American Red Cross Text-Book on Home Hygiene and Care of the Sick by Isabel McIsaac (best large ereader TXT) 📖

—Heredity plays an important rôle in the predisposition to nervousness, so that children of nervous parents are particularly likely to show nervous instability. It is, however, difficult to say in a given case how much of his nervousness a child inherits and how much he acquires by imitating the irritability, the out-breaks of temper, and the other evidences of imperfect emotional control displayed by his nervously disposed parents. On the other hand, even children of nervous predisposition sometimes overcome their defects to some extent by imitating parents who have acquired self-control.

Children predisposed to nervousness should be watched with special care, but they should not be allowed to realize that they are the objects of unusual solicitude. They need the most favorable surroundings that can be obtained, and their general health should be maintained at the highest possible level. Any condition that lowers vitality tends to increase their troubles; nervousness may be caused among children of good inheritance, and increased among others, by poor nutrition, lack of exercise and play out-of-doors, fatigue, loss of sleep, eyestrain, adenoid growths, and the poisons of infectious diseases.

It is characteristic of many nervous children that they are too easily stimulated; they may be excitable, restless, unnaturally quick in moving, over-sensitive to pain and discomfort, easily fatigued, irritable in temper, and unable to control the emotions. They frequently make involuntary motions like grimacing and winking the eyes. Children of low nervous tone, however, are not necessarily excitable. A nervous child may be muscularly weak, awkward in gait, listless, dull, clumsy, forgetful, and inattentive. Such children often suffer from cold hands and feet and from profuse perspiration.

Much can be done for these unfortunate children by removing the cause of their troubles if possible, by giving them simple and wholesome surroundings, by suiting their occupations to their strength, by eliminating mental strain, particularly during the adolescent period, and by training them to control their minds as well as their bodies.

"In addition to the hardening of the body, the education of the child should include measures which increase the resistance of the child against pain and discomforts of various sorts. Every child, therefore, should undergo a gradual process of 'psychic hardening' and be taught to bear with equanimity the pain and discomfort to which everyone sooner or later cannot help but be exposed. What I have said about clothing, cold baths, walking in all weather and at all temperatures, play and exercise in the open air, has a bearing on this point, for a child who has formed good habits in these various directions will have learned many lessons in the steeling of his mind to bear pain and to ignore small discomforts."—(Barker: "Principles of Mental Hygiene Applied to the Management of Children Predisposed to Nervousness.")

After serious or prolonged illness the vitality is generally low and all bodily processes are likely to be depressed. During convalescence, therefore, the digestion is feeble, the muscles are weak so that fatigue follows slight exertion, and the sluggish condition of the circulation renders the patient especially sensitive to cold. Since the nervous system also becomes depressed and irritable, a convalescent patient is easily excited, easily discouraged, and quickly fatigued by mental effort. He finds the simplest decisions hard to make, and his emotions difficult to control; indeed, many a patient who has borne acute pain with unflinching courage becomes peevish at this stage, weeps easily, and expects more expression of sympathy than is good for him. Some persons naturally make quick recoveries, while others recuperate slowly. A long and tedious convalescence, it should be remembered, is the patient's misfortune rather than his fault.

In restoring a convalescent patient to normal living it is imperative to proceed slowly. Food should be increased gradually both in variety and in amount; but the patient's appetite is not always a safe guide, and it may need to be encouraged or to be restrained. Both mental and physical exertion should begin only under careful supervision, and should increase by slow degrees. The patient should sleep as much as possible, should take long intervals of rest, and should continue no occupation to the point of fatigue. A patient who has been ill in a hospital or who has had at home the exclusive services of a nurse or an attendant, often finds the period following his return or following the nurse's departure an exceedingly difficult transition. The family should not expect or allow him to resume too many duties at a time when the mere acts of bathing and dressing may demand all the strength he has. Many convalescents are obliged, or think they are obliged, to take up regular work again before their strength is fully restored. There is generally no economy in so doing; indeed, time is saved in the end by waiting until recovery is complete before undertaking full work.

Important as it is to build up the patient's physical strength, it is hardly less important to direct his thoughts away from himself and his sickness, and to help him renew his interest in normal living. During his illness he has of necessity relied upon the judgment and support of other persons, and his pain and discomfort have forced him to think constantly of himself and his many needs. The habit of sickness is readily broken by some persons, particularly by those whose nervous exhaustion has not been great and whose interests outside themselves are naturally keen. But the sick point of view has remarkable tenacity, and other patients, unless circumstances or deliberate efforts redirect their thoughts, will look upon themselves as invalids to the end of time.

Hopefulness promotes health, while discouragement, apprehension, and unhappiness lower the tone of the whole system. Hence set backs, failures, delays, and relapses should not be dwelt upon, but signs of progress should be mentioned; judiciously however, since overdone attempts to cheer a patient seldom fail to have the opposite effect. If objects or situations that suggest undesirable thoughts are eliminated, the less often those thoughts tend to recur. Therefore, in order to break the habit of sickness, old thoughts must be gradually banished and new ones must be substituted. Sick-room appliances should be put out of sight as soon as they are no longer needed, and the patient may profit by moving into a different bed room. A few days spent away from home as soon as his strength permits often prove effective in breaking up sickness associations; the patient is generally encouraged when he finds that he can sleep in a different bed, endure some fatigue, and exist without daily visits from the doctor. Even a day spent at a different house in the same town sometimes directs the patient's thoughts into fresh channels. Gradually, but as quickly as safety allows, he should take his place in the normal family life and cease to be treated as an exception.

Merely eliminating associations with sickness, however, is not enough; and exhorting a patient to forget himself and to become interested in something seldom accomplishes anything, especially if he is so depleted by illness that the thought of everyday activities suggests only weariness and pain. A person so weak that he is thoroughly fatigued by dressing himself should not be expected to view with enthusiasm the prospect of a full day's work. Much, however, may be accomplished by providing something that the patient really likes to do, and deliberate efforts must be made to stimulate his interest in some occupation, however simple it may be.

Occupations for invalids are more than a means to pass away the time; they are also of distinct curative value. The patient's interest is not always easy to arouse, and some ingenuity may be needed in the beginning; sometimes interest is best aroused by working at some handicraft in his presence, and finally offering, as a favor, to teach him to do it also. His interest in any occupation is invariably increased if a well person not only directs but shares in the work.

Care should be taken to select occupations suited to the patient's physical condition, to his age, tastes, and mental development. Two or three occupations are better than one, so that he may change from one to another before any one becomes tedious. Work requiring fine motions, close attention, or concentrated thought should be used for short periods, only, and no work should be continued to the point of fatigue. The patient should not be allowed to feel that he must finish a certain amount in a certain time. Even poor work is better than none, and a patient should always be encouraged by judicious praise.

Games and puzzles are useful to some extent, but an aimless occupation is not so beneficial as one which has a tangible product, particularly a product that is useful as well as beautiful. Occupations frequently possible for invalids and convalescents include knitting, crocheting, many kinds of needle work, clay modeling, basketry, stenciling, weaving, book-binding, metal work, and photography. Manuals are now available giving directions for these and many other handicrafts. Sick children often enjoy collecting stamps, post marks, and other objects, making scrap books, sewing, weaving, knitting, paper folding, and various other kindergarten occupations.

The whole field of caring for the sick offers nowhere greater opportunity for fine and finished work than it offers in the case of chronic invalids. It is an achievement of which an artist might be proud to make a chronic patient comfortable in body, happy in mind, and agreeable to others. Moreover, since success can never be attained by one who wearies in well doing, the care given to a chronic invalid tests not only the attendant's skill but also her moral and spiritual quality.

Care of a chronic patient has for its aims maintaining the patient's health, rendering him as happy and comfortable in mind and body as it is possible for him to be, and providing whatever special treatment and attention his case requires. In order to maintain his health constant attention must be given to diet, to hygiene of the sick room, and indeed to all his surroundings. In many chronic illnesses, such as rheumatism and kidney disease, the diet is prescribed by the doctor; in every case care should be taken that the patient is not overfed or underfed, that the food is suited to his digestive powers, that foods causing flatulence are eliminated, particularly if the patient's trouble is heart disease, and not the least important requirement, that he derive as much pleasure from his food as possible.

The regular daily care of the patient and of his room, already described in this book, should be scrupulously carried out, and no less scrupulously during the tenth year than it was during the tenth day. Cleanliness in every detail is absolutely essential to the patient's welfare; no one is more unpleasant either to himself or to others than a chronic patient who is neglected. Patients who are constantly in bed, it should be remembered, and paralyzed