Care of cancer patient 1937

aruna

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Hello all you medical experts, need some more advice!
The situation is an adult woman who has untreatable cancer and will be cared for at home by her 18 year old daughter; the year is 1937-38. She lives on a remote sugar plantation, British Guiana. She has spent some time in a town hospital. Medical care is presumably very basic. But I want the daughter to take care of her, maybe with the help of a nurse if that is necessary, for about a year while she is slowly dying. No operation as the hospital is not up to it.
From my own experience of cancer patients I know that there will be much pain, emaciation, etc and wounds to treat. But I need a bit more medical knowledge pertaining to the time frame. A doctor comes to visit occasionally.

First of all, what kind of cancer could it be? It should be something that is fatal and untreatable in respect of medical knowledge of the time -- a slow and painful death, where she needs constant care, but is able to talk to her daughter. I'm thinking breast cancer which is the most obvious.
WHat would the doctor say? (Just a few snippets of conversation, advice for the daughter would be great for dialogue!)
What would the sickroom smell of?
WHat would the daughter mostly be doing, with or without a nurse?
What kind of food would she need, also in respect of the time and place? (A staple is rice -- also vegetables etc and self-raised chicken is the main diet)
What basic medication would she have; painkiller for certain but what kind, and how would it be administered?
Remember that it's a tropical country, and there is no electricity, no fans (the place is too remote). But they are wealthy so mod cons of the day are available.

Any help, even just a few hints, much appreciated!
 
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TellMeAStory

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I'm going to be really interested in the answers you get, arena.

My impression of nursing at the time is emphasis on keeping the patient and her linens clean--that and "stimulating bloodflow" that is, using heat and massage to induce blood to flow to the desired region.

Sponging with alcohol to reduce fevers or simply for cooling in hot weather. Ice baths might be possible if there's an ice factory nearby. No electricity in the house, I get that, but could there be a nearby factory that makes it? If so, your nurse will have to chip ice from the delivered block and mix those chips with water in a basin. She'll place a rubberized sheet between patient and bed with rolled blankets beneath the edges of the sheet to fashion a sort of "tub" there on the bed (remember, no plastic in 1937.)

Every nurse had her own favorite method of treating bedsores, a constant concern. Honey featured in some. Bismuth was popular as well.

As for diet, the name of the game was "digestible." It was generally agreed that raw eggs are more digestible than cooked, perhaps because liquid was thought more digestible than solid--so your patient would have been given chicken broth rather than chicken. Custard. Gruel. Nothing spiced, everything bland. Rice OK, but not as identifiable grains, only cooked into some kind of watered-down mush.

For pain, aspirin for sure. Cold cloths over the sore place, changed frequently. Ice packs if there's ice. Again, no plastic, so the pack is made of rubberized cloth. Google "ice pack" images to see what I mean. Folks called them "ice caps" then, but if you Google that, you get snow-capped peaks.
 

aruna

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Thanks so much! Since posting I've written a bit more and she is going to be moved to the capital, Georgetown, to her sister's house so ice from the Ice House will be available. But everyhting you've said here is most helpful -- thanks again!
What about vomiting, incontinence? Ma husband has been diabled and was cared for both at home and in a residential home and he is incontinent in every way and I can't imagine how it must have been before there were adult pampers and incontinence pads.
 

TellMeAStory

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Adult cloth diapers worked exactly like infant cloth diapers, just bigger. Absorbent flannel, Birdseye weave, any absorbent cotton cloth really, safety pinned in place, and covered by a sort of hourglass-shaped rubberized cloth that fastened with snaps--or when the snaps got loose, another set of safety pins.

The bed of an incontinent patient was made up with a rubberized cloth sheet beneath the bed sheet, and a "draw sheet" beneath the patient. The draw sheet is an ordinary sheet folded--I think into thirds, maybe fourths--that crosses the bed under the patient's hips. That way, you can "draw" the patient into this position or that more easily. Oh, and all sheets are flat. No such thing as fitted sheets in the 30s.

Bedpans have been around for ages. Enameled metal, usually white with a "decorative" narrow band of black around the opening. Now that I'm writing this, I cannot fathom why anyone would decorate a bedpan, but there you are. Just now, I Googled vintage bedpans and found porcelain ones with the black band I remember. I've never seen a porcelain bedpan in real life, only metal.

For vomiting, you'd have a dedicated basin or bucket, and if it happened a lot, the patient might wear a sort of bib. A towel does nicely, safety pinned behind the neck.

Laundry is going to be a heavy duty for your fictional caretaker. Now that you've moved her to the city, she might want to consider engaging a laundry service. If she's doing her own, her two blessed breaks in the day are going to be hanging out wet laundry and bring in dry.
 
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aruna

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Adult cloth diapers worked exactly like infant cloth diapers, just bigger. Absorbent flannel, Birdseye weave, any absorbent cotton cloth really, safety pinned in place, and covered by a sort of hourglass-shaped rubberized cloth that fastened with snaps--or when the snaps got loose, another set of safety pins.

The bed of an incontinent patient was made up with a rubberized cloth sheet beneath the bed sheet, and a "draw sheet" beneath the patient. The draw sheet is an ordinary sheet folded--I think into thirds, maybe fourths--that crosses the bed under the patient's hips. That way, you can "draw" the patient into this position or that more easily. Oh, and all sheets are flat. No such thing as fitted sheets in the 30s.

Bedpans have been around for ages. Enameled metal, usually white with a "decorative" narrow band of black around the opening. Now that I'm writing this, I cannot fathom why anyone would decorate a bedpan, but there you are. Just now, I Googled vintage bedpans and found porcelain ones with the black band I remember. I've never seen a porcelain bedpan in real life, only metal.

For vomiting, you'd have a dedicated basin or bucket, and if it happened a lot, the patient might wear a sort of bib. A towel does nicely, safety pinned behind the neck.

Laundry is going to be a heavy duty for your fictional caretaker. Now that you've moved her to the city, she might want to consider engaging a laundry service. If she's doing her own, her two blessed breaks in the day are going to be hanging out wet laundry and bring in dry.


Thanks -- again very useful! I do remember that many old people back in the day had porcelain potties under the bed, and they would often be decorated with flowers etc!

Laundry is no problem. Even middle class families would have had a washer-woman who washed everything by hand. It was normal.

I've given her breast cancer, with a lump at the side of the breast. Would this be hot and hard to the touch, not moving?
 

TellMeAStory

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There's a world of difference between a potty and a bed pan. Google images is your friend here.

My info comes from the research I've been doing for my own stories of nursing in the 30s. Hopefully a real medical person can answer your question about the lump.
 

GeorgeK

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There's a world of difference between a potty and a bed pan. Google images is your friend here.

My info comes from the research I've been doing for my own stories of nursing in the 30s. Hopefully a real medical person can answer your question about the lump.
As a physician, and as someone who has been seriously ill, I've often had nurses question my order for a bedside commode. If the patient has no reason to be at bedrest (unstable fracture and significant clotting disorder) then a bedpan is just a torture device. Try it sometime when you are actually healthy. Trust me it's worse when you are sick. Get a bed pan and try to poop laying down on top of a bedpan.

Bedpans should all be emblazoned with, "Nobody ever expects the Spanish Inquisition!"

As to the OP, 1937 wasn't much different than 1973...or 93. There was a severe bias among, "medicine," doctors vs, "surgical," doctors. In the Us it wasn't until around 1900 until the two disciplines were starting to combine. Even now, at least in rural areas, it is not unusual to hear Internists say, "We must save the patient from the surgeons."

It depends on where the doctors were trained and what they were trained in. Some patients with their particular illnesses are far better off being treated surgically (assuming by a competent surgeon) and some are better off without surgery.

1937 was a time when the bias was so far against surgery that it became a self perpetuating prophecy. People delayed surgery for malignancy beyond the point of surgery being of any use. That's where we got the term, "exploratory laparotomy." It was an open and close thing. Open, see that the cancer could not be resected and close. That is what gave rise to the myth that oxygen makes cancer spread.