moments when she is lying quite still. If the nurse attempts to hold the restless patient’s head, or so much as places her hand upon the chin to steady it in order to give water, the irritation, though slight, may be enough to cause a return of the tossing and struggling. ”

“ During the warmest part of the day, however, he will often be much better off and more comfortable in the house, in a room with the shutters closed. But while keeping the baby cool, the nurse must bear in mind the harm that will be done by chilling him or exposing him to a cold draft or wind. Several tub baths, daily, are often given, at a temperature of 100° F., rather than cool sponge baths because of the baby’s feebleness and inability to react to cool bathing. ”

“ Extreme cleanliness is of vital importance; this should be combined with extreme simplicity of detail, and with providing for considerable numbers at once. You can effectually clean a large ward in much less time than two small ones; a long stair than two short ones, &c. Extreme, not finicking, cleanliness, thorough ventilation, for which an ample supply of opposite windows will certainly in the long run prove infinitely the best plan, and careful nursing, are probably the main conditions, humanly speaking, of a large proportion of cures—subsidiary to the medical or surgical treatment. ”

“ The surgical nurse must be ever on the watch, ever on her guard, against want of cleanliness, foul air, want of light, and of warmth.
Nevertheless let no one think that because sanitary nursing is the subject of these notes, therefore, what may be called the handicraft of nursing is to be undervalued. A patient may be left to bleed to death in a sanitary palace. Another who cannot move himself may die of bed-sores, because the nurse does not know how to change and clean him, while he has every requisite of air, light, and quiet. ”

“ Walk through the wards of a hospital, remember the bed sides of private patients you have seen, and count how many sick you ever saw lying with their faces towards the wall.
X. CLEANLINESS OF ROOMS AND WALLS.
Cleanliness of carpets and furniture.
It cannot be necessary to tell a nurse that she should be clean, or that she should keep her patient clean,—seeing that the greater part of nursing consists in preserving cleanliness. No ventilation can freshen a room or ward where the most scrupulous cleanliness is not observed. ”

“ But a careless nurse, be her rank and education what it may, will stop up every cranny and keep a hot-house heat when her patient is in bed, — and, if he is able to get up, leave him comparatively unprotected. The time when people take cold (and there are many ways of taking cold, besides a cold in the nose,) is when they first get up after the two-fold exhaustion of dressing and of having had the skin relaxed by many hours, perhaps days, in bed, and thereby rendered more incapable of reaction. Then the same temperature which refreshes the patient in bed may destroy the patient just risen. ”

“ But in the case of children in a foundling hospital, it is preferable that they should be boarded out with non-resident wet-nurses, for in the present condition of medical science, the institutional care of infants is a very difficult matter to carry out with success.
But the choice of a wet-nurse involves other considerations in addition to those just stated. A woman can safely be employed in this capacity only if her own confinement has taken place some little time before. By suckling the child of another the wet-nurse deprives her own child of its natural nourishment. ”

“ It is, furthermore, true that a great majority of ordinary diseases are commonly so void of danger under careful nursing and hygienic management that the application of water is a simple matter which any intelligent mother can perform successfully. A case is related by good authority of a person who fell in apoplexy an hour after taking an excessively hot bath. Another patient became a paralytic from the same cause. Water is a remedy which cannot be safely used by one who has not informed himself of its effects, and of the proper modes of application. ”

“ Most doctors advise a warm, not hot, shower or tub bath every day, with soap used freely over the entire body, followed by a brisk rub. The best time for this warm, cleansing bath, as a rule, is just before retiring, as it is soothing and restful and tends to induce sleep. Very hot baths are fatiguing, particularly during pregnancy, and should never be taken except with the doctor’s permission; but cold baths usually may be continued throughout pregnancy if the patient is accustomed to them and reacts well afterwards. ”

“ The curative treatment for puerperal infection resolves itself largely into good nursing care. The patient should be kept warm and quiet and as comfortable as possible; elimination is promoted, her strength is saved and her general resistance increased in every way possible. The head of the bed is frequently elevated, to promote drainage; the windows are kept open to provide plenty of fresh air; the diet is light and nourishing and the patient is encouraged to drink an abundance of water. ”

“ Water keeps the food minutely subdivided or in solution, so that the infant's delicate organs can digest it. It also enables the body to get rid of the waste material.
NURSING. Should all mothers make an attempt at nursing their babies? Yes, as a rule.
What are the most important conditions that may prevent nursing? Tuberculosis now or in the past or, in fact, any other serious chronic diseases; very delicate health herself. Some acute disease like typhoid fever or cancer.
How soon after labor should the baby be put to the breast? As soon as the mother is able to have it. ”

“ But in the water-treatment, as you all know, we are not obliged to resort to cold immersion alone; the rubbing wet-sheet is a most excellent application in those cases where the reactive or calorific force is at a low ebb. We can also use tepid ablutions of various kinds with great advantage, under such circumstances—great, not only as regards the patient’s feelings of comfort and strength, but as to cleanliness, which is also an important consideration. ”

“ In the first place, all effective care given to a consumptive has to include nursing as well as teaching. Now, one can “educate” in a woollen dress, but one certainly cannot give bed-baths in anything but a cotton dress, which can be plunged into a tub and washed. And whether she enters the home to give a bed-bath, or whether she goes in merely to distribute prophylactic supplies, the 30fact remains that a nurse spends some eight hours a day in contact with an infectious disease. Good technique demands that she be dressed in washable material. ”

“ To place the baby in the tub the nurse may slip her left hand under his head in such a way that his head will rest upon her wrist, her fingers support his shoulders and her thumb curve over and hold the upper part of his arm. She may then grasp his ankles with her right hand and lower the little body into the water, feet first. If his arm and shoulder are firmly held and supported by the left hand it is an easy matter to steady the entire body and keep the baby’s head out of the water while giving the bath with the right hand. ”

“ Nothing more is requisite for their avoidance than strict observance of the rules of modern hospital hygiene, with individualisation in all departments, and especially in the matter of diet, which should whenever possible be carried out through the instrumentality of wet-nurses. Since wet-nurses of the best quality are difficult to obtain in sufficient numbers, it is best that the hospital for infants should be associated with a lying-in hospital. ”

“ In the slighter cases of after-pains, the frequent laying on the abdomen cold wet compresses, the same upon the back, together with frequent drinking of cold water, and the use of the accustomed baths—such as are always taken, even when labor pains do not appear—will in general prove sufficient. But in many cases a far more heroic treatment will be found necessary. Many times in the twenty-four hours we may have to persevere in the water appliances, particularly the shallow-bath; the common wash-tub, or the sitting-bath tub, answer very well for this ”

“ Some nurses and mothers think that if the child's skin is wiped dry after bathing, it will impair, if not destroy, the good effects of the operation. Others still, shocking to relate, will even put it to bed in its wet clothes; this, too, from principle. Not unlike this, is the belief, very common among adults, that if we get our clothes wet—even our stockings—we must, by all means, suffer them to dry on us; a belief which, in its results, has sent thousands to a premature grave—and, what is still worse, made invalids, for life, of a still greater number. ”

“ The fact that it used to be the common practice of wet nurses to keep secret bottles of these dangerous syrups and to use them to a terrible extent, is notorious; and too great care cannot be taken by any employer of a wet nurse to-day to guard her child against the possibility of such ignorant or unprincipled treatment, remembering in all cases to consult a medical man for her infant, in preference to following the counsel of her nurse. ”

“ It is often a good plan to have the patient, without stitches, begin to bathe herself in bed, after the third or fourth day, for the sake of the exercise, and also the encouragement that it offers. When all is going well, tub-bathing is usually resumed by the third or fourth week. ”

“ In either case the female should be disturbed as little as possible, particularly if there be danger of flooding, and she should be carefully guarded from cold. When the soiled and wet clothes are removed, as completely as possible, warm napkins should be placed under the Pelvis and between the limbs, to soak up the discharge, and they should be carefully changed as often as needed, without uncovering the patient. If she be disposed to sleep however, and is much exhausted, these attentions need not be pressed too much till she is recovered a little. ”