SPECIAL POINTS IN THE CARE OF CHILDREN, CONVALESCENTS, CHRONICS, AND THE
AGED
In many cases of sickness institutional care has marked advantages. It
may be the only solution when adequate provision for the sick is
impossible at home; and it is often a necessity when a patient requires
special equipment or apparatus, expert nursing, and medical attention
within reach both day and night.
On the other hand, it would not be desirable even if it were possible
for all sick persons to be cared for in institutions. Care at home when
it is adequate may be more successful than equally skillful care given
elsewhere, since the sick quite as much as the well are injured by long
separation from normal family life. Most children, because they need the
attention of their own mothers, most convalescent and chronic patients,
and most aged persons are cared for at home; and in the great majority
of cases no better place for them could be found. Since patients of
these four groups have needs peculiar to themselves, some special
points in caring for them are considered in this chapter.
CHILDREN
Ability to observe quickly and accurately is seldom more needed than it
is by a woman who cares for children. No one expects babies to explain
their troubles, but people forget that small children are unable to
describe their physical sensations with any degree of accuracy, although
discomfort or sickness may show itself in all degrees of ill temper and
bad conduct. For these exhibitions many a suffering child has been
punished, where an older and more articulate person would have received
considerate attention.
Children, like babies, have a low resistance to disease. Moreover, they
react quickly both to favorable and to unfavorable surroundings. Hence
slight causes sometimes produce pronounced or even violent symptoms in
children without giving cause for great anxiety, although the same
symptoms if exhibited by adults, might indicate critical illness. On the
other hand the recuperative power of children is high, and their
recoveries are sometimes surprisingly rapid. It is a mistake, when a
child has completely recovered from an acute but brief illness, to
coddle him for weeks afterward merely because a grown person in similar
circumstances would have failed to regain his strength.
When a child is sick in bed, especial efforts should be made to insure
adequate ventilation without chilling him. Children always lose heat
rapidly because the body surface is proportionately large; when they are
ill, therefore, it is especially necessary to keep them well covered, to
see that their hands and feet are warm, and to avoid chilling them
during their baths. But overheating must also be avoided, since all
children, sick or well, who are too warmly dressed or who stay in rooms
that are too warm, become weak and irritable and more susceptible than
others to colds and other respiratory disorders. The child's skin should
be kept clean and dry, but he should not be disturbed nor handled
unnecessarily.
Sick children require very simple food at short intervals. Variety is
not so necessary for a child as for an adult, unless the child has been
allowed to form bad habits of eating. Sick children should not be
indulged unnecessarily, either in regard to their food or in other ways.
However, attempts made during an illness to change the habits of a badly
trained child are unwise because usually unsuccessful; parents who sow
the wind by neglecting to train their children when they are in good
health may as well make up their minds to reap a veritable whirlwind
when the children are ill. Even when children are well trained it is
difficult and sometimes impossible to prevent them from forming bad
habits during sickness. Yet the labor of training a child reaps perhaps
at no other time a richer reward than it does when the child is ill, and
his recovery might be seriously impeded by unwillingness to accept
necessary food, medicine, or treatment.
PHYSICAL DEFECTS are faults in the structure of the body; adenoid
growths, imperfect eyes, abnormally curved spines, and defective teeth
are examples. Most physical defects can be cured in childhood by
treatment or by slight operations. If untreated they frequently lead to
sickness or to serious impairment of the body, and if neglected until
adult life their injurious consequences are generally beyond remedy,
even when the defects themselves can be repaired.
Some indications of common physical defects are given below; they ought
to be more generally known than they are. If a child exhibits one or
more of the symptoms mentioned, he ought to be given a complete physical
examination by a competent physician, and treatment, if needed, should
begin without delay. The idea that children will outgrow these defects
without treatment is erroneous. Better, however, than waiting until
symptoms appear is the modern way of giving every child a physical
examination at stated intervals, a practice already common in public
schools where effective health work is carried on.
EYESTRAIN frequently comes from imperfections in the shape of the eye;
these imperfections can almost always be corrected by glasses. When a
child is suffering from eyestrain, the eyes themselves may show
indications of trouble; they may be blood-shot, the lids may itch or be
crusted or inflamed, or styes may appear. In other cases the symptoms of
eyestrain have no apparent connection with the eyes; such symptoms are
headache, nausea, vomiting, indigestion, fatigue, irritability, poor
scholarship, and nervous exhaustion. If a child shows any of these
symptoms, or if he rubs his eyes, frowns, squints, wrinkles his
forehead, sits bent over his book, or develops round shoulders, there is
sufficient reason for having his eyes examined by an oculist.
Examination by an optician should not be considered sufficient.
ENLARGED TONSILS AND ADENOIDS.--The tonsils are masses of spongy tissue
situated at the back of the mouth, on either side of the opening into
the throat. If enlarged they may seriously interfere with breathing, and
if diseased they frequently harbor the germs causing many acute
infections, as well as germs of rheumatism and most of the heart
disease originating in early life. Therefore the tonsils ought to be
removed if they are diseased or greatly enlarged, but there is
ordinarily no good reason for removing normal tonsils.
Adenoids are situated at the back of the nose, and like the tonsils are
composed of spongy tissue. Adenoids sometimes become so enlarged that
they interfere with the passage of air through the nose, thus
predisposing to catarrh, colds, and other respiratory diseases, to high
palate with irregular teeth, to inflammation of the middle ear leading
to deafness, to diminished mental activity, and to general poor health.
If a child breathes through his mouth, if he snores at night, keeps his
mouth open and has a dull, apathetic expression, his nose and throat
should be examined, and if advisable his tonsils and adenoids should be
removed.
DEFECTIVE HEARING.--Permanent deafness among children in the great
majority of cases comes from trouble in the throat or nose; hence the
most effective measure to prevent deafness is to make sure that every
child's nose, throat, and mouth are in a normal condition. Sensitive or
timid children try to hide infirmities of any kind, but deaf children
seem peculiarly unable to explain their difficulties. "No one," says
Cornell, "has ever recorded that a small child complained of inability
to hear." A child's ears should be examined if he breathes through his
mouth, if he stoops habitually, if he is persistently inattentive, or if
he is vague or stupid in carrying out directions. A child who appears
normal at times and inattentive or stupid at other times should also be
examined, since he may be deaf in one ear.
Temporary deafness may come from accumulated wax in the ear. The wax
should be removed by a doctor; inexpert attempts are likely to cause
serious injury to the ear drum. Intermittent deafness may be caused by
enlarged tonsils and adenoids. Children thus affected are not
infrequently punished for seeming disobedience. Such children are
especially liable to street accidents.
DEFECTIVE TEETH have been considered on page 44.
POSTURE.--In childhood the bones are soft and yield with comparative
ease to continued strains; hence they often become deformed by bad
positions assumed in sitting, standing, or in using the body in other
ways. The postures habitually assumed by a child should be noticed and
good postures should be insisted upon. But it is not enough to admonish
him. The various causes tending to encourage bad positions should be
corrected; among them are insufficient illumination of books and work,
defective eyesight or hearing, obstructions in breathing, muscular
weakness, and low general vitality. Children should have their chairs
and tables suited to their size for their work both at home and in
school.
[Illustration: FIG. 28.--INCORRECT SITTING POSTURES. (_From Cornell,
"Health and Medical Inspection of School Children." F. A. Davis Co.,
Philadelphia._)]
[Illustration: FIG. 29.--INCORRECT SITTING POSTURES. (_From Cornell,
"Health and Medical Inspection of School Children." F. A. Davis Co.,
Philadelphia._)]
[Illustration: FIG. 30.--INCORRECT SITTING POSTURES. (_From Cornell,
"Health and Medical Inspection of School Children." F. A. Davis Co.,
Philadelphia._)]
[Illustration: FIG. 31.--INCORRECT AND CORRECT STANDING POSTURES. (_From
Cornell, "Health and Medical Inspection of School Children," F. A. Davis
Co., Philadelphia._)]
The adjustable chairs and desks now used in schools are a marked
improvement upon the school furniture which has caused so many
deformities in the past.
[Illustration: FIG. 32.--ROUND SHOULDERS. (_Goldthwait, from Pyle's
"Personal Hygiene."_)]
One of the serious deformities caused by habitual faulty posture is
curvature of the spine. A curvature not only injures a child's
appearance and thus handicaps him in later life, but it brings strains
and pressure upon the organs of the chest and abdomen which may
seriously impair his health. As curvatures often pass unnoticed in their
early stages, every child should be inspected occasionally when all his
clothing has been removed, to see whether the weight is borne evenly on
both feet, whether the development of the two sides is uniform, and
whether the head and shoulders are properly carried. It should be
noticed when the child stands, whether one shoulder is higher than the
other, whether one shoulder blade projects more than the other, whether
one hip is higher than the other, and whether one hand is lower than the
other when the arms are hanging at the sides. The child should walk
both toward and away from the observer, who should notice whether the
child uses the two sides of his body in the same way, and whether he
drags or shuffles his feet or has other abnormalities of gait.
[Illustration: FIG. 33.--LATERAL CURVATURE. (_From Bancroft's "Posture
of School Children." The Macmillan Co., New York._)]
[Illustration: FIG. 34.--"WING SHOULDER BLADES IN FORWARD SHOULDERS.
(_From Bancroft's "Posture of School Children." The Macmillan Co., New
York._)]
If abnormalities are found, a physician should be consulted. Often
corrective exercises are all that is needed, and no one should put
braces of any kind upon a child unless they have been prescribed by a
physician. No attempt should be made to correct the common tendency of
children to toe in or "walk pigeon-toed." Toeing-in is a natural manner
of walking during the formative period and tends to strengthen the arch
of the foot, while toeing-out tends to weaken the arch and to cause flat
foot or broken arches.
PREDISPOSITION TO NERVOUSNESS.--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.")
CONVALESCENT PATIENTS
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.
CHRONIC PATIENTS
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 patients in particular, are
peculiarly susceptible to pressure sores. If a patient is able, it is
extremely important for him to sit up in a chair part of the day.
Sitting up should never be omitted because it involves the expenditure
of time and trouble for the attendant.
It is often said that for most people some personal experience of
sickness is beneficial; it can safely be said, however, that no one
benefits from spending any considerable portion of his life in a state
of helplessness and suffering. Behavior and character itself are
determined by influences constantly coming into the mind from daily
surroundings and associations with other people: one who recalls this
fact needs only a moment's reflection to realize how ill adapted to
healthy development of mind and character are the limited lives of the
sick. Especially unfortunate is the situation of chronic invalids, shut
off as they are from the objective interests and activities of normal
life, deprived of all practice in making the salutary small adjustments
and sacrifices required in every day living with other people, and
self-centered as they necessarily tend to become from the inevitable
focusing of attention upon their own discomforts and pain.
On the whole, a surprisingly large number of invalids successfully
resist the disintegrating effects of sickness upon character. But it is
nevertheless true, as Dr. Weir Mitchell says, that "Sickness ennobles a
few but debases many." A selfish invalid has more than once destroyed
the happiness of an entire family, or spoiled the life of one member of
it by monopolizing her whole time and attention. Families should
remember that their injudicious sacrifices seldom bring enduring
happiness or contentment to the patient himself; indeed, in the long run
such sacrifices generally injure him even more than they injure his
victims. Clearly much must and should be sacrificed by members of a
family to the needs of an invalid; but in general it may be said that a
sacrifice is injudicious if it relieves the patient of activity or
responsibility that he can support without injury, if it makes him more
dependent in mind or body, if it results in restricting his attention to
himself and his affairs, or if it increases his tendency to make demands
on others.
Purposeful activity of some sort and the necessity for contributing to
the welfare of others are essential parts of a wholesome life. If these
essentials are entirely eliminated from the life of an invalid, the
patient's greatest needs are probably left unsatisfied, even though the
physical care he receives may be perfect in every detail. All that was
said in regard to occupations for invalids applies with particular force
to occupations for chronic patients, since however valuable manual
occupations may be as a means to bring about recovery, they are still
more valuable in furnishing interest and purpose in a life whose only
prospect is a succession of weary, useless years. Handicapped patients
sometimes learn occupations that yield a financial return, and ability
to earn even a little stimulates self respect and mental health, whether
the money is needed or not. The important point, however, is that the
finished product should have a recognized use.
In addition to enabling the patient to make things with his hands, a way
should be found if possible by which he may contribute to the group of
people with whom he lives. If a way can be discovered for him to do so,
the opportunity should not be denied him nor should his service fail to
be noted and appreciated, even if it is nothing more than telling a
story to a restless child.
CARE OF THE AGED
At the end of life, as at its beginning, every individual especially
needs the interest and protection of his own family. In ordinary
circumstances neither a baby nor an aged person can be cared for so
fittingly or so successfully in any other place as he can be in his own
home.
With advancing years is to be expected a general slowing down of all the
powers. In old age both body and mind show characteristic changes, and
particularly changes causing lowered resistance and diminished vigor. If
the manner of living is adapted to these changes, both happiness and
usefulness may be prolonged. But so gradually do the changes often come
that they may escape notice for a long time, and the younger generation
in looking back sometimes realizes with regret how much earlier measures
might have been taken to prolong the usefulness and to mitigate the
discomforts of aged parents and friends.
Old people are keenly sensitive to cold, since the circulation gradually
becomes less vigorous and they take little exercise. Keeping them warm
both in bed and out adds more perhaps to their comfort than any other
one measure. They should have warm underclothing and soft shawls and
other extra wraps. A real service will be rendered by the person who
invents a suitable and dignified wrap for old or feeble men, who dislike
the informality of sweaters and feel disgraced by shawls. Old persons
should and can be kept warm in bed, by providing them with hot water
bags, with warm night clothes including stockings, by using woollen or
outing flannel sheets if necessary, and by providing a sufficient number
of light but warm bed covers. It is not always understood that many
covers do not remedy the deficiencies of a thin mattress. If a thick
mattress or two thin mattresses cannot be provided, a thick comforter or
even many layers of newspaper should be placed between the mattress and
the springs, and another thick comforter should be placed between the
mattress and the lower sheet. Rubbing the body with warm olive oil often
affords great comfort, by improving the circulation and thus increasing
the sensation of warmth, and also by relieving the tendency of the skin
to become dry and cracked. Poor circulation at night may cause cramps in
the muscles of the legs; the cramps can usually be relieved by warmth
and gentle rubbing.
Old people frequently wish their rooms to be very hot, both by day and
by night, even as hot as 80° or 85°, but if it is possible to keep them
warm in any other way the temperature of the room should be kept at 70°.
Well ventilated rooms are highly important for old people as for all
others of low resistance, and it is entirely possible for their rooms to
be warm and yet well ventilated. Aged persons should be carefully
guarded from chill, exposure, crowds, and infected persons. Like little
children they are peculiarly susceptible to the respiratory diseases,
which cause many of the deaths commonly attributed to old age.
Digestion usually becomes weaker than in earlier years, and less food is
needed. It should be simple, hot, and divided into four or five meals
rather than three. Old people often wake at an early hour, and hot
nourishment will prevent them from growing weak and faint while waiting
for the family breakfast. Both constipation and looseness of the bowels
are common ailments in old age. So far as possible the bowels should be
regulated by means of diet; but muscular weakness resulting in inability
to control the bowels should not be mistaken for and treated as
diarrhœa.
It is unwise for old people to undertake unaccustomed or sudden muscular
exertion, since the muscular system including the heart muscle grows
weak and is generally unable to endure great strain. The bones,
moreover, grow brittle and heal with difficulty if broken, so that
persons of advanced years no matter how active should avoid walking on
icy pavements, climbing on chairs to reach high shelves, and placing
themselves in other insecure positions. Assistance must be tactfully
given, however, as active old people are inclined to resent it. On the
other hand, old people should be encouraged to continue moderate and
safe activities, and to take regular exercises suited to their strength.
Although increasing muscular weakness tends to make most old people
indolent, it is far better for them both in mind and in body to remain
as active as they can without danger of too great fatigue. At all
events, they should be prevented if possible from becoming bedridden.
Since in old age sight, hearing, and other special senses become less
acute, one should remember that an old person may not notice the odor of
escaping gas, the light of a smouldering match, or the sound of an
approaching motor car, and that he must be specially guarded from such
dangers of every day life. On account of their dulled perceptions old
people are sometimes unjustly considered to be less intelligent than
they really are. Young people moreover should be told, if an aged person
is untidy and careless in personal habits, that the apparent negligence
is caused by dulled perceptions and diminished muscular control for
which old people are no more responsible than they are for failing
eyesight or for inability to hear.
Families should also realize that changes in mind and character are
beyond an aged person's control and that they should not be made the
cause for remonstrance or arguing. Just as the arteries harden with
advancing years, as the bones become brittle and as other tissues become
less flexible, so changes are likely to occur in the nervous system. It
is not surprising when the brain substance like other tissues is
becoming less flexible, that the powers of attention should weaken,
that memory for recent events should diminish, or that other mental
powers should fail. Changes in disposition are not uncommon: previously
controlled persons sometimes become querulous and exacting, while
excitable and irritable persons become more placid. With most old people
emotions become less intense; feeble old people hardly realize great joy
or great sorrow, and seldom look forward to death with apprehension.
Among the most important changes that occur in the nervous system is its
gradual loss in power to respond to new demands. New habits are
difficult or impossible to form, and old habits are hard to break.
Attempts to break the habits of a life time are therefore dangerous, and
radical changes in old people's ways of living are attended by risk as
well as by unhappiness. Such loss of adaptability in the nervous system
makes it increasingly difficult for old people to assimilate new ideas
and to understand new points of view. The feeling that the world is
strange and that the next generation has gone on without them accounts
for the tragic loneliness of many old people. Clearly it is for those
who are younger and more flexible to bridge the gulf between the
generations by their understanding and their sympathy.
Physical care to whatever extent it is needed should be given to all old
people as soon as they are unable to care for themselves, and thought
should be given to adapting their surroundings and ways of living to
their strength and needs, just as they should be adapted to the strength
and needs of chronic patients. But a warning should be given against
managing old people too much. It is hard for people who have managed
their own lives successfully for many years to be managed, even for
their own good. Indeed, it is questionable kindness to deprive old
people of all freedom of action, even if following their own
inclinations occasionally has disastrous results. Few persons would wish
to prolong their lives if long life involved being thwarted in every
desire, and sometimes real kindness consists in allowing old people to
do certain things that are not good for them. Keeping them warm and
letting them do as they please will go far to make old people happy.
Many of the changes in old age reverse the developing process of
childhood. In youth and age extremes meet, and the care of the aged
presents certain marked similarities to the care of little children.
Both require simple food, occupations suited to their strength, and
protection from infections, from fatigue, and from nervous strain; both
are dependent, more or less helpless, and for their happiness both need
the affectionate care of their own families. But in one respect their
needs are fundamentally different. In childhood formation of proper
habits is all important, and in caring for children the future effect of
every word and act must be taken into consideration. Old people, on the
other hand, since they live largely in the past and their habits are
irrevocably formed, may be indulged without harm in ways that would
demoralize a child; with a clear conscience one may make them happy in
ways both great and small. This difference makes possible one of the
greatest pleasures that come to one who cares for the helpless and the
sick, for of all enduring satisfactions few are greater than the power
to fill with comfort and happiness the closing days of life.
EXERCISES
1. What is meant by a physical defect? Name some of the most common
defects.
2. Name some permanent injuries to the body caused by defective teeth;
by diseased or enlarged tonsils and adenoids; by faulty posture.
3. Describe some common symptoms of eye strain in children; of enlarged
tonsils and adenoids; of deafness.
4. Name several possible causes of round shoulders, and explain why
urging a round-shouldered child to hold himself erect is seldom enough
to make him correct his posture.
5. What measures should be taken to overcome nervousness in children?
6. Describe in detail the health work carried on in the public schools
of your city or town. Considering the important part played by
uncorrected physical defects in causing permanent physical disability
among adults, do you think in the long run it is cheaper or more
expensive for a community to spend money in protecting the health of
school children?
7. Discuss the particular needs of convalescent and of chronic patients.
8. Explain the effect of activity upon recovery, and explain why it is
desirable for invalids to have occupation.
9. What special needs should be provided for in caring for old people?
FOR FURTHER READING
Invalid Occupations--Tracy.
Occupation Therapy--Dunton.
Handicrafts for the Handicapped--Hall and Buck.
When Mother Lets Us Make Toys--Rich.
Amusements for Convalescent Children--New York State Department of
Health, Albany.
Essentials of Medicine--Emerson, Chapter IX.
Civics and Health--Allen.
How to Live--Fisher and Fisk, Chapter III, Section II; and Supplementary
Notes, Section III.
Health Work in the Schools--Hoag and Terman.
Medical Inspection of Schools--Gulick and Ayres.
The Hygiene of the Child--Terman.
Posture of School Children--Bancroft.