Browsing in a used bookstore, I came across a copy of Nursing in the Home by Lee Smith, MD, published in 1920. The first page alone made me thankful to be a nurse in the 21st century! The author offered advice on mattresses for the sick room-a hair mattress should be covered with a cotton ticking, and, in the case of a fractured hip, a second hard mattress filled with straw should be placed under the hair mattress to prevent sagging. A straw mattress was also recommended when the patient had a contagious illness so it could be burned afterward to prevent transmission of the disease.
A total of 20 different therapeutic baths were described, including acid, alkaline, iodine, sulfur, and spirit-vapor baths. I don't know who I feel sorrier for: the home care nurse of the 1920s who had to administer a Russian bath or the patient who was subjected to it! Hot vapors were applied, followed by a plunge into cold water. Thought to be therapeutic for those with rheumatic diseases and "nervous affections," I think it may have also produced some "nervous affections."
Have you ever wondered why some of your older patients seem to be obsessed with daily bowel movements? Wonder no more. Dr. Smith blamed constipation for "nine tenths of all human sickness including jaundice, torpid liver, pimples, nightmares, drowsiness, and depression. ... [C]onstipation is the indirect cause of many fevers and other dangerous diseases, because poisonous germs are not carried off, but remain to be taken into the circulation and the system" (Smith, 1920, p. 408). To cure chronic constipation, he recommended that the patient be given "Dr. Pierce's Pleasant Pellets" every morning.
Nursing in the Home was published a few years before the discovery of insulin, so diabetes was described as a wasting disease, although there was a beginning recognition that diabetes was different for older than younger patients: "But fat old people, or middle aged people, often live for many years if proper care and treatment be taken" (Smith, 1920, p. 412). Proper treatment was described as high-frequency electrical currents, which was thought to affect metabolism.
The sick room was to be filled with sunlight. The home nurse was advised to choose a light airy room with hard wood floors for the sick room. If only carpeted rooms were available, the carpet was to be covered with tea leaves and vacuumed daily (by the nurse of course).
Dr. Smith also had words of advice on the characteristics of a good home care nurse. She should be:
attentive to the requirements of the physician and patient for she sustains an intimate relation to both. The nurse must be kind but firm, and not yield to such whims of the patient as may be detrimental to recovery; neither must she arouse dislike or anger by opposition, but endeavor to win the patient from all delusions.
The nurse should possess an inexhaustible store of patience. ... The nurse should always be cheerful, look on the bright side of every circumstance, animate them with encouragement, and inspire them with hope. ... The nurse should possess moral principles, which alone can win the confidence of a patient. She should have judgment, circumspection, intelligence, forethought, alacrity carefulness and neatness. In a word, she should exercise common sense (Smith, 1920, p. 38).
To sum up Dr. Smith's opinion of the contribution of nursing to patient outcomes he stated:
"Success in the treatment of the sick requires good nursing. Without it, the most skilled physicians fail to effect a cure; with it, the most unqualified may success." (Smith, 1920, p. 36).
Wouldn't we all agree? To see Dr. Smith's "Don'ts for Young Nurses," see the below.
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