Notes on Nursing

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Episode Transcript

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Preface. The following notes are byno means intended as a rule of thought
by which nurses can teach themselves tonurse, still less as a manual to
teach nurses to nurse. They aremeant simply to give hints for thought to
women who have personal charge of thehealth of others. Every woman, or

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at least almost every woman in England, has, at one time or another
of her life, charge of thepersonal health of somebody, whether child or
invalid. In other words, everywoman is a nurse every day. Sanitary
knowledge, or the knowledge of nursing, or in other words, how to

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put the constitution in such a stateas that it will have no disease or
that it can recover from disease,takes a higher place. It is recognized
as the knowledge which every one oughtto have, distinct from medical knowledge,
which only a profession can have.If then every woman must, at some

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time or other of her life becomea nurse, i e. Have charge
of somebody's health, How immense andhow valuable would be the produce of her
united experience. If every woman wouldthink how to nurse? I do not
pretend to teach her how I askher to teach herself, and for this

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purpose I venture to give her somehints notes on nursing. What it is
and what it is not. Shallwe begin by taking it as a general
principle that all disease, at someperiod or another of its course, is

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more or less a reparative process,not necessarily accompanied with suffering, an effort
of nature to remedy a process ofpoisoning or of decay, which has taken
place weeks, months, sometimes theyears beforehand unnoticed, the termination of the
disease being then while the antecedent processwas going on determined. If we accept

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this as a general principle, weshall be immediately met with anecdotes and instances
to prove the contrary. Just so, if we were to take as a
principle all the climates of the Earthare meant to be made habitable for man
by the efforts of man, theobjection would immediately be raised, will the
top of Mount Blanc ever be madehabitable? Our answer would be, it

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will be many thousands of years beforewe have reached to the bottom of Mount
Blanc. In making the Earth healthy, wait till we have reached the bottom
before we discuss the top. Inwatching diseases, both in private houses and
in public hospitals, the thing whichstrikes the experienced observer most forcibly is this

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that the symptoms or the sufferings generallyconsidered to be inevitable and incident to the
disease are very often not symptoms ofthe disease at all, but of something
quite different, of the want offresh air, or of light, or
of warmth, or of quiet,or of cleanliness, or of punctuality and
care in the administration of diet,of each or of all of these.

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And this quite as much in privateas in hospital nursing. The reparative process
which nature has instituted, and whichwe call disease, has been hindered by
some want of knowledge or attention inone or in all of these things.
And pain, suffering, or interruptionof the whole process sets in. If

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a patient is cold, if apatient is feverish, if a patient is
faint, if he is sick aftertaking food, if he has a bed
sore. It is generally the faultnot of the disease, but of the
nursing. I use the word nursingfor want of a better It has been

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limited to signify little more than theadministration of medicines and the application of poultices.
It ought to signify the proper useof fresh air, light, warmth,
cleanliness, quiet, and the properselection and administration of diet, all
at the least expensive vital power tothe patient. It has been said and

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written scores of times that every womanmakes a good nurse. I believe,
on the contrary, that the veryelements of nursing are all but unknown.
By this, I do not meanthat the nurse is always to blame.
Bad sanitary, bad architectural, andbad administrative arrangements often make it impossible to

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nurse. But the art of nursingought to include such arrangements as alone make
what I understand by nursing possible.The art of nursing as now practiced seems
to be expressly constituted to unmake whatGod had made disease to be. That
is a reparative process. To recurto the first objection, if we are

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asked, is such and such adisease a reparative process? Can such an
illness be unaccompanied with suffering? Willany care prevent such a patient from suffering?
This or that? I humbly sayI do not know. But when
you have done away with all thatpain and suffering, which in patience are

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the symptoms not of their disease,but of the absence of one or all
of the above mentioned essentials to thesuccess of nature's reparative processes, we shall
then know what are the symptoms ofand the sufferings inseparable from the disease Another,
and the commonest exclamation which will instantlybe made is would you do nothing?

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Then? In cholera, fever,et cetera. So deep rooted and
universal is the conviction that to givemedicine is to be doing something, or
rather everything, To give air,warmth, cleanliness, et cetera, is
to do nothing. The reply isthat in these and many other similar diseases,

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the exact value of particular remedies andmodes of treatment is by no means
ascertained. While there is universal experienceas to the extreme importance of careful nursing
in determining the issue of the disease. Two, the very elements of what
constitutes good nursing are as little understoodfor the well as for the sick.

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The same laws of health or ofnursing, for they are in reality the
same obtain among the well as amongthe sick. The breaking of them produces
only a less violent consequence among theformer than among the latter. And this
sometimes not always, it is constantlyobjected. But how can I obtain this

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medical knowledge? I am not adoctor. I must leave this to doctors.
Oh mothers of families, you whosay this, do you know that
one in every seven infants in thiscivilized land of England perishes before it is
one year old, That in Londontwo in every five die before they are
five years old, and in theother great cities of England nearly one out

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of two. The life duration oftender babies, as some saturn turned analytical
chemist says, is the most delicatetest of sanitary conditions. Is all this
premature suffering and death necessary? Ordid nature intend mothers to be always accompanied

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by doctors? Or is it betterto learn the pianoforte than to learn the
laws which subserve the preservation of offspring? Macaulay somewhere says that it is extraordinary
that, whereas the laws of themotions of the heavenly bodies, far removed
as they are from us, areperfectly well understood, the laws of the

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human mind which are under our observationall day and every day, are no
better understood than they worth two thousandyears ago. But how much more extraordinary
is it that, whereas what wemight call the coxcomeries of education e g.
The elements of astronomy are now taughtto every school girl, neither mothers

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of families of any class, norschoolmistresses of any class, nor nurses of
children, nor nurses of hospital aretaught anything about those laws which God has
assigned to the relations of our bodieswith the world in which he has put
them. In other words, thelaws which which make these bodies into which
He has put our minds healthy orunhealthy. Organs of those minds are all

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but unlearnt. Not but those laws, the laws of life, are in
a certain measure understood. But noteven mothers think it worth their while to
study them, to study how togive their children healthy existences. They call
it medical or physiological knowledge, fitonly for doctors. Another objection we are

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constantly told, but the circumstances whichgovern our children's healths are beyond our control.
What can we do with winds?There is the east wind. Most
people can tell before they get upin the morning whether the wind is in
the east. To this one cananswer with more certainty than to the former
objections. Who is it who knowswhen the wind is in the east.

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Not the highland drover, certainly exposedto the east wind, but the young
lady, who is worn out withthe want of exposure to fresh air,
to sunlight, et cetera. Putthe latter under as good sanitary circumstances as
the former, and she too willnot know when the wind is in the
east. End of preface and startSection one. Ventilation and warming, the

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very first cannon of nursing, thefirst and the last thing upon which a
nurse's attention must be fixed. Thefirst essential to a patient, without which
all the rest you can do forhim is as nothing with which I had
almost said you may leave all therest alone. Is this to keep the

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air he breathes as pure as theexternal air, without chilling him. Yet,
what is so little attended to evenwhere it is thought of at all?
The most extraordinary misconceptions rain about it. Even in admitting air into the
patient's room or ward, few peopleever think where that air comes from.

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It may come from a corridor intowhich other wards are ventilated from a hall,
always unaired, always full of thefumes of gas, dinner of various
kinds of mustiness, from an undergroundkitchen, sink, wash house, water
closet, or even as I myselfhave had sorrowful experience, from open sewers

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loaded with filth. And with thisthe patient's room or ward is aired,
as it is called poisoned. Itshould rather be said, always air from
the air without, and that toothrough those windows through which the air comes
freshest. From a closed court,especially if the wind do not blow that

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way, air may come as stagnantas any from a hall or corridor.
Again a thing I have often seen, both in private houses and institutions.
A room remains uninhabit. The fireplaceis carefully fastened up with a board,
The windows are never opened, Probablythe shutters are kept always shut. Perhaps

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some kind of stores are kept inthe room. No breath of fresh air
can by possibility enter into that room, nor any ray of sun. The
air is as stagnant, musty,and corrupt as it can by possibility be
made. It is quite ripe tobreed smallpox, scarlet, fever, diphtheria,

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or anything else you please. Yetthe nursery ward or sick room adjoining
will be positively aired by having thedoor opened into that room. What children
will be put into that room withoutprevious preparation to sleep? A short time
ago, a man walked into aback kitchen in Queen's Square and cut the

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throat of a poor consumptive creature sittingby the fire. The murderer did not
deny the act, but simply said, if it's all right. Of course
he was mad, But in ourcase, the extraordinary thing is that the
victim says it's all right, andthat we are not mad yet, though

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he knows the murderers in the musty, unaired, unsunned room, the scarlet
fever which is behind the door,or the fever and hospital gangrene which are
stalking among the crowded beds of ahospital ward, we say it's all right.
With a proper supply of windows anda proper supply of fuel in open
fireplaces, fresh air is comparatively easyto secure when your patient or patients are

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in bed. Never be afraid ofopen windows. Then people don't catch cold
in bed. This is a popularfallacy. With proper bedclothes and hot bottles
if necessary, you can always keepa patient warm in bed and well ventilate
him at the same time. Buta carelessness, her rank and education what

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it may, will stop up everycranny and keep a hot house heat when
her patient is in bed, andif he is able to get up,
leave him comparatively unprotected. The timewhen people take cold, and there are
many ways of taking cold besides acold in the nose, is when they
first get up after the twofold exhaustionof dressing, and of having had the

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skin relaxed by many hours perhaps days, in bed, and thereby rendered more
incapable of reaction. Then the sametemperature which refreshes the patient in bed may
destroy the patient just risen, andcommon sense will point out that while purity
of air is essential, a temperaturemust be secured which shall not chill the

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patient. Otherwise the best that canbe expected will be a feverish reaction.
To have the air within as pureas the air without it is not necessary,
as often appears to be thought,to make it as cold in the
afternoon again without care, the patient, whose vital powers have then risen,

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often finds the room as close andoppressive as he found it cold in the
morning, Yet the nurse will beterrified if a window is opened. I
know an intelligent humane house surgeon whomakes practice of keeping the ward windows open.
The physicians and surgeons invariably close themwhile going their rounds, and the

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house surgeon, very properly as invariablyopens them whenever the doctors have turned their
backs. In a little book onnursing, published a short time ago,
we are told that with proper care, it is very seldom that the windows
cannot be opened for a few minutestwice in the day to admit fresh air
from without. I should think notnor twice in the hour either. It

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only shows how little the subject hasbeen considered. Of all methods of keeping
patients warm, the very worst certainlyis to depend for heat on the breath
and bodies of the sick. Ihave known a medical officer keep his ward
windows hermetically closed, thus exposing thesick to all the dangers of an infected

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atmosphere, because he was afraid thatby admitting fresh air, the temperature of
the ward would be too much lowered. This is a destructive fallacy to attempt
to keep a ward warm at theexpense of making the sick repeatedly breathe their
own hot humid putressing atmosphere is acertain way to delay recovery or to destroy

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life. Do you ever go intothe bedrooms of any persons of any class,
whether they hold one, two,or twenty people, whether they hold
sick or well, at night orbefore the windows are opened in the morning,
and ever find the air anything butunwholesomely close and foul? And why

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should it be so? And ofhow much importance is it that it should
not be so? During sleep?The human body, even when in health,
is far more injured by the influenceof foul air than when awake.
Why can't you keep the air allnight then, as pure as the air
without in the rooms you sleep in? But for this you must have sufficient

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outlet for the impure air you makeyourselves to go out, sufficient inlet for
the pure air from without to comein. You must have open chimneys,
open windows or ventilators, No closecurtains round your beds, no shutters or
curtains to your windows, none ofthe contrivances by which you undermine your own

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health or destroy the chances of recoveryof your sick. A careful nurse will
keep a constant watch over her sick, especially weak, protracted and collapsed cases,
to guard against the effects of theloss of vital heat by the patient
himself. In certain diseased states,much less heat is produced than in health,

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and there is a constant tendency tothe decline and ultimate extinction of the
vital powers by the care made uponthem to sustain the heat of the body.
Cases where this occurs should be watchedwith the greatest care, from hour
to hour. I had almost saidfrom minute to minute. The feet and
legs should be examined by the handfrom time to time, and whenever a

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tendency to chilling is discovered, hotbottles, hot bricks, or warm flannels
with some warm drink should be madeuse of until the temperature is restored.
The fire should be, if necessary, replenished. Patients are frequently lost in
the latter stages of disease from wantof attention to such simple precautions. The

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nurse may be trusting to the patient'sdiet, or to his medicine, or
to the occasional dose of stimulant whichshe is directed to give him, while
the patient is all the while sinkingfrom want of a little external warmth.
Such cases happen at all times,even during the height of summer. This
fatal chill is most apt to occurtowards early morning, at the period of

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the lowest temperature of the twenty fourhours, and at the time when the
effect of the preceding day's diets isexhausted. Generally speaking, you may expect
that weak patients will suffer cold muchmore in the morning than in the evening.
The vital powers are much lower.If they are feverish at night,

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with burning hands and feet, theyare almost sure to be chilly and shivering
in the morning. But nurses arevery fond of heating the foot warmer at
night, and of neglecting it inthe morning when they are busy. I
should reverse the matter. All thesethings require common sense and care. Yet
perhaps in no one single thing isso little common sense shown in all ranks

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as in nursing. The extraordinary confusionbetween cold and ventilation, even in the
minds of well educated people, illustratesthis. To make a room cold is
by no means necessary to ventilate it, nor is it at all necessary in
order to ventilate a room to chillit. Yet if a nurse finds a

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room close, she will let outthe fire, thereby making it closer,
or she will open the door intoa cold room without a fire or an
open window in it, by wayof improving the ventilation. The safest atmosphere
of all for a patient is agood fire and an open window, excepting
in extremes of temperature. Yet nonurse can ever be made to understand this.

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To ventilate a small room without drafts, of course, requires more care
than to ventilate a large one.Another extraordinary fallacy is the dread of night
air. What air can we breatheat night but night air? The choice
is between pure night air from withoutand foul night air from within. Most

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people prefer the latter, an unaccountablechoice. What will they say if it
is proved to be true that fullyone half of all the disease we suffer
from is occasioned by people sleeping withtheir windows shut. An open window most
nights in the year can never hurtanyone. This is not to say that

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light is not necessary for recovery.In great cities, night air is often
the best and purest air to behad in the twenty four hours. I
could better understand in towns shutting thewindows during the day than during the night,
for the same the sick, theabsence of smoke, the quiet all
tends to making night the best timefor airing the patients. One of our

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highest medical authorities on consumption and climatehas told me that the air in London
is never so good as after teno'clock at night. Always air your room
then from the outside air. Ifpossible, windows are made to open,
doors are made to shut, atruth which seems extremely difficult of apprehension.

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I have seen a careful nurse airingher patient's room through the door near to
which were two gas lights, eachof which consumes as much air as eleven
men, a kitchen, a corridor. The composition of the atmosphere in which
consisted of gas, paint, foulair, never changed, full of effluvia,

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including a current of sewer air froman ill placed sink, ascending in
a continual stream by a well staircase, and just charging themselves constantly into the
patient's room. The window of thesaid room, if opened, was all
that was desirable to air it.Every room must be aired from without,

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every passage from without, But thefewer passages there are in a hospital,
the better. If we are topreserve the air within as pure as the
air without. It is needless tosay that the chimney must not smoke.
Almost all smoky chimneys can be curedfrom the bottom, not from the top.

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Often it is only necessary to havean inlet for air to supply the
fire which is feeding itself for wantof this from its own chimney. On
the other hand, almost all chimneyscan be made to smoke by a careless
nurse who lets the fire get lowand then overwhelms it with coal, not,
as we verily believe, in orderto spare her self trouble. Rare

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is unkindness to the sick, butfrom not thinking what she is about.
In laying down the principle that thefirst object of the nurse must be to
keep the air breathed by her patientas pure as the air without, it
must not be forgotten that everything inthe room which can give off effluvia besides

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the patient evaporates itself into his air. And it follows that there ought to
be nothing in the room excepting him, which can give off effluvia or moisture
out of all damp towels et cetera, which become dry in the room.
The damp, of course, goesinto the patient's air. Yet this,

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of course, seems as little thoughtof, as if it were an obsolete
fiction. How very seldom you seea nurse who acknowledges by her practice that
nothing at all ought to be airedin the patient's room, that nothing at
all ought to be cooked at thepatient's fire. Indeed, the arrangements often

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make this rule impossible to observe.If the nurse be a very careful one,
she will, when the patient leaveshis bed but not his room,
open the sheets wide and throw thebed clothes back in order to air his
bed. And she will spread thewet towels or flannels carefully out upon a
horse in order to dry them.Now, either these bed clothes and towels

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are not dried and aired, orthe air and dry themselves into the patient's
air. And whether the damp andeffluvia do him most harm in his air
or in his bed, I leaveyou to determine, for I cannot.
Even in health, people cannot repeatedlybreathe air in which they live with impunity

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on account of it becoming charged withunwholesome matter from the lungs and skin.
In disease where everything given off fromthe body is highly noxious and dangerous,
not only must there be plenty ofventilation to carry off the effluvia, but
everything which the patient passes must beinstantly removed away, as being more noxious

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than even the emanations from the sickof the fatal effects of the effluvia from
the excretia, it would seem unnecessaryto speak were they not so constantly neglected.
Concealing the utensils behind the valence tothe bed seems all the precaution which
is thought necessary for safety in privatenursing. Did you but think for one

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moment of the atmosphere under that bed, the saturation of the under side of
the mattress with the warm evaporations,you would be startled and frightened too.
The use of any chamber utensil withouta lid should be utterly abolished, whether
among sick or well. You caneasily convince yourself of the necessity of this

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absolute rule by taking one with alid and examining the under side of that
lid. It will be found alwayscovered. Whenever the utensil is not empty
by condensed offensive moisture. Where doesthat go? When there is no lid
earthenware, or if there is anywood, highly polished and varnished wood are

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the only materials fit for patient's utensils. The very lid of the old abominable
clothes stool is enough to breed apestilence. It becomes saturated with offensive matter,
which scouring is only wanted to bringout. I prefer an earthenware lid
as being always cleaner, but thereare various good, new fashioned arrangements.

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A slop pail should never be broughtinto a sick room. It should be
a rule invariable, rather more importantin the private house than elsewhere, that
the utensil should be carried directly tothe water closet, emptied there, rinsed
there, and brought back. Thereshould always be water and a cock in
every water closet for rinsing, buteven if there is not, you must

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carry water there to rinse with.I have actually seen in the private sick
room the utensils emptied into the footpanand put back unrinsed, under the bed.
I can hardly say which is mostabominable, whether to do this or
to rinse the utensil in the sickroom. In the best hospitals, it

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is now a rule that no sloppail shall ever be brought into the wards,
but that the utensils should be carrieddirect to be emptied and rinsed at
the proper place. I would itwere so in the private house. Let
no one ever depend on few migations, disinfectants and the like for purifying the
air. The offensive thing, notits smell, must be removed. A

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celebrated medical lecturer began one day.Fewmigations, gentlemen, are of essential importance.
They make such an abominable smell thatthey compare you to open the window.
I wish all the disinfecting fluids inventedmade such an abominable smell that they
forced you to omit fresh air.That would be a useful invention. End

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of Section one, Section two Healthof houses. There are five essential points
in securing the health of houses.One pure air, two pure water,
three efficient drainage, four cleanliness fivelight. Without these, no house can

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be healthy, and it will beunhealthy just in proportion as they are deficient.
One. To have pure air,your house be so constructed as that
the outer atmosphere shall find its waywith ease to every corner of it.
House architects hardly ever consider this.The opt in building a house is to

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obtain the largest interest for the money, not to save doctor's bills to the
tenants. But if tenants should everbecome so wise as to refuse to occupy
unhealthy constructed houses, and if insurancecompanies should ever come to understand their interests
so thoroughly as to pay a sanitarysurveyor to look after the houses where their

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clients live, speculative architects would speedilybe brought to their senses. As it
is, they build what pays best, and there are always people foolish enough
to take the houses they build.And if in the course of time the
families die off, as is sooften the case, nobody ever thinks of

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blaming any but providence for the result. Ill informed medical men aid in sustaining
the delusion by laying the blame oncurrent contagions. Badly constructed houses do for
the healthy what badly constructed hospitals dofor the sick. Once in sure the
the air and house is stagnant,and sickness is certain to follow. Two

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pure water is more generally introduced intohouses than it used to be, thanks
to the exertions of the sanitary reformers. Within the last few years. A
large part of London was in thedaily habit of using water polluted by the
drainage of its sewers and water closets. This has happily been remedied, but
in many parts of the country wellwater of a very impure kind is used

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for domestic purposes, and when epidemicdisease shows itself, persons using such water
are almost sure to suffer three.It would be curious to ascertain by inspection
how many houses in London are reallywell drained. Many people would say surely

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all or most of them. Butmany people have no idea in what good
drainage consists. They think that asewer in the street and a pipe leading
to it from the house is gooddrainage. All the while the sewer may
be nothing but a laboratory from whichepidemic disease and ill health is being distilled
into the house. No house withany untapped drain pipe communicating immediately with a

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sewer, whether it be from watercloset, sink or gully grate, can
never be healthy, An untrapped sinkmay at times spread fever or piemia among
the inmates. For palace, theordinary oblong sink is an abomination. That
great surface of stone, which isalways left wet, is always exhaling into

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the air. I have known wholehouses and hospitals smell of the sink.
I have met just as strong astream of sewer air coming up the back
staircase of a grand London house fromthe sink as I have ever met at
Scutari. And I have seen therooms in that house all ventilated by the
open doors and the passages, orunventilated by the closed windows, in order

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that as much of the sewer airas possible might be conducted into and retained
in the bedrooms. It is wonderful. Another great evil in house construction is
carrying drains underneath the house. Suchdrains are never safe. All house drains
should begin and end outside the walls. Many people will readily admit as a

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theory the importance of these things.But how few are there who can intelligently
trace disease in their households to suchcauses. Is it not a fact that
when scarlet fever measles or small poxappear among the children, the very first
thought which occurs is where the childrencan have caught the disease, and the

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parents immediately run over in their mindsall the families with whom they may have
been. They never think of lookingat home for the source of the mischief.
If the neighbor's child is seized withsmallpox, the first question which occurs
is whether it had been vaccinated.No one would undervalue vaccination, but it
becomes of doubtful benefit to society whenit leads people to look abroad for the

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source of evils which exist at home. Four. Without cleanliness within and without
your house, ventilation is comparatively useless. In certain foul districts of London,
poor people used to object to opentheir windows and doors because of the foul

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smells that came in. Rich peoplelike to have their stables and dunghill near
their houses, But does it everoccur to them that with many arrangements of
this kind, it would be saferto keep the windows shut than open.
You cannot have the air of thehouse pure with dung heaps under the windows.
These are common all over London,and yet people are surprised that their

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children brought up in large, wellaired nurseries and bedrooms suffer from children's epidemics.
If they studied nature's laws in thematter of children's health, they would
not be so surprised. There areother ways of having filth inside a house,
besides having dirt in heaps. Oldpapered walls of years standing, dirty

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carpets, uncleansed furniture are just asready sources of impurity to the air as
if there were a dung heap inthe basement. People are so unaccustomed from
education and habits to consider how tomake a home healthy that they either never
think of it at all and takeevery disease as a matter of course to
be resigned to when it comes asfrom the hand of providence, or if

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they ever entertain the idea of preservingthe health of their household as a duty,
they are very apt to commit allkinds of negligences and ignorances in performing
it. A dark house is alwaysan unhealthy house, always an ill aired
house, always a dirty house.Want of light stops growth and promotes scrofula

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rickets, et cetera among the children. People lose their health in a dark
house, and if they get illthey cannot get well again in it.
More will be said about this fartheron. Three. Out of many negligences
and ignorances in managing the health ofhouses generally, I will here mentioned as
specimens. One that the female headin charge of any building does not think

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it necessary to visit every hole andcorner of it every day. How can
she expect those who are under herto be more careful to maintain her house
in a healthy condition than she whois in charge of it. Two That
it is not considered essential to air, to sun and to clean rooms while
uninhabited, which is simply ignoring thefirst elementary notion of sanitary things and laying

(37:02):
the ground ready for all kinds ofdiseases. Three that the window and one
window is considered enough to air aroom. Have you never observed that any
room without a fireplace is always close? And if you have a fireplace,

(37:22):
would you cram it up not onlywith a chimney board, but perhaps with
a great wisp of brown paper inthe throat of the chimney to prevent the
soot from coming down. You say, if your chimney is foul, sweep
it, But don't expect that youcan ever air a room with only one
aperture. Don't suppose that to shutup a room is the way to keep
it clean. It is the bestway to foul the room and all that

(37:45):
is in it. Don't imagine thatif you, who are in charge,
don't look to all these things yourself, those under you will be more careful
than you are. It appears asif the part of a mistress now is
to complain of her servants and toaccept their excuses, not to show them
how there need be neither complaints made, nor excuses. But again, to

(38:09):
look to all these things yourself doesnot mean to do them yourself. I
always open the windows. The headin charge often says, if you do
it, it is by so muchthe better, certainly than if it were
not done at all. But canyou ensure that it is done when not
done by yourself? Can you ensurethat it is not undone when your back

(38:31):
is turned. This is what beingin charge means, and a very important
meaning it is too. The formeronly implies that just what you can do
with your own hands is done,the latter that what ought to be done
is always done. And now youthink these things trifles or at least exaggerated.

(38:53):
But what you think or what Ithink, matters little. Let us
see what God thinks of them.God always justifies his ways while we are
thinking, He has been teaching.I have known cases of hospital piemia quite
as severe in handsome private houses asin any of the worst hospitals, and

(39:14):
from the same cause, that isfoul air. Yet nobody learnt the lesson.
Nobody learned anything at all from it. They went on thinking, thinking
that the sufferer had scratched his thumb, or that it was singular that all
the servants had whitlows, or thatsomething was much about this year. There

(39:35):
is always sickness in our house.This is a favorite mode of thought,
leading not to inquire what is theuniform cause of these general whitlows, but
a stifle all inquiry. In whatsense is sickness being always there? A
justification of its being there at all? I will tell you what was the

(39:55):
cause of this hospital piemia being inthat large private house. It was that
the sewer air from an ill placedsink was carefully conducted into all the rooms
by sedulously opening all of the doorsand closing all the passage windows. It
was that the slops were emptied intothe footpans. It was that the utensils

(40:15):
were never properly rinsed. It wasthat the chamber crockery was rinsed with dirty
water. It was that the bedswere never properly shaken, aired, picked
to pieces, or changed. Itwas that the carpets and curtains were always
musty. It was that the furniturewas always dusty. It was that the

(40:35):
papered walls were saturated with dirt.It was that the floors were never cleaned.
It was that the uninhabited rooms werenever sunned or cleaned or aired.
It was that the cupboards were alwaysreservoirs of foul air. It was that
the windows were always tight shut upat night. It was that no window
was ever systematically opened even in theday, or that the right window was

(41:00):
not opened. A person gasping forair might open a window for himself.
But the servants were not taught toopen the windows to shut the doors.
Or they opened the windows upon adank well between high walls, not upon
the area court, or they openedthe room doors into the unaired halls and
passages by way of airing the rooms. Now, all of this is not

(41:25):
fancy but fact. In that handsomehouse, I have known in one summer
three cases of hospital piemia, oneof phlebitis, two of consumptive cough,
all the immediate products of foul air. When in temperate climates a house is
more unhealthy in summer than in winter, it is a certain sign of something

(41:47):
wrong. Yet nobody learns the lesson. Yes, God always justifies his ways.
He is teaching while you are notlearning. This poor body loses his
finger, that one loses his life, and all from the most easily preventable
causes. The houses of the grandmothersand great grandmothers of this generation, at

(42:10):
least the country houses with front doorand back door always standing open winter and
summer, and a thorough draft alwaysblowing through with all the scrubbing and cleaning
and polishing and scouring which used togo on the grandmothers, and still more,
the great grandmothers always out of doors, and never with a bonnet on,

(42:31):
except to go to church. Thesethings entirely account for the fact so
often seen of a great grandmother whowas a tower of physical vigor, descending
into a grandmother, perhaps a littleless vigorous, but still sound as a
bell and healthy to the core,into a mother languid and confined to her
carriage and house, and lastly intoa daughter sickly and confined to her bed.

(42:57):
For remember, even with a generaldecrease of immortality, you may often
find a race thus degenerating and stilloftener a family. You may see poor
little feeble, washed out rags,children of a noble stock, suffering morally
and physically throughout their useless, degeneratelives. And yet people who are going
to marry and bring more such intothe world will consult nothing but their own

(43:22):
convenience as to where they are tolive or how they are to live.
With regard to the health of houseswhere there is a sick person, it
often happens that the sickroom is madeof ventilating shaft for the rest of the
house. For while the house iskept as close, unaired and dirty as
usual, the window of the sickroomis kept a little open always, and

(43:44):
the door occasionally. Now, thereare certainly sacrifices which a house with one
sick person in it does make tothat sick person. It ties up its
knocker, it lays straw before itin the street. Why can't it keep
itself thoroughly clean and unusually well aired, indeferent to the sick person. We

(44:05):
must not forget what inordinary language iscalled infection, a thing of which people
are generally so afraid that they frequentlyfollow the very practice in regard to it
which they ought to avoid. Nothingused to be considered so infectious or contagious
as small pox, and people notvery long ago used to cover up patients

(44:27):
with heavy bedclothes while they kept uplarge fires and shut the windows. Smallpox,
of course, under this regime,is very infectious. People are somewhat
wiser now in their management of thisdisease. They have ventured to cover the
patients lightly and to keep the windowsopen. And we hear much less of
the infection of small pox than weused to do. But do people in

(44:51):
our days act with more wisdom onthe subject of infection in fevers, scarlet
fever, measles, et cetera.Than their forefathers did with small does not?
The popular idea of infection involve thatpeople should take greater care of themselves
than of the patient, that,for instance, it is safer not to
be too much with the patient,not to attend too much to his wants.

(45:16):
Perhaps the best illustration of the utterabsurdity of this view of duty in
attending on infectious diseases is afforded bywhat was very recently the practice, if
it is not so even now,in some of the European lazarettes, in
which the plague patient youth be condemnedto the horrors of filth, overcrowding,
and want of ventilation, while themedical attendant was ordered to examine the patient's

(45:39):
tongue through an opera glass and totoss him a lancet to open his absesses.
With true nursing ignores infection except toprevent it. Cleanliness and fresh air
from open windows with unremitting attention tothe patient are the only defense a true
nurse, either or needs wise andhumane management of the patient is the best

(46:06):
safeguard against infection. There are nota few popular opinions in regards to which
it is useful at times to aska question or two. For example,
it is commonly thought that children musthave what are commonly called children's epidemics,
current contagions, etc. In otherwords, that they are born to have

(46:28):
measles, hooping cough, perhaps evenscarlet fever, just as they are born
to cut their teeth if they live. Now, do tell us why must
a child have measles? Oh,because you say we cannot keep it from
infection? Other children have measles,and it must take them, and it
is safer that it should. Butwhy must other children have measles? And

(46:53):
if they have, why must yourshave them too? If you believed in
and observed the laws for preserving thehealth of houses which inculcate cleanliness, ventilation,
whitewashing, and other means, andwhich, by the way, are
laws as implicitly as you believe inthe popular opinion, For it is nothing

(47:15):
more than an opinion that your childmust have children's epidemics. Don't you think
that, upon the whole your childwould be more likely to escape altogether?
End of Section two. Section threepetty management. All the results of good

(47:36):
nursing as detailed in these notes maybe spoiled or utterly negatived by one defect,
that is in petty management, orin other words, by not knowing
how to manage that what you dowhen you are there shall be done when
you are not there. The mostdevoted friend or nurse cannot always be there,

(48:00):
nor is it desirable that she should, and she may give up her
health all her other duties. Andyet, for want of a little management,
be not one half so efficient asanother, who is not one half
so devoted, but who has thisart of multiplying herself. That is to
say, the patient of the firstwill not be really so well cared for

(48:23):
as the patient of the second.It is as impossible in a book to
teach of person in charge of sickhow to manage, as it is to
teach her how to nurse. Circumstancesmust vary with each different case. But
it is possible to press upon herto think for herself, Now, what
does happen during my absence? Iam obliged to be away on Tuesday,

(48:47):
But fresh air or punctuality is notless important to my patient on Tuesday than
it was on Monday. Or atten p m. I am never with
my patient, but quiet, asof no less consequence to him at ten
than it was at five minutes toten. Curious as it may seem,

(49:07):
this very obvious consideration occurs comparatively tofew, or if it does occur,
it is only to cause the devotedfriend or nurse to be absent. Fewer
hours or fewer minutes from her patient, not to arrange so as that no
minute and no hour shall be forher patient without the essentials of her nursing.

(49:28):
A very few instances will be sufficient, not as precepts, but as
illustrations. A strange washerwoman, cominglate at night for the things, will
burst in by mistake, to thepatient's sick room after he has fallen into
his first doze, giving him ashock, the effects of which are irremediable,
though he himself laughs at the causeand probably never even mentions it.

(49:52):
The nurse, who is and isquite right to be at her supper,
has not provided that the washer awoman shall not lose her way and go
into the wrong room. The patient'sroom may always have the window open,
but the passage outside the patient's room, though provided with several large windows,

(50:13):
may never have one open, becauseit is not understood that the charge of
the sick room extends to the chargeof the passage, and thus, as
often happens, the nurse makes ither business to turn the patient's room into
a ventilating shaft for the foul airof the whole house. An uninhabited room,
a newly painted room, an uncleanedcloset or cupboard may often become a

(50:37):
reservoir of foul air for the wholehouse. Because the person in charge never
thinks of arranging that these places shallalways be aired, always cleaned. She
merely opens the window herself when shegoes in. An agitating letter or message
may be delivered, or an importantletter or message not delivered. A visit

(51:00):
whom it was of consequence to seemay be refused, or one whom it
was of still more consequence not tosee may be admitted. Because the person
in charge has never asked herself thisquestion, what is done when I am
not there? At all events,one may safely say a nurse cannot be

(51:20):
with the patient, open the door, eat her meals, take a message,
all at one and the same time. Nevertheless, the person in charge
never seems to look the impossibility inthe face. Add to this that the
attempting this impossibility does more to increasethe poor patient's hurry and nervousness than anything

(51:40):
else. It is never thought thatthe patient remembers these things. If you
do not, he has not onlyto think whether the visit or letter may
arrive, but whether you will bein the way at the particular day and
hour when it may arrive, sothat your partial measures for being in the
way yourself only increase the necessity forhis thought. Whereas if you could but

(52:04):
arranged that the thing should always bedone, whether you were there or not,
he need never think at all aboutit. For the above reasons,
whatever a patient can do for himself, it is better that is less anxiety
for him to do for himself,unless the person in charge has the spirit
of management. It is evidently muchless exertion for a patient to answer a

(52:28):
letter for himself by return of postthan to have four conversations, wait five
days, have six anxieties before itis off his mind before the person who
is to answer it has done so. Apprehension, uncertainty, waiting, expectation,
fear of surprise do a patient moreharm than any exertion. Remember,

(52:52):
he has face to face with hisenemy all the time, internally wrestling with
him, having long imaginary conversations withhim you are thinking of something else.
Rid him of his adversary quickly isa first rule with the sick. For
the same reasons, always tell apatient, and tell him beforehand when you

(53:14):
are going out and when you willbe back, whether it is for a
day, an hour, or tenminutes. You fancy perhaps that it is
better for him if he does notfind out your going at all, better
for him if you do not makeyourself of too much importance to him,
or else you cannot bear to givehim the pain or the anxiety of the
temporary separation. No such thing youought to go, we will suppose health

(53:40):
or duty requires it. Then sayso to the patient openly. If you
go without his knowing it and hefinds it out, he will never feel
secure again that the things which dependupon you will be done when you are
away, And in nine times outof ten he will be right. If
you go out without telling him whenyou will be back, he can take

(54:04):
no measures nor precautions as to thethings which concern you both, or which
you do for him. If youlook into the reports of trials or accidents,
and especially of suicides, or intothe medical history of fatal cases,
it is almost incredible how often thewhole thing turns upon something which has happened
because he or still oftener she wasnot there. But it is still more

(54:30):
incredible, how often, how almostalways, this is accepted as a sufficient
reason A justification. Why the veryfact of a thing having happened is the
proof of its not being a justification. The person in charge was quite right
not to be there. He wascalled away for quite sufficient reason, or

(54:50):
he was away for a daily,recurring and unavoidable cause. Yet no provision
was made to supply his absence.The fault was not in his being away,
but in there being no management tosupplement his being away. When the
sun is under a total eclipse,or during his nightly absence, we light
candles. But it would seem asif it did not occur to us that

(55:14):
we must also supplement the person incharge of sick or of children, whether
under an occasional eclipse or during aregular absence. In institutions where many lives
would be lost, and the effectof such want of management would be terrible
and patent, there is less ofit than in the private house. But

(55:35):
in both, Let whoever is incharge keep this simple question in her head,
Not how can I always do thisright thing myself? But how can
I provide for this right thing tobe always done? Then when anything wrong
has actually happened in consequence of herabsence, which absence we will suppose to
have been quite right. Let herquestion still be not how can I provide

(56:00):
against any more of such absences,which is neither possible nor desirable, but
how can I provide against anything wrongarising out of my absence? How few
men or even women understand, eitherin great or in little things, what
it is the being in charge,I mean, know how to carry out

(56:23):
a charge, from the most colossalcalamities down to the most trifling accidents.
Results are often traced, or rathernot traced, to such want of someone
being in charge, or of hisknowing how to be in charge. A

(56:43):
short time ago, the bursting ofa funnel casing on board the finest and
strongest ship that was ever built onher trial trip destroyed several lives and put
several hundreds in jeopardy, not fromany undetected floor in her new and untried
work, but from a tap beingclosed which ought not to have been closed,

(57:05):
from what every child knows, wouldmake its mother's tea kettle burst.
And this simply because no one seemedto know what it is to be in
charge or who was in charge.Nay more, the jury at the inquest
actually altogether ignored the same, andapparently considered the tap in charge, for
they gave us a verdict accidental death. This is the meaning of the word

(57:31):
on a large scale. On amuch smaller scale, it happened a short
time ago that an insane person burntherself slowly and intentionally to death while in
her doctor's charge and almost in hisnurse's presence. Yet neither was considered at
all to blame. The very factof the accident happening proves its own case.

(57:55):
There is nothing more to be said. Either they did not know their
business, or they did not knowhow to perform it. To be in
charge is certainly not only to carryout the proper measures yourself, but to
see that everyone else does so too, to see that no one, either
wilfully or ignorantly thwarts or prevents suchmeasures. It is neither to do everything

(58:22):
yourself, nor to appoint a numberof people to each duty, but to
ensure that each does that duty towhich he is appointed. This is the
meaning which must be attached to theword by above all those in charge of
sick, whether of numbers or ofindividuals. And indeed, I think it
is with individual sick that it isleast understood. One sick person is often

(58:46):
waited on by four with less precision, and is less really well cared for
than ten who are waited on byone, or at least than forty who
are waited on by four, andall for want of this one person in
charge. It is often said thatthere are few good servants. Now,

(59:07):
I say there are few good mistresses. Now, as the jury seems to
have thought the tap was in chargeof the ship's safety, so mistresses now
seem to think the house is incharge of itself. They neither know how
to give orders, nor how toteach their servants to obey orders, that
is, to obey intelligently, whichis the real meaning of all discipline.

(59:30):
Again, people who are in chargeoften seem to have a pride in feeling
that they will be missed, thatno one can understand or carry on their
arrangements, their system, books,accounts, et cetera, but themselves.
It seems to me that the prideis rather in carrying on a system,
in keeping stores, closets, books, accounts, et cetera, so that

(59:52):
anybody can understand and carry them on, so that in case of absence or
illness, one can deliver everything upto others and know that all will go
on as usual, and that oneshall never be missed. End of Section
three. Section four. Noise,unnecessary noise or noise that creates an expectation

(01:00:19):
in the mind is that which hurtsa patient. It is rarely the loudness
of the noise, the effect uponthe organ of the air itself, which
appears to affect the sick how wella patient will generally bear, for example,
the putting up of a scaffolding closeto the house, when he cannot
bear the talking, still less thewhispering, especially if it be of a

(01:00:42):
familiar voice outside his door. Thereare certain patients, no doubt, especially
where there is slight concussion or otherdisturbance of the brain, who are affected
by mere noise. But intermittent noise, or sudden and sharp noise in these
as in all other cases, affectsfar more than continuous noise. Noise with

(01:01:04):
jar far more than noise. Withoutof one thing, you may be certain
that anything which wakes a patient suddenlyout of his sleep will invariably put him
into a state of greater excitement tohim, more serious aye and lasting mischief
than any continuous noise. However loudnever to allow A patient to be waked,

(01:01:29):
intentionally or accidentally is a sine quanon of all good nursing. If
he is roused out of his firstsleep, he is almost certain that to
have no more sleep. It isa curious but quite intelligible fact that if
a patient is waked after a fewhours instead of a few minutes sleep,
he is much more likely to sleepagain, because pain, like irritability of

(01:01:52):
brain, perpetuates and intensifies itself.If you have gained a respite of either
in sleep, you have gained morethan the mere respite. Both the probability
of recurrence and of the same intensitywill be diminished, whereas both will be
terribly increased by want of sleep.This is the reason why sleep is so

(01:02:15):
all important. This is the reasonwhy a patient waked in the early part
of his sleep loses not only hissleep but his power to sleep. A
healthy person who allows himself to sleepduring the day will lose his sleep at
night, but it is exactly thereverse with the sick. Generally, the
more they sleep, the better willthey be able to sleep. I have

(01:02:40):
often been surprised at the thoughtlessness resultingin cruelty, quite unintentionally of friends or
of doctors who will hold a longconversation just in a room or passage adjoining
to the room of the patient,who is either every moment expecting them to
come in, or who has justseen them and knows they are talking about

(01:03:00):
him. If he is an amiablepatient, he will try to occupy his
attention elsewhere and not to listen,and this makes matters worse, for the
strain upon his attention and the efforthe makes are so great that it is
well if he is not worse forhours after. If it is a whispered
conversation in the same room, thenit is absolutely cruel, for it is

(01:03:22):
impossible that the patient's attention should notbe involuntarily strained to hear walking on tiptoe
doing anything in the room very slowlyare injurious for exactly the same reasons.
A firm, light quick step,a steady quick hand at the deciderata not

(01:03:42):
the slow lingering, shuffling foot,the timid, uncertain touch. Slowness is
not gentleness, though it is oftenmistaken for such quickness. Lightness and gentleness
are quite compatible. Again, iffriends and doctors did but watch as nurses
can and should watch, the featuressharpening the eyes growing almost wild of fever.

(01:04:08):
Patients who were listening for the entrancefrom the corridor of the persons whose
voices they are hearing there These wouldnever run the risk again of creating such
unnecessary noise as undoubtedly induced or aggravateddelirium in many cases I have known such.
In one case, death ensued.It is but fair to say that

(01:04:30):
this death was attributed to fright.It was the result of a long whispered
conversation within sight of the patient aboutan impending operation. But anyone who has
known the more than stoicism, thecheerful coolness with which the certainty of an
operation will be accepted by any patientcapable of bearing an operation at all,

(01:04:50):
if it is properly communicated to him, will hesitate to believe that it was
mere fear which produced, as wasAverred, the fatal result. In this
instance, it was rather the uncertainty, the strained expectation as to what was
to be decided upon. I needhardly say that the other common cause,

(01:05:12):
namely for a doctor or friend toleave the patient and communicate his opinion on
the result of his visit to thefriends just outside the patient's doore or in
the adjoining room after the visit,but within hearing or knowledge of the patient,
is, if possible, worst ofall. It is, I think,
alarming peculiarly at this time, whenthe female ink bottles are perpetually impressing

(01:05:35):
upon us woman's particular worth than generalmissionariness, to see that the dress of
women is daily more and more unfittingthem for any mission or usefulness at all.
It is equally unfitted for all poeticand all domestic purposes. A man
is now a more handy and farless objectionable being in a sick room than

(01:05:57):
a woman. Compelled by her address, every woman now either shuffles or waddles.
Only a man can cross the floorof a sick room without shaking it.
What is become of women's light step, the firm, light quick step
we have been asking for. Unnecessarynoise, then is the most cruel absence

(01:06:18):
of care which can be inflicted eitheron sick or well. For in all
these remarks, the sick are onlymentioned as suffering in a greater proportion than
the well from precisely the same causesunnecessary Although slight noise injures a sick person
much more than necessary noise of amuch greater amount. All doctrines about mysterious

(01:06:44):
affinities and aversions will be found toresolve themselves very much, if not entirely,
into presence or absence of care inthese things. A nurse who rustles,
I'm speaking of nurses professional and unprefers, is the horror of a patient,
though perhaps he does not know why. The fidget of silk and of

(01:07:06):
crinoline, the rattling of keys,the creaking of stays and of shoes will
do a patient more harm than allthe medicines in the world will do him
good. The noiseless step of women, the noiseless drapery of women, a
mere figures of speech in this dayas skats, and well, if they

(01:07:28):
do not throw down, some pieceof furniture will at least brush against every
article in the room as she movesagain. One nurse cannot open the door
without making everything rattle, or sheopens the door unnecessarily, often for want
of remembering all the articles that mightbe brought in at once. A good

(01:07:48):
nurse will always make sure that nodoor or window in her patient's room shall
rattle or creak, that no blindor curtain shell by any change of wind
through the open window be made toflap. Especially, will she be careful
of all this before she leaves herpatience for the night. If you wait
till your patients tell you or remindyou of these things, where is the

(01:08:12):
use of their having a nurse.There are more shy than exacting patients in
all classes, and many a patientpasses a bad night time after time,
rather than remind his nurse every nightof all the things she has forgotten.
If there are blinds to your windows, always take care to have them well
up when they are not being used. A little piece slipping down and flapping

(01:08:36):
with every draft will distract a patient. All hurry or bustle is peculiarly painful
to the sick. And when apatient has compulsory occupations to engage him,
instead of having simply to amuse himself, it becomes doubly injurious. The friend
who remains standing and fidgeting about whilea patient is to looking business to him,

(01:09:00):
or the friend who sits and proses, the one from an idea of
not letting the patient talk, theother from an idea of amusing him,
Each is equally inconsiderate. Always sitdown when a sick person is talking business
to you, show no signs ofhurry, give complete attention and full consideration
if your advice is wanted, andgo away the moment the subject is ended.

(01:09:26):
Always sit within the patient's view,so that when you speak to him,
he has not painfully to turn hishead round in order to look at
you. Everybody involuntarily looks at theperson speaking. If you make this act
a wearisome one on the part ofthe patient, you would doing him harm.
So also, if by continuing tostand you make him continuously raise his

(01:09:47):
eyes to see you, be asmotionless as possible, and never gesticulate in
speaking to the sick. Never makea patient repeat a message your request is
especially if it be some time afteroccupied Patients are often accused of doing too
much of their own business. Theyare instinctively right. How often you hear

(01:10:11):
the person charged with the request ofgiving the message or writing the letter say
half an hour afterwards to the patient, did you appoint twelve o'clock? Or
what did you say was the address? Or ask perhaps some much more agitating
question, thus causing the patient theeffort of memory or worse still, of
decision all over again. It isreally less exertion to him to write his

(01:10:34):
letters himself. This is the almostuniversal experience of occupied invalids. This brings
us to another caution. Never speakto an invalid from behind, nor from
the door, nor from any distancefrom him, nor when he is doing
anything. The official politeness of servantsin these things is so grateful to invalids

(01:10:59):
that many, without knowing why,having none but servants about them. These
things are not fancy. If weconsider that with sick, as with well,
every thought decomposes some nervous matter.That decomposition, as well as recomposition
of nervous matter, is always goingon, and more quickly with the sick

(01:11:20):
than with the well. That toobtrude abruptly another thought upon the brain,
while it is in the act ofdestroying nervous matter, by thinking, is
calling upon it to make a newexertion. If we consider these things,
which are facts, not fancies,we shall remember that we are doing positive
injury by interrupting, by startling afanciful person, as it is called alas

(01:11:46):
it is no fancy. If theinvalid is forced by his allocations to continue
occupations requiring much thinking, the injuryis doubly great in feeding a patient suffering
under delirium or stupor. You maysuffocate him by giving him his food suddenly.
But if you rub his lips gentlywith a spoon, and thus attract

(01:12:10):
his attention, he will swallow thefood unconsciously, but with perfect safety.
Thus it is with the brain.If you offer it a thought, especially
one requiring a decision abruptly, youdo it a real, not fanciful injury.
Never speak to a sick person suddenly, but at the same time,
do not keep his expectation on thetiptoe. This rule indeed applies to the

(01:12:34):
well quite as much as to thesick. I have never known persons who
exposed themselves for years to constant interruptionwho did not muddle away their intellects by
it. At last, the processwith them may be accomplished without pain.
With the sick, pain gives warningof the injury. Do not meet or

(01:12:56):
overtake a patient who is moving aboutin order to speak to him, or
to give him any message or letter. You might just as well give him
a box on the ear. Ihave seen a patient fall flat on the
ground who was standing when his nursecame into the room. This was an
accident which might have happened to themost careful nurse, but the other is

(01:13:17):
done with intention. A patient insuch a state is not going to the
East Indies. If you would waitten seconds or walk ten yards further,
any promenade he could make would beover. You do not know the effort
it is to a patient to remainstanding for even a quarter of a minute
to listen to you. If Ihad not seen a thing done by the

(01:13:40):
kindest nurses and friends, I shouldhave thought this caution quite superfluous. Patients
are often accused of being able todo much more when nobody is by.
It is quite true that they canunless nurses can be brought to attend to
considerations of the kind of which wehave given here Feu specimens. A very
weak patient finds it really much lessexertion to do things for himself than to

(01:14:05):
ask for them, and he will, in order to do them, very
innocently and from instinct, calculate thetime his nurse is likely to be absent,
from a fear of her coming inupon him or speaking to him,
just at the moment when he findsit quite as much as he can do
to crawl from his bed to hischair, or from one room to another,

(01:14:28):
or downstairs or out of doors fora few minutes. Some extra call
made upon his attention at that momentwill quite upset him. In these cases,
you may be sure that a patientin the state we have described does
not make such exertions more than onceor twice a day, and probably much
about the same hour every day.And it is hard, indeed, if

(01:14:50):
nurse and friends cannot calculate so asto let him make them undisturbed. Remember
that many patients can walk who cannotstand or even sit up. Standing is,
of all positions the most trying toa weak patient. Everything you do

(01:15:10):
in a patient's room after he isput up for the night increases tenfold the
risk of his having a bad night. But if you rouse him up after
he has fallen asleep, you donot risk you secure him a bad night.
One hint I would give to allwho attend or visit the sick,

(01:15:30):
To all who have to pronounce anopinion upon sickness or its progress, Come
back and look at your patient afterhe has had an hour's animated conversation with
you. It is the best testof his real state. We know,
but never pronounce upon him from merelyseeing what he does or how he looks
during such a conversation, learn alsocarefully and exactly, if you can,

(01:15:56):
how he passed the night after it. People, if ever faint while making
an exertion, it is after itis over. Indeed, almost every effect
of over exertion appears after, notduring such exertion. It is the highest
folly to judge of the sick,as is so often done, when you

(01:16:17):
see them merely during a period ofexcitement. People have very often died of
that which, it has been proclaimedat the time, has done them no
harm. Remember never to lean against, sit upon, or unnecessarily shake or
even touch the bed in which apatient lies. This is invariably a painful

(01:16:39):
annoyance. If you shake the chairon which he sits, he has a
point by which to steady himself inhis feet. But on a bed or
sofa, he is entirely at yourmercy, and he feels every jar you
give him all through him. Inall that we have said, both here
and elsewhere, let it be distinctlyunderstood that we are not speaking of hypochondriacs.

(01:17:03):
To distinguish between real and fancied diseaseforms, an important branch of the
education of a nurse to manage fancypatients forms an important branch of her duties.
But the nursing which real and thatwhich fancied patients require is of different,
or rather of opposite character, andthe latter will not be spoken of

(01:17:26):
here. Indeed, many of thesymptoms which are here mentioned are those which
distinguish real from fancied disease. Itis true that hypochondriacs very often do that
behind a nurse's back, which theywould not do before her face. Many
such I have had as patients whoscarcely ate anything at their regular meals,
but if you concealed food for themin a drawer, they would take it

(01:17:49):
at night or in secret. Butthis is from quite a different motive.
They do it from the wish toconceal, whereas the real patient will often
boast to his nurse or doctor ifthese do not shake their heads at him
of how much he has done,or eaten or walked To return to real
disease. Conciseness and decision are aboveall things necessary with the sick. Let

(01:18:16):
your thought express to them be conciselyand decidedly expressed. What doubt and hesitation
there may be in your own mind, must never be communicated to theirs,
not even I would rather say,especially not in little things. Let your
doubt be to yourself, your decisionto them. People who think outside their

(01:18:39):
heads, the whole process of whosethought appears like Homer's in the act of
secretion, who tell everything that ledthem towards this conclusion and away from that
ought, never to be with thesick. Irresolution is what all patients most
dread. Rather than meet this inothers, they will collect all their data

(01:19:00):
and make up their minds for themselves. A change of mind in others,
whether it is regarding an operation orrewriting a letter, always injures the patient
more than the being called upon tomake up his mind to the most dreaded
or difficult decision. Farther than this, In very many cases, the imagination
in disease is far more active andvivid than it is in health. If

(01:19:24):
you propose to the patient change ofair to one place one hour and to
another the next, he has,in each case immediately constituted himself in imagination,
the tenant of the place gone overthe whole premises in idea, and
you have tired him as much bydisplacing his imagination as if you had actually
carried him over both places. Aboveall, leave the sick room quickly and

(01:19:49):
come into it quickly, not suddenly, not with a rush. But don't
let the patient be wearily waiting forwhen you will be out of the room
or when you will be in it. Conciseness and decision in your movements,
as well as your words, arenecessary in the sick room, as necessary
as absence of hurry and bustle.To possess yourself entirely will ensure you from

(01:20:14):
either failing, either loitering or hurrying. If a patient has to see not
only to his own but also tohis nurse's punctuality or perseverance, or readiness
or calmness, to any or allof these things, he is far better
without that nurse than with her,however valuable and handy her services may otherwise

(01:20:35):
be to him, and however incapablehe may be of rendering them to himself.
With regard to reading aloud in thesick room, my experience is that
when the sick too ill to readto themselves, they can seldom bear to
be read to children. Eye patienceand uneducated persons are exceptions, or when

(01:20:58):
there is any mechanical difficulty reading.People who like to be read to have
generally not much the matter with them, while in fevers, or where there
is much irritability of brain, theeffort of listening to reading aloud has often
brought on delirium. I speak withgreat diffidence because there is an almost universal
impression that it is sparing the sickto read aloud to them. But two

(01:21:23):
things are certain. One, ifthere is some matter which must be read
to a sick person, do itslowly. People often think that the way
to get it over with least fatigueto him is to get it over in
least time. They gabble, theyplunge, and gallop through the reading.
There never was a greater mistake.Houdin the Conjurer says that the way to

(01:21:47):
make a story seem short is totell it slowly. So it is with
reading to the sick. I haveoften heard a patient say to such a
mistaken reader, don't read it tome, tell it me. Unconsciously.
He is aware that this will regulatethe plunging the reading with unequal paces,

(01:22:08):
slurring over one part instead of leavingit out altogether. If it is unimportant
and mumbling. Another. If thereader lets his own attention wander and then
stops to read up to himself,or finds he has read the wrong bit,
then it is all over with thepoor patient's chance of not suffering.
Very few people know how to readto the sick. Very few people read

(01:22:31):
aloud as pleasantly even as they speak. In reading, they sing, they
hesitate, they stammer, they hurry, they mumble, when in speaking they
do none of these things. Readingaloud to the sick ought always to be
rather slow and exceedingly distinct, butnot mouthing, rather monotonous, but not

(01:22:55):
sing song, rather loud, butnot noisy, and above all not too
long. Be very sure of whatyour patient can bear. Two. The
extraordinary habit of reading to one's selfin a sick room, and reading aloud
to the patient any bits which willamuse him or more often, the reader

(01:23:17):
is unaccountably thoughtless. What do youthink the patient is thinking of during your
gaps of non reading? Do youthink that he amuses himself upon what you
have read for precisely the time itpleases you to go on reading to yourself,
and that his attention is ready forsomething else at precisely the time it
pleases you to begin reading again.Whether the person thus read to be sick

(01:23:41):
or well, whether he be doingnothing or doing something else while thus being
read to the self absorption and wantof observation, the person who does it
is equally difficult to understand, althoughvery often the read is too amiable to
say how much it hurts him.One thing more, from the flimsy manner

(01:24:02):
in which most modern houses are built, where every step on the stairs and
along the floors is felt all overthe house. The higher the story,
the greater the vibration, it isinconceivable how much the sick suffer by having
anybody overhead. In the solidly builtold houses, which fortunately most hospitals are,

(01:24:27):
the noise and shaking is comparatively trifling, but it is a serious cause
of suffering in lightly built houses,and with the irritability peculiar to some diseases,
better far put such patients at thetop of the house, even with
the additional fatigue of stairs. Ifyou cannot secure the room above them,
being untenanted, you may otherwise bringon a state of restlessness which no opium

(01:24:50):
will subdue. Do not neglect thewarning when a patient tells you that he
feels every step above him to crosshis head. Remember that every noise a
patient cannot see partakes of the characterof suddenness to him. And I am
persuaded that patients with these peculiarly irritablenerves are positively less injured by having persons

(01:25:14):
in the same room with them thanoverhead or separated by only a thin compartment.
Any sacrifice to secure silence for thesecases is worth while, because no
heir, however good, no attendance, however careful, will do anything for
such cases without quiet end of Sectionfour, Section five variety. To any

(01:25:43):
but an old nurse or an oldpatient, the degree would be quite inconceivable
to which the nerves of the sicksuffer from seeing the same walls, the
same ceiling, the same surroundings duringa long confinement to one or two rooms.
The superior cheerfulness of persons suffering severeparoxysms of pain over that of persons

(01:26:06):
suffering from nervous stability has often beenremarked upon and attributed to the enjoyment of
the former of their intervals of respite. I incline to think to the majority
of cheerful cases is to be foundamong those patients who are not confined to
one room, whatever their suffering,and that the majority of depressed cases will

(01:26:28):
be seen among those subjected to along monotony of objects about them. The
nervous frame really suffers as much fromthis as the digestive organs from long monotony
of diet, as for example thesoldier from his twenty one years boiled beef.
The effect in sickness of beautiful objects, a variety of objects, and

(01:26:50):
especially of brilliancy of colour, ishardly at all appreciated. Such cravings are
usually called the fancy of patience,and often doubtless patients have fancies, as
for example, when they desire toocontradictions. But much more often there so

(01:27:11):
called fancies are the most valuable indicationsof what is necessary for their recovery.
And it would be well if nurseswould watch these so called fancies closely.
I have seen in fevers and feltwhen I was a fever patient myself,
the most acute suffering produced from thepatient in a hut not being able to

(01:27:33):
see out of window, and theknots in the wood being the only view.
I shall never forget the rapture offever patients over a bunch of bright
colored flowers. I remember in myown case, and those gay of wild
flowers being sent me, and fromthat moment recovery becoming more rapid. People

(01:27:55):
say the effect is only on themind. It is no such thing.
The effect is on the body.Too. Little as we know about the
way in which we are affected byform, by color and light, we
do know this that they have anactual physical effect. Variety of form and
brilliancy of color in the objects presentedto patients are actual means of recovery.

(01:28:23):
But it must be slow variety.That is, if you show a patient
ten or twelve engravings successively, tendto one that he does not become cold
and faint, or feverish, oreven sick. But hang one up opposite
him, one on each successive dayor week or month, and he will

(01:28:43):
revel in the variety. The follyand ignorance which reign too often supreme over
the sick room cannot be better exemplifiedthan by this. While the nurse will
leave the patient stewing in a corruptingatmosphere, the best ingredient of which is
carbonic acid, she will deny himon the plea of unhealthiness a glass of

(01:29:05):
cut flowers or a growing plant.Now, no one ever saw overcrowding by
plants in a room or ward,and the carbonic acid they give off at
nights would not poison a fly.Nay, in overcrowded rooms, they actually
absorb carbonic acid and give off oxygen. Cut flowers also decompose water and produce

(01:29:31):
oxygen gas. It is true thereare certain flowers, for example, lilies,
the smell of which is said todepress the nervous system. These are
easily known by the smell and canbe avoided. Volumes are now written and
spoken upon the effect of the mindupon the body. Much of it is

(01:29:51):
true, But I wish a littlemore was thought of the effect of the
body on the mind. You whobelieve yourselves overwhelmed with anxieties, but are
every day able to walk up RegentStreet or out in the country, to
take your meals with others in otherrooms, et cetera, et cetera,

(01:30:12):
You little know how much your anxietiesare thereby lightened. You little know how
intensified they become to those who canhave no change. How the very walls
of their sick rooms seem hung withtheir cares, how the ghosts of their
troubles haunt their beds, how impossibleit is for them to escape from a
pursuing thought without some help from variety. A patient can just as much move

(01:30:40):
his leg when it is fractured aschange his thoughts when no external help from
variety is given him. This isindeed one of the main sufferings of sickness,
just as the fixed posture is oneof the main sufferings of the broken
limb. It is an ever recurringwonder to see educated people who call themselves

(01:31:00):
nurses acting thus they vary their ownobjects, their own employments, many times
a day, and while nursing somebed ridden sufferer, they let him lie
there staring at a dead wall,without any change of object to enable him
to vary his thoughts. And itnever even occurs to them, at least
to move his bed so that hecan look out of window. No,

(01:31:25):
the bed is always to be leftin the darkest, dullest, remotest part
of the room. I think itis a very common error among the well
to think that with a little moreself control, the sick might, if
they choose dismiss painful thoughts which aggravatetheir disease, et cetera. Believe me,

(01:31:45):
almost any sick person who behaves decentlywell exercises more self control every moment
of his day than you will everknow till you are sick yourself. Almost
every step that cross his room ispainful to him. Almost every thought that
crosses his brain is painful to him. And if he can speak without being

(01:32:06):
savage and look without being unpleasant,he is exercising self control. Suppose you
have been up all night, andinstead of being allowed to have your cup
of tea, you were to betold that you ought to exercise self control.
What should you say now? Thenerves of the sick are always in

(01:32:28):
the state that yours are in afteryou have been up all night. We
will suppose the diet of the sickto be cared for. Then this state
of nerves is most frequently to berelieved by care in affording them a pleasant
view. A judicious variety as toflowers and pretty things, light by itself,

(01:32:49):
will often relieve it. The cravingfor the return of day, which
the six so constantly evince, isgenerally nothing but the desire for lofe ight,
the remembrance of the relief which avariety of objects before the eye affords
to the harassed sick mind. Again, every man and every woman has some

(01:33:13):
amount of manual employment, excepting afew fine ladies who do not even dress
themselves, and who are virtually inthe same category as to nerves as the
sick. Now you can have noidea of the relief which manual labor is
to you, of the degree towhich the deprivation of manual employment increases the
peculiar irritability from which many sick suffer. A little needlework, a little writing,

(01:33:40):
a little cleaning, would be thegreatest relief the sick could have,
if they could do it. Theseare the greatest relief to you, though
you do not know it. Reading, although it is often the only thing
the sick can do, is notthis relief. Bearing this in mind,
bearing in mind, and that youhave all these varieties of employment which the

(01:34:02):
sick cannot have, bear also inmind to obtain for them all the varieties
which they can enjoy. I needhardly say that I am well aware that
excess in needlework, in writing,in any other continuous employment, will produce
the same irritability that defect in manualemployment as one cause produces in the sick.

(01:34:29):
End of Section five, Section sixtaking food. Every careful observer of
the sick will agree in this thatthousands of patients are annually starved in the
midst of plenty, from want ofattention to the ways which alone make it
possible for them to take food.This want of attention is as remarkable in

(01:34:53):
those who urge upon the sick todo what is quite impossible to them as
in the sick themselves, who willnot make them the effort to do what
is perfectly possible to them. Forinstance, to the large majority of very
weak patients, it is quite impossibleto take any solid food before eleven a
m. Nor then if their strengthis still further exhausted by fasting till that

(01:35:15):
hour. For weak patients have generallyfeverish nights and in the morning dry mouths,
and if they could eat with thosedry mouths, it would be the
worse for them. A spoonful ofbeef, tea of arrowroot, and wine
of egg flip every hour will givethem the requisite nourishment and prevent them being

(01:35:40):
too much exhausted to take at alater hour the solid food which is necessary
for their recovery. And every patientwho can swallow at all can swallow these
liquid things if he chooses. Buthow often do we hear a mutton chop,
an egg a bit of bacon orderedto a patient for breakfast, to
who boom, As a moment's considerationwould show us, it must be quite

(01:36:03):
impossible to masticate such things at thathour. Again, a nurse is ordered
to give a patient a teacupful ofsome article of food every three hours.
The patient's stomach rejects it. Ifso, try a tablespoonful every hour.
If this will not do, ateaspoonful every quarter of an hour, I

(01:36:27):
am bound to say that I thinkmore patients are lost by want of care
and ingenuity in these momentous minutii inprivate nursing than in public hospitals. And
I think there is more of theentente cordial to assist one another's hands between
the doctor and his head nurse inthe latter institutions than between the doctor and

(01:36:47):
the patient's friends in the private house. If we did but know the consequences
which may ensue in very weak patientsfrom ten minutes fasting or repletion. I
call it repletion when they are obligedto let too small an interval elapse between
taking food and some other exertion owingto the nurse's unpunctuality. We should be

(01:37:11):
more careful never to let this occur. In very weak patients, there is
often a nervous difficulty of swallowing,which is so much increased by any other
call upon their strength, that unlessthey have their food punctually at the minute,
which minute again must be arranged soas to fall in with no other
minute's occupation, they can take nothinguntil the next respite occurs, so that

(01:37:35):
an unpunctuality or delay of ten minutesmay very well turn out to be one
of two or three hours. Andwhy is it not as easy to be
punctual to a minute? Life oftenliterally hangs upon these minutes in acute cases
where life or death is to bedetermined in a few hours. These matters

(01:37:58):
are very generally attended to, especiallyin hospitals, and the number of cases
is large where the patient is,as it were, brought back to life
by exceeding care on the part ofthe doctor or nurse or both in ordering
and giving nourishment with minute selection andpunctuality. But in chronic cases lasting over

(01:38:19):
months and years, where the fatalissue is often determined at last by mere
protracted starvation, I had rather notenumerate the instances which I have known where
a little ingenuity and a great dealof perseverance might, in all probability have
averted the result. The consulting thehours when the patient can take food,

(01:38:43):
the observation of the times, oftenvarying when he is most faint, the
altering seasons of taking food in orderto anticipate and prevent such times. All
this which requires observation, ingenuity,and perseverance, and these really constitute the
good nurse might save more lives thanwe what of. To leave the patient's

(01:39:08):
untasted food by his side from mealto meal, in hopes that he will
eat it in the interval is simplyto prevent him from taking any food at
all. I have known patience literallyincapacitated from taking one article of food after
another by this piece of ignorance.Let the food come at the right time
and be taken away, eaten oruneaten at the right time. But never

(01:39:31):
let a patient have something always standingby him. If you don't wish to
disgust him of everything. On theother hand, I have known a patient's
life saved he was sinking for wantof food, by the simple question put
to him by the doctor. Butis there no hour when you feel you
could eat? Oh? Yes,he said, I could always take something

(01:39:55):
at a clock and o'clock. Thething was tried and succeeded. Patients very
seldom, however, can tell youthis. It is for you to watch
and find it out. A patientshould, if possible, not see or
smell either the food of others,or a greater amount of food than he

(01:40:16):
himself can consume at one time,or even hear food talked about, or
see it in the raw state.I know of no exception to the above
rule. The breaking of it alwaysinduces a greater or less incapacity of taking
food. In hospital wards, itis of course impossible to observe all this,
and in single wards, where apatient must be continuously and closely watched,

(01:40:41):
it is frequently impossible to relieve theattendant so that his or her own
meals can be taken out of theward. But it is not the less
true that in such cases, evenwhere the patient is not himself aware of
it, his possibility of taking foodis limited by seeing the attendant eating meals
under him observation. In some casesthe sick are aware of it and complain.

(01:41:05):
A case where the patient was supposedto be insensible but complained as soon
as able to speak, is nowpresent to my recollection. Remember, however,
that the extreme punctuality in well orderedhospitals, the rule that nothing shall
be done in the ward while thepatients are having their meals, go far
to counterbalance what unavoidable evil there isin having patients together. I have often

(01:41:30):
seen the private nurse go on dustingor fidgeting about in a sick room all
the while the patient is eating ortrying to eat. That the more alone
an invalid can be when taking food, the better is unquestionable. And even
if he must be fed, thenurse should not allow him to talk or
to talk to him, especially aboutfood while eating. When a person is

(01:41:56):
compelled by the pressure of occupation tocantinue his business while sick, it ought
to be a rule, without anyexception whatever, that no one shall bring
business to him or talk to himwhile he is taking food, nor go
on talking to him on interesting subjectsup to the last moment before his meals,
nor make an engagement with him immediatelyafter, so that there can be

(01:42:19):
any hurry of mind while taking them. Upon the observance of these rules,
especially the first, often depends thepatient's capability of taking food at all,
or if he is amiable and forceshimself to take food, of deriving any
nourishment from it. A nurse shouldnever put before a patient milk that is

(01:42:43):
sour, meat or soup that isturned, an egg that is bad,
or vegetables underdone. Yet often Ihave seen these things brought into the sick
in a state perfectly perceptible to everynose or eye except the nurses. It
is here that the clever nurse appears. She will not bring in the peccant
article, but not to disappoint thepatient, she will whip up something else

(01:43:08):
in a few minutes. Remember thatsick cookery should half do the work of
your poor patient's weak digestion. Butif you further impair it with your bad
articles, I know not what isto become of him or of it.
If the nurse is an intelligent beingand not a mere carrier of diets too
and from the patient, let herexercise her intelligence in these things. How

(01:43:32):
often we have known a patient eatnothing at all in the day because one
meal was left untasted at that timehe was incapable of eating. At another,
the milk was sour, the thirdwas spoiled by some other accident.
And it never occurred to the nurseto extemporize some expedient. It never occurred
to her that, as he hadhad no solid food that day, he

(01:43:54):
might eat a bit of toast,say, with his tea in the evening,
or he might have some meal anhour early. A patient who cannot
touch his dinner at two will oftenaccept it gladly if brought to him at
seven. But somehow nurses never thinkof these things. One would imagine they
did not consider themselves bound to exercisetheir judgment. They leave it to the

(01:44:16):
patient. Now, I am quitesure that it is better for a patient
rather to suffer these neglects than totry to teach his nurse to nurse him
if she does not know how itruffles him, and if he is ill,
he is in no condition to teach, especially upon himself. The above
remarks apply much more to private nursingthan to hospitals. I would say to

(01:44:42):
the nurse, have a rule ofthought about your patient's diet. Consider remember
how much he has had and howmuch he ought to have today. Generally,
the only rule of the private patient'sdiet is what the nurse has to
give. It is true she cannotgive him what she has not got,
but his stomach does not wait forher convenience or even her necessity. If

(01:45:04):
it is used to having its stimulusat one hour to day, and tomorrow
it does not have it because shehas failed in getting it, he will
suffer. She must be always exercisingher ingenuity to supply defects and to remedy
accidents which will happen among the bestcontrivers, but from which the patient does
not suffer the less because they cannotbe helped. One very minute caution,

(01:45:30):
take care not to spill into yourpatient's saucer. In other words, take
care that the outside bottom rim ofhis cup should be quite dry and clean.
If every time he lifts his cupto his lips, he has to
carry the saucer with it, orelse to drop the liquid upon and to
soil his sheet or his bed gownor pillow, or if he is sitting

(01:45:53):
up his dress, you have noidea. What a difference this minute want
of care on your part makes tohis comfort and even to his willingness for
food. End of Section six,Section seven what food? I will mention

(01:46:13):
One or two of the most commonerrors among women in charge of sick respecting
sick diet. One is the beliefthat beef tea is the most nutritive of
all articles. Now, just tryand boil down a pound of beef into
beef tea. Evaporate your beef tea, and see what is left of your
beef. You will find that thereis barely a teaspoonful of solid nourishment to

(01:46:38):
half a pint of water in beeftea. Nevertheless, there is a certain
reparative quality in it. We donot know what as there is in tea,
but it may be safely given inalmost any inflammatory disease, and is
as little to be depended upon withthe healthy or convalescent, where much nourishment
is required. Again, it isan ever ready saw that an egg is

(01:47:01):
equivalent to a pound of meat,whereas it is not so at all.
Also, it is seldom noticed withhow many patients, particularly of nervous or
billious temperament, eggs disagree, allpuddings made with eggs are distasteful to them.
In consequence, an egg whipped upwith wine is often the only form

(01:47:24):
in which they can take this kindof nourishment. Again, if the patient
has attained to eating meat, itis supposed that to give him meat is
the only thing needful for his recovery. Whereas scorbutic saws have been actually known
to appear among sick persons living inthe midst of plenty in England, which
could be traced to no other saucethan this. That is that the nurse,

(01:47:46):
depending on meat alone, had allowedthe patient to be without vegetables for
considerable time, these latter being sobadly cooked that he always left them untouched.
Arrowroot is another grand day dependence ofthe nurse as a vehicle for wine
and as a restorative quickly prepared.It is all very well, but it

(01:48:08):
is nothing but starch and water.Flour is both more nutritive and less liable
to ferment, and is preferable whereverit can be used. Again, Milk
and the preparations from milk are amost important article of food for the sick.
Butter is the lightest kind of animalfat. And though it wants the

(01:48:29):
sugar and some of the other elementswhich there are in milk, yet it
is most valuable both in itself andin enabling the patient to eat more.
Bread. Flour, oats, groats, barley, and their kind are as
we have already said, preferable inall their preparations to all the preparations of
arrowroot, sago, tapiocre and theirkind. Cream, in many long chronic

(01:48:55):
diseases is quite irreplaceable by any otherarticle whatever. It seems to act in
the same manner as beef tea,and to most it is much easier of
digestion than the milk. In fact, it seldom disagrees. Cheese is not
usually digestible by the sick, butit is pure nourishment for repairing waste.
And I have seen sick, andnot a few either whose craving for cheese

(01:49:19):
showed how much it was needed bythem. But if fresh milk is so
valuable a food for the sick,the least change or sourness in it makes
it. Of all articles, perhapsthe most Injurious diarrhea is a common result
of fresh milk allowed to become atall sour The nurse therefore ought to exercise

(01:49:43):
her utmost care in this In largeinstitutions for the sick, even the poorest,
the utmost care is exercised whenham lakeice is used for this express purpose
every summer. While the private patientperhaps never tastes a drop of milk that
is not sour all through the hotweather, so little does the private nurse

(01:50:04):
understand the necessity of such care.Yet, if you consider that the only
drop of real nourishment in your patient'stea is the drop of milk, and
how much almost all English patients dependupon their tea, you will see the
great importance of not depriving your patientof this drop of milk. Buttermilk,

(01:50:26):
a totally different thing, is oftenvery useful, especially in fevers, in
laying down rules of diet by theamounts of solid nutriment in different kinds of
food. It is constantly lost sightof what the patient requires to repair his
waist, what he can take andwhat he cannot. You cannot diet a

(01:50:46):
patient from a book. You cannotmake up the human body as you would
make up a prescription. So manyparts carboniferous, so many parts nitrogenous,
will constitute a perfect diet for thepatient. The nurse's observation here will materially
assist the doctor. The patients fancieswill materially assist the nurse. For instance,

(01:51:11):
sugar is one of the most nutritiveof all articles, being pure carbon,
and is particularly recommended in some books. But the vast majority of all
patients in England, young and old, male and female, rich and poor,
hospital and private, dislike sweet things. And while I have never known
a person take to sweets while hewas ill, who disliked them when he

(01:51:34):
was well, I have known manyfond of them when in health, who
in sickness would leave off anything sweet, even to sugar in tea, sweet
puddings, sweet drinks are their aversion. The furred tongue almost always likes what
is sharp or pungent scorbutic patients arean exception. They often crave for sweetmeats

(01:51:57):
and jams. Jelly is another articleof diet in great favor with nurses and
friends of the sick. Even ifit could be eaten solid, it would
not nourish. But it is simplythe height of folly to take an eighth
of an ounce of gelatine and makeit into a certain bulk by dissolving it
in water, and then to giveit to the sick, as if the
mere bulk represented nourishment. It isnow known that jelly does not nourish,

(01:52:24):
that it has a tendency to producediarrhea, and to trust to it to
repair the waste of a diseased constitutionis simply to starve the sick under the
guise of feeding them. If ahundred spoonfuls of jelly were given in the
course of the day, you wouldhave given one spoonful of gelatine, which
spoonful has no nutritive power whatever,And nevertheless, gelatine contains a large quantity

(01:52:48):
of nitrogen, which is one ofthe most powerful elements in nutrition. On
the other hand, beef tea maybe chosen as an illustration of great nutrient
power in sickness, coexisting with avery small amount of solid nitrogenous matter.
Doctor Christensen says that everyone will bestruck with the readiness with which certain classes

(01:53:10):
of patience will often take diluted meat, juice or beef tea repeatedly when they
refuse all other kinds of food.This is particularly remarkable in cases of gastric
fever, in which he says,little or nothing else besides beef tea or
diluted meat juice has been taken forweeks or even months, and yet a

(01:53:30):
pint of beef tea contains scarcely aquarter of an ounce of anything but water.
The result is so striking that heasks what is its mode of action?
Not simply nutrient? A quarter ounceof the most nutritive material cannot nearly
replace the daily wear and tear ofthe tissues in any circumstances. Possibly,

(01:53:53):
he says it belongs to a newdenomination of remedies. It has been observed
that a small quantity of beef teaadded to other articles of nutrition augments their
power out of all proportion to theadditional amount of solid matter. The reason
why jelly should be innutritious and beeftea nutritious to the sick is a secret

(01:54:15):
yet undiscovered, but it clearly showsthat careful observation of the sick is the
only clue to the best dietary chemistryhas yet afford a little insight into the
dieting of the sick. All thatchemistry can tell us is the amount of
carboniferous or nitrogenous elements discoverable in differentdietic articles. It has given us lists

(01:54:39):
of dietic substances arranged in the orderof their richness in one or other of
these principles, but that is all. In the great majority of cases,
the stomach of the patient is guidedby other principles of selection than merely the
amount of carbon or nitrogen in thediet. No doubt in this, as
in other things, Nature has verydefinite rules for her guidance. But these

(01:55:02):
rules can only be ascertained by themost careful observation at the bedside. She
there teaches us that living chemistry,the chemistry of reparation, is something different
from the chemistry of the laboratory.Organic chemistry is useful, as all knowledge
is, when we come face toface with nature, but it by no

(01:55:25):
means follows that we should learn inthe laboratory any one of the reparative processes
going on in disease. Again,the nutritive power of milk and of the
preparations from milk, is very muchundervalued. There is nearly as much nourishment
in half a pint of milk asthere is in quarter a pound of meat.

(01:55:45):
But this is not the whole question. Or nearly the whole. The
main question is what the patient's stomachcan assimilate or derive nourishment from, and
of this the patient's stomach is thesole judge. Chemistry cannot tell us this.
The patient's stomach must be its ownchemist. The diet which will keep

(01:56:06):
the healthy man healthy will kill thesick one. The same beef, which
is the most nutritive of all meat, and which nourishes the healthy man,
is the least nourishing of all foodto the sick man, whose half dead
stomach can assimilate no part of it, that is, make no food out
of it. On a diet ofbeef tea. Healthy men, on the

(01:56:29):
other hand, speedily lose their strength. I have known patients live for many
months without touching bread because they couldnot eat baker's bread. These were mostly
country patients, but not all.Homemade bread or brown bread is a most
important article of diet for many patients. The use of asperians may be entirely

(01:56:54):
superseded by it. Oatcake is another. To watch for the opinions, then,
which the patient's stomach gives, ratherthan to read analyzes of foods,
is the business of all those whohave to settle what the patient is to
eat, perhaps the most important thingto be provided for him, after the
air he is to breathe. Now, the medical man who sees the patient

(01:57:18):
only once a day, or evenonly once or twice a week, cannot
possibly tell this without the assistance ofthe patient himself, or of those who
are in constant observation on the patient. The utmost the medical man can tell
is whether the patient is weaker orstronger at this visit than he was the
last visit. I should therefore saythat, incomparably, the most important office

(01:57:44):
of the nurse, after she hastaken care of the patient's heir, is
to take care to observe the effectof his food, and to report it
to the medical attendant. It isquite incalculable the good that would certainly come
from such sound and close observation inthis almost neglected branch of nursing, or
the help it would give to themedical man. A great deal too much

(01:58:10):
against tea is said by wise people, and a great deal too much of
tea is given to the sick byfoolish people. When you see the natural
and almost universal craving in English sickfor their tea, you cannot but feel
that nature knows what she is about. But a little tea or coffee restores

(01:58:30):
them quite as much as a greatdeal, and a great deal of tea,
and especially of coffee impairs the littlepower of digestion they have. Yet
a nurse, because she sees howone or two cups of tea or coffee
restores her patient, thinks that threeor four cups will do twice as much.
It is, however, certain thatthere is nothing yet discovered which is

(01:58:53):
a substitute to the English patient forhis cup of tea. He can take
it when he can take nothing else, and he often can't take anything else
if he has it not. Ishould be very glad if any of the
abuses of tea would point out whatto give to an English patient after a
sleepless night instead of tea, Ifyou give it at five or six o'clock

(01:59:15):
in the morning, he may evensometimes fall asleep after it and get perhaps
his only two or three hours sleepduring the twenty four At the same time,
you should never give tea or coffeeto the sick as a rule after
five o'clock in the afternoon. Sleeplessnessin the early night is from excitement generally,
and is increased by tea or coffee. Sleeplessness, which continues to the

(01:59:41):
early morning, is from exhaustion oftenand is relieved by tea. The only
English patients I have ever known refusetea have been typhus cases, and the
first sign of their getting better wastheir craving again for tea. In general,
the dry and dirty tongue always preferstea to coffee, and will quite

(02:00:03):
decline milk unless with tea. Coffeeis a better restorative than tea, but
a greater impairer of the digestion.Let the patient's taste decide. You will
say that in cases of great thirst, the patient's craving decides that it will
drink a great deal of tea,and that you cannot help it. But

(02:00:28):
in these cases be sure that thepatient requires diluents for quite other purposes than
quenching the thirst. He wants agreat deal of some drink, not only
of tea, and the doctor willorder what he is to have barley water
or lemonade, or soda water andmilk, as the case may be.
Lemon quoted by doctor Christensen, saysthat among the well and active, the

(02:00:51):
infusion of one ounce of roasted coffeedaily will diminish the waste going on in
the body by one fourth, anddoctor Christensen adds that tea has the same
property. Now this is actual experiment. Lemon weighs the man and finds the
fact from his weight. It isnot deduced from any analysis of food.

(02:01:15):
All experience among the sick shows thesame thing. Coco is often recommended to
the sick in lieu of tea orcoffee, but independently of the fact that
English sick very generally dislike coco.It has quite a different effect from tea
or coffee. It is an oily, starchy nut, having no restorative power

(02:01:36):
at all, but simply increasing fat. It is pure mockery of the sick.
Therefore, to call it a substitutefor tea, for any renovating stimulus
it has, you might just aswell offer them chestnuts instead of tea.
An almost universal error among nurses isin the bulk of the food and especially

(02:01:57):
the drinks they offer to their patients. Suppose a patient ordered four ounces of
brandy during the day, How ishe to take this if you make it
into four pints with diluting it thesame with tea and beef tea with arrowroot
milk, et cetera. You havenot increased the nourishment. You have not
increased the renovating power of these articles. By increasing their bulk, you have

(02:02:21):
very likely diminished both by giving thepatient's digestion more to do. And most
likely of all, the patient willleave half of what he has been ordered
to take because he cannot swallow thebulk with which you have been pleased to
invest it. It requires very niceobservation and care, and meets with hardly

(02:02:41):
any to determine what will not betoo thick or strong for the patient to
take, while giving him no morethan the bulk which he is able to
swallow. End of Section seven.Section eight. Bed and bedding. A
few words upon bedsteads and bedding,and principally as regards patients who are entirely

(02:03:03):
or almost entirely confined to bed feverishnessis generally supposed to be a symptom of
fever. In nine cases out often, it is a symptom of bedding.
The patient has had reintroduced into thebody the emanations from himself, which
day after day and week after weeksaturate his unaired bedding. How can it

(02:03:27):
be otherwise? Look at the ordinarybed in which a patient lies. If
I were looking out for an example, in order to show what not to
do, I should take the specimenof an ordinary bed in a private house,
a wooden bedstead, two or eventhree mattresses piled up to above the
height of a table, a valanceattached to the frame. Nothing but a

(02:03:49):
miracle could ever thoroughly dry or airsuch a bed and bedding. The patient
must inevitably alternate between cold damp afterhis bed is made and warm damp before,
both saturated with organic matter. Andthis from the time the mattresses are
put under him till the time theyare picked to pieces, if this is

(02:04:09):
ever done. If you consider thatan adult in health exhales by the lungs
and skin in the twenty four hoursthree pints at least of moisture loaded with
organic matter ready to enter into putrefaction, that in sickness the quantity is often
greatly increased, the quality is alwaysmore noxious. Just ask yourself next,

(02:04:30):
where does all this moisture go to? Chiefly into the bedding, because it
cannot go anywhere else, and itstays there because except perhaps a weekly change
of sheets. Scarcely any other airingis attempted. A nurse will be careful
to fidgetiness about airing the clean sheetsfrom clean damp, but airing the dirty

(02:04:53):
sheets from noxiou stamp will never evenoccur to her. Besides this, the
most dangerous affluvia we know of arefrom the excretia of the sick. These
are placed, at least temporarily,where they must throw their affluvia into the
underside of the bed, and thespace under the bed is never aired.
It cannot be with our arrangements.Must not such a bed be always saturated,

(02:05:19):
and be always the means of reintroducinginto the system of the unfortunate patient
who lies in it that excrementitious matter, to eliminate which from the body nature
had expressly appointed the disease. Myheart always sinks within me when I hear
the good housewife of every class say, I assure you the bed has been

(02:05:41):
well slept in, And I canonly hope it is not true. What
is the bed already saturated with somebodyelse's damp before my patient comes to exhale
into it his own damp? Hasit not had a single chance to be
aired. No, not one.It has been slept in every name.

(02:06:01):
The only way of really nursing areal patient is to have an iron bedstead
with reoclined springs, which are permeableby the air up to the very mattress
no valence, of course, themattress to be a thin hair one,
the beds to be not above threeand a half feet wide. If the
patient be entirely confined to his bed, there should be two such bedsteads,

(02:06:26):
each beds to be made with mattress, sheets, blankets, et cetera.
Complete the patient to pass twelve hoursin each bed, on no account to
carry his sheets with him, thewhole of the bedding to be hung up
to air for each intermediate twelve hours. Of course, there are many cases
where this cannot be done at all, many more where only an approach to

(02:06:48):
it can be made. I amindicating the ideal of nursing and what I
have actually had done. But aboutthe kind of bedstead, there can be
no doubt whether there be one ortwo. Provided there is a prejudice in
favor of a wide bed, Ibelieve it to be a prejudice. All

(02:07:08):
the refreshment of moving a patient fromone side to the other of his bed
is far more effectually secured by puttinghim into a fresh bed, And a
patient who is really very ill doesnot stray far in bed. But it
is said there is no room toput down a tray on a narrow bed.
No goodness will ever put a trayon a bed at all. If

(02:07:30):
the patient can turn on his side, he will eat more comfortably from a
bedside table. And on no accountwhatever should a bed ever be higher than
a sofa. Otherwise the patient feelshimself out of humanity's reach. He can
get at nothing for himself, hecan move nothing for himself. If the
patient cannot turn a table over,the bed is a better thing. I

(02:07:56):
need hardly say that a patient's bedshould never have its side against the wall.
The nurse must be able to geteasily to both sides of the bed,
and to reach easily every part ofthe patient without stretching. A thing
impossible if the bed be either toowide or too high. When I see
a patient in a room nine orten feet high upon a bed between four

(02:08:18):
and five feet high, with hishead when he is sitting up in bed
actually within two or three feet ofthe ceiling, I ask myself, is
this expressly planned to produce that peculiarlydistressing feeling common to the sick? That
is, as if the walls andceiling were closing in upon them, and
they becoming sandwiches between floor and ceiling, which imagination is not indeed here so

(02:08:43):
far from the truth. If overand above this the window stops short of
the ceiling, then the patient's headmay literally be raised above the stratum of
fresh air, even when the windowis open. Can human perversity any farther
go in unmaking the process of restorationwhich God has made. The fact is

(02:09:07):
that the heads of sleepers or ofsick should never be higher than the throat
of the chimney, which ensures theirbeing in the current of best air.
And we will not suppose it possiblethat you have closed your chimney with a
chimney board. If a bed ishigher than a sofa, the difference of
the fatigue of getting in and outof bed will just make the difference very

(02:09:28):
often to the patient who can getin and out of bed at all,
of being able to take a fewminutes exercise, either in the open air
or in another room. It isso very odd that people never think of
this, or of how many moretimes a patient who is in bed for
the twenty four hours is obliged toget in and out of bed than they

(02:09:50):
are who only it is to behoped get into bed once and out of
bed once during the twenty four hours. A patient's bed should all be in
the lightest spot in the room,and he should be able to see out
of window. I need scarcely saythat the old four post bed with curtains
is utterly inadmissible, whether for sickor well. Hospital bedsteads are, in

(02:10:15):
many respects very much less objectionable thanprivate ones. There is reason to believe
that not a few of the apparentlyunaccountable cases of scrofula among children proceed from
the habit of sleeping with a headunder the bedclothes, and so inhaling air
already breathed, which is farther contaminatedby exhalations from the skin. Patients are

(02:10:39):
sometimes given to a similar habit,and it often happens that the bed clothes
are so disposed that the patient mustnecessarily breathe air more or less contaminated by
exhalations from his skin. A goodnurse will be careful to attend to this.
It is an important part. Soto speak of ventilation. It may
be worth while to remark that wherethere is any danger of bed saws,

(02:11:03):
a blanket should never be placed underthe patient. It retains damp and acts
like a poultice. Never use anythingbut light whitney blankets as bed covering for
the sick. The heavy cotton imperviouscounterpane is bad for the very reason that
it keeps in the emanations from thesick person, while the blanket allows them

(02:11:26):
to pass through. Weak patients areinvariably distressed by a great weight of bedclothes,
which often prevents their getting any soundsleep. Whatever, note one word
about pillows. Every weak patient,be his illness, what it may suffers
more or less from difficulty in breathing. To take the weight of the body

(02:11:48):
off the poor chest, which ishardly up to its work. As it
is ought therefore to be the objectof the nurse in arranging his pillows.
Now, what does she do andwhat are the consequences? She piles the
pillows one atop the other like awall of bricks. The head is thrown
upon the chest, and the shouldersare pushed forward so as not to allow

(02:12:09):
the lung's room to expand. Thepillows in fact lean upon the patient,
not the patient upon the pillows.It is impossible to give a rule for
this because it must vary with thefigure of the patient, and tall patients
suffer much more than short ones becauseof the drag of the long limbs upon
the waist. But the object isto support with the pillows the back below

(02:12:33):
the breathing apparatus, to allow theshoulders room to fall back, and to
support the head without throwing it forward. The suffering of dying patients is immensely
increased by neglect of these points,and many an invalid, too weak to
drag about his pillows himself slips hisbook or anything at hand behind the lower

(02:12:54):
part of his back to support it. End of Section eight. Section nine.
Light. It is the unqualified resultof all my experience with the sick
that second only to their need offresh air is their need of light.
That after a close room, whathurts the most is a dark room,

(02:13:18):
and that it is not only lightbut direct sunlight they want. I had
rather have the power of carrying mypatient about after the sun. According to
the aspect of the rooms. Ifcircumstances permit, than let him linger in
a room when the sun is off. People think the effect is upon the
spirits only. This is by nomeans the case. The sun is not

(02:13:43):
only a painter, but a sculptor. You admit that he does the photograph.
Without going into any scientific exposition,we must admit that light has quite
as real and tangible effects upon thehuman body. But this is not all
who has not observed the purifying effectof light, and especially of direct sunlight

(02:14:07):
upon the air of a room.Here is an observation within everybody's experience.
Go into a room where the shuttersare always shut, in a sick room
or a bedroom, there should neverbe shutters shut. And though the room
be uninhabited, though the air hasnever been polluted by the breathing of human
beings, you will observe a close, musty smell of corrupt air, of

(02:14:30):
air that is unpurified by the effectof the sun's rays. The mustiness of
dark rooms and corners, indeed,is proverbial. The cheerfulness of a room,
the usefulness of light in treating diseaseis all important. A very high
authority in hospital construction has said thatpeople do not enough consider the difference between

(02:14:54):
wards and dormitories in planning their buildings. But I go farther and say that
healthy people never remember the difference betweenbedrooms and sick rooms in making arrangements for
the sick. To a sleeper inhealth, it does not signify what the
view is from his bed. Heought never to be in it, excepting

(02:15:15):
when asleep and at night. Aspectdoes not very much signify either, provided
the sun reach his bedroom at sometime in every day to purify the air,
because he ought never to be inhis bedroom except during the hours when
there is no sun. But thecase is exactly reversed with the sick,
even should they be as many hoursout of their beds as you are in

(02:15:37):
the oars, which probably they arenot. Therefore that they should be able
without raising themselves or turning in bed, to see out of window from their
beds, to see sky and sunlight, at least if you can show them
nothing else, I assert to be, if not of the very first importance
for recovery, at least something verynear it. And you should therefore look

(02:16:01):
to the position of the beds ofyour sick. One of the very first
things if they can see out oftwo windows instead of one, so much
the better. Again, the morningsun and the midday sun, the hours
when they are quite certain not tobe up, are of more importance to
them. If a choice must bemade than the afternoon sun, perhaps you

(02:16:24):
can take them out of bed inthe afternoon and set them by the window
where they can see the sun.But the best rule is, if possible,
to give them direct sunlight from themoment he rises till the moment he
sets. Another great difference between thebedroom and the sick room is that the

(02:16:45):
sleeper has a very large balance offresh air to begin with when he begins
the night. If his room hasbeen open all day, as it ought
to be, the sick man hasnot, because all day he has been
breathing the air in the same roomand dirte it by the emanations from himself.
Far more care is therefore necessary tokeep up a constant change of air

(02:17:07):
in the sick room. It ishardly necessary to add that there are acute
cases, particularly a few ophthalmic casesand diseases where the eye is morbidly sensitive,
where a subdued light is necessary,but a dark north room is inadmissible
even for these you can always moderatethe light by blinds and curtains. Heavy

(02:17:31):
thick, dark window or bed curtainsshould, however, hardly ever be used
for any kind of sick in thiscountry. A light white curtain at the
head of the bed is in generalall that is necessary, and a green
blind to the window to be drawndown only when necessary. One of the

(02:17:52):
greatest observers of human things, notphysiological, says in another language, where
there is there is thought, allphysiology goes to confirm this. Where is
the shady side of deep valleys thereis cretinism, where as sellers and the
unsunned sides of narrow streets there isthe degeneracy and weakliness of the human race,

(02:18:18):
mind and body equally degenerating. Putthe pale, withering plant and human
being into the sun, and ifnot too far gone, each will recover
health and spirit. It is acurious thing to observe how almost all patients
lie with their faces turned towards thelight, exactly as plants always make their

(02:18:41):
way towards the light. A patientwill even complain that it gives him pain
lying on that side. Then whydo you lie on that side? He
does not know but we do.It is because it is the side towards
the window. A fashionable physician hasrecently published in a government report that he

(02:19:01):
always turns his patient's faces from thelight. Yes, but nature is stronger
than fashionable physicians, and depend uponit. She turns the phases back and
towards such light as she can get. Walk through the wards of a hospital.
Remember the bedsides of private patients youhave seen, and count how many

(02:19:22):
sick you ever saw lying with theirfaces towards the wall. End of Section
nine, Section ten cleanliness of roomsand walls. It cannot be necessary to
tell on us that she should beclean, or that she should keep her

(02:19:43):
patient clean, seeing that the greaterpart of nursing consists in preserving cleanliness.
No ventilation can freshen a room orward where the most scrupulous cleanliness is not
observed unless the wind be blowing throughthe windows at the rate of twenty miles
an hour. Dusty carpets, dirtywainscots, musty curtains and furniture will infallibly

(02:20:07):
produce a close smell. I havelived in a large and expensively furnished London
house where the only constant inmate intwo very lofty rooms with opposite windows was
myself, And yet owing to theabove mentioned dirty circumstances, no opening of
windows could ever keep those rooms fromcloseness. But the carpet and curtains having

(02:20:31):
been turned out of the rooms altogether, they became instantly as fresh as could
be wished. It is pure nonsenseto say that in London a room cannot
be kept clean. Many of ourhospitals show the exact reverse. But no
particle of dust is ever or canever be removed or really got rid of,

(02:20:52):
by the present system of dusting.Dusting in these days means nothing but
flapping the dust from one part ofa room on to another, with doors
and windows closed. What you doit for? I cannot think you had
much better leave the dust alone ifyou are not going to take it away
altogether. For from the time aroom begins to be a room up to

(02:21:15):
the time when it ceases to beone, no one atom of dust ever
actually leaves its precincts. Tidying aroom means nothing now but removing a thing
from one place, which it haskept clean for itself, on to another,
and a dirtier one, flapping byway of cleaning is only admissible in

(02:21:35):
the case of pictures or anything madeof paper. The only way I know
to remove dust, the plague ofall lovers of fresh air, is to
wipe everything with a damp cloth.And all furniture ought to be so made
as that it may be wiped witha damp cloth without injury to itself,
and so polished as that it maybe damped without injury to others. To

(02:21:58):
dust, as it is now practiced, truly means to distribute dust more equally
over a room as to floors.The only really clean floor I know is
the Berlin lacquered floor, which iswet rubbed and dry rubbed every morning to
remove the dust. The French parquetis always more or less dusty, although

(02:22:22):
infinitely superior in point of cleanliness andhealthiness to our absorbent floor. For a
sick room, a carpet is perhapsthe worst expedient which could, by any
possibility have been invented. If youmust have a carpet, the only safety
is to take it up two orthree times a year instead of once.

(02:22:43):
A dirty carpet literally infects the room, and if you consider the enormous quantity
of organic matter from the feet ofpeople coming in, which must saturate it.
This is by no means surprising.As for walls, the worst is
the papered wall. The next worstis plaster. But the plaster can be

(02:23:05):
redeemed by frequent lime washing. Thepaper requires frequent renewing. A glazed paper
gets rid of a good deal ofthe danger. But the ordinary bedroom paper
is all that it ought not tobe. The close connection between ventilation and
cleanliness is shown in this. Anordinary light paper will last clean much longer

(02:23:30):
if there is an Arnot's ventilator inthe chimney than it otherwise would. The
best wall, now extant is oilpaint. From this you can wash the
animal exuvii. These are what makea room musty. The best wall for
a sick room or ward that couldbe made is pure white, non absorbent

(02:23:52):
cement, or glass or glazed tiles, if they were made slightly enough.
Air can be soiled, just likewater. If you blow into water,
you will soil it with the animalmatter from your breath. So it is
with air. Air is always soiled. In a room where walls and carpets
are saturated with animal exhalations, wantof cleanliness, then in rooms and wards

(02:24:18):
which you have to guard against,may arise in three ways. One dirty
air coming in from without, soiledby sewer emanations, the evaporation from dirty
streets, smoke, bits of unburntfuel, bits of straw, bits of
horse dung. If people would butcover the outside walls of their houses with

(02:24:41):
plain or encaustic tiles, what anincalculable improvement would there be in light,
cleanliness, dryness, warmth, andconsequently economy. The play of a fire
engine would then effectually wash the outsideof a house. This kind of walling
would stand next to paving in improvingthe health of towns. Two dirty air

(02:25:07):
coming from within from dust which youoften displace but never remove. And this
recalls what ought to be a sineque. Non have as few ledges in your
room or ward as possible, andunder no pretense have any ledge whatever out
of sight. Dust accumulates there andwill never be wiped off. This is

(02:25:28):
a certain way to soil the air. Besides this, the animal exhalations from
your inmates saturate your furniture. Andif you never clean your furniture properly,
how can your rooms or wards beanything but musty? Ventilate as you please,
the rooms will never be sweet.Besides this, there is a constant

(02:25:52):
degradation, as it is called,taking place from everything except polished or glazed
articles. Example, in coloring certaingreen papers, arsenic is used. Now
in the very dust even which islying about rooms hung with this kind of
green paper, arsenic has been distinctlydetected. You see, your dust is

(02:26:16):
anything but harmless. Yet you willlet such dust lie about your ledges for
months, your rooms forever. Againthe fire fills the room with coal dust.
Three. Dirty air coming from thecarpet. Above all, take care
of the carpets that the animal dirtleft there by the feet of visitors does

(02:26:39):
not stay there. Floors unless thegrain is filled up and polished, are
just as bad. The smell fromthe floor of a schoolroom or ward,
when any moisture brings out the organicmatter by which it is saturated, might
alone be enough to warn us ofthe mischief that is going on. The

(02:27:00):
Air, then, can only bekept clean by sanitary improvements and by consuming
smoke. The expense in soap whichthis single improvement would save is quite incalculable.
The inside air can only be keptclean by excessive care in the ways
mentioned above to rid the walls,carpets, furniture, ledges, et cetera,

(02:27:22):
of the organic matter and dust dustconsisting greatly of this organic matter with
which they become saturated, and whichis what really makes the room musty.
Without cleanliness, you cannot have allthe effect of ventilation. Without ventilation,
you can have no thorough cleanliness.Very few people, be they of what

(02:27:46):
class they may, have any ideaof the exquisite cleanliness required in the sick
room. For much of what Ihave said applies less to the hospital than
to the private sickroom. The smokychimney, the dusty furniture, the utensils
emptied, but once a day oftenkeep the air of the sick constantly dirty.

(02:28:09):
In the best private houses, thewell have a curious habit of forgetting
that what is to them but atrifling inconvenience to be patiently put up with,
is to the sick a source ofsuffering, delaying recovery, if not
actually hastening death. The well arescarcely ever more than eight hours at most

(02:28:30):
in the same room. Some changethey can always make, if only for
a few minutes. Even during thesupposed eight hours they can change their posture
or their position in the room.But the sick man who never leaves his
bed, who cannot change by anymovement of his own, his air,
or his light, or his warmth, who cannot obtain quiet or get out

(02:28:54):
of the smoke or the smell orthe dust, he is really poisoned or
depressed by what is to you themerest trifle. What can't be cured,
must be endured. Is the veryworst and most dangerous maxim for a nurse,
which ever was made. Patience andresignation in her are but other words

(02:29:15):
for carelessness or indifference, contemptible ifin regard to herself, culpable if in
regard to her sick. End ofSection ten, Section eleven personal cleanliness.
In almost all diseases, the functionof the skin is more or less disordered,

(02:29:39):
and in many most important diseases,nature relieves herself almost entirely by the
skin. This is particularly the casewith children. But the excretion which comes
from the skin is left there unlessremoved by washing or by the clothes.
Every nurse should keep this fact constantlyin mind, for if she allow her

(02:30:01):
sick to remain unwashed, or theirclothing to remain on them after being saturated
with perspiration or other excretion. Sheis interfering injuriously with the natural processes of
health, just as effectually as ifshe were to give the patient a dose
of slow poison by the mouth.Poisoning by the skin is no less certain

(02:30:22):
than poisoning by the mouth, onlyit is slower in its operation. The
amount of relief and comfort experienced bysick after the skin has been carefully washed
and dried is one of the commonestobservations made at a sick bed. But
it must not be forgotten that thecomfort and relief so obtained are not all.

(02:30:45):
They are, in fact, nothingmore than a sign that the vital
powers have been relieved by removing somethingthat was oppressing them. The nurse therefore
must never put off attending to thepersonal cleanliness of her patient under the Please
see that all that is to begained is a little relief, which can
be quite as well given later.In all well regulated hospitals this ought to

(02:31:07):
be and generally is attended to,but it is very generally neglected with private
sick Just as it is necessary torenew the air round a sick person,
frequently to carry off morbid effluvia fromthe lungs and skin by maintaining free ventilation.
So is it necessary to keep thepores of the skin free from all

(02:31:30):
obstructing excretions. The object both ofventilation and of skin cleanliness is pretty much
the same, to it removing noxiousmatter from the system as rapidly as possible.
Care should be taken in all theseoperations of sponging, washing and cleansing

(02:31:50):
the skin not to expose too greata surface at once, so as to
check the perspiration which would renew theevil in another form. The various ways
of washing the sick need not herebe specified, the less so as the
doctors ought to say which is tobe used. In several forms of diarrhea,

(02:32:11):
dysentery, et cetera. Where theskin is hard and harsh, the
relief afforded by washing with a greatdeal of soft soap is incalculable. In
other cases, sponging with tepid soapand water, then with tepid water and
drying with a hot towel will beordered. Every nurse ought to be careful

(02:32:33):
to wash her hands very frequently duringthe day, if her face too,
so much the better. One wordas to cleanliness merely as cleanliness, Compare
the dirtiness of the water in whichyou have washed. When it is cold
without soap, cold with soap,hot with soap. You will find the

(02:32:56):
first has hardly removed any dirt atall, the second a little more,
the third a great deal more.But hold your hand over a cup of
hot water for a minute or two, and then by merely rubbing with the
finger, you will bring off flakesof dirt or dirty skin. After a
vapor bath, you may peel yourwhole self clean. In this way.

(02:33:20):
What I mean is that by simplywashing or sponging with water, you do
not really clean your skin. Takea rough towel, dip one corner in
very hot water. If little spiritbe added to it, it will be
more effectual, and then rub asif you were rubbing the towel into your
skin with your fingers. The blackflakes which will come off will convince you

(02:33:43):
that you were not clean before.However much soap and water you have used,
these flakes are what require removing,and you can really keep yourself cleaner
with a tumbler of hot water anda rough towel and rubbing than with a
whole apparatus of bath and soap andsponge without rubbing. It is quite nonsense

(02:34:05):
to say that anybody need be dirty. Patients have been kept clean by these
means on a long voyage when abasin full of water could not be afforded,
and when they could not be movedout of their berths, as if
all the appertinences of home had beenat hand. Washing, however, with
a large quantity of water, hasquite other effects than those of mere cleaniness.

(02:34:30):
The skin absorbs the water and becomessofter and more perspirable to wash with
soap and soft water is therefore desirablefrom other points of view than that of
cleanliness. End of Section eleven,Section twelve. Chattering hopes and advices the

(02:34:54):
sick man to his advisers, Myadvisers, the name is Legion. Somehow
or other, it seems a provisionof the universal destinies that every man,
woman and child should consider hymn heror itself privileged, especially to advise me.
Why that is precisely what I wantto know, and this is what

(02:35:20):
I have to say to them.I have been advised to go to every
place extant in and out of Englandto take every kind of exercise by every
kind of cart carriage, Yes,and even swing and dumb bell in existence,
to imbibe every different kind of stimulusthat ever has been invented. And

(02:35:41):
this when those best fitted to knowthat his medical men, after long and
close attendants, had declared any journeyout of the question, had prohibited any
kind of motion whatever, had closelylaid down the diet and drink. What
would my advisers say, were theythe medical attendants, and I the patient,

(02:36:03):
left their advice and took the casualadvisers. But the singularity in Legion's
mind is this. It never occursto him that everybody else is doing the
same thing, and that I,the patient must perforce say in sheer defense
like Rosalind I could not do withall chattering hopes may seem an odd heading,

(02:36:28):
but I really believe there is scarcelya greater worry which invalids have to
endure than the incurable hopes of theirfriends. There is no one practice against
which I can speak more strongly fromactual personal experience, wide and long of
its effects during sickness, observed bothupon others and upon myself. I would

(02:36:52):
appeal most seriously to all friends,visitors, and attendants of the sick to
leave off this practice of attempting tocheer the sick by making light of their
danger and by exaggerating their probabilities ofrecovery. Far more now than formerly does
the medical attendant tell the truth tothe sick, who are really desirous to

(02:37:13):
hear it about their own state.How intense is the folly, then,
to say the least of it ofthe friend, be he even a medical
man who thinks that his opinion,given after cursory observation, will weigh with
the patient against the opinion of themedical attendant, given perhaps after years of
observation, after using every help todiagnosis afforded by the stethoscope, the examination

(02:37:39):
of pulse, tongue, etc.And certainly after much more observation than the
friend can possibly have had. Supposingthe patient to be possessed of common sense,
how can the favorable opinion, ifit is to be called an opinion
at all, of the casual visitor, cheer him when different from that of
the experienced deay tenant. Unquestionably,the latter may and often does turn out

(02:38:05):
to be wrong, But which ismost likely to be wrong the fact is
that the patient is not cheered atall by these well meaning, most tiresome
friends. On the contrary, heis depressed and wearied. If, on
the one hand, he exerts himselfto tell each successive member of this too

(02:38:26):
numerous conspiracy, whose name is Legion, why he does not think as they
do, in what respect he isworse? What symptoms exist that they know
nothing of? He is fatigued insteadof cheered, and his attention is fixed
upon himself. In general, patientswho are really ill do not want to

(02:38:46):
talk about themselves. Hypochondriacs do.But again I say, we are not
on the subject of hypochondriacs. If, on the other hand, and which
is much more frequently the case,the patient says nothing but the shakespearian oh
ah, go too, and ingood sooth, in order to escape from

(02:39:09):
the conversation about himself. The soonerhe is depressed by want of sympathy.
He feels isolated in the midst offriends. He feels what convenience it would
be if there were any single personto whom he could speak simply and openly,
without pulling the string upon himself ofthis shower bath of silly hopes and

(02:39:30):
encouragements to whom he could express hiswishes and directions without that person persisting in
saying, I hope that it willplease God yet to give you twenty years,
or you have a long life ofactivity before you. How often we
see, at the end of biographiesor of cases recorded in medical papers,

(02:39:50):
after a long illness, a diedrather suddenly or unexpectedly, both to himself
and to others, unexpectedly to othersperhaps who did not see because they did
not look, but by no meansunexpectedly to himself. As I feel entitled
to believe, both from the internalevidence in such stories and from watching similar

(02:40:13):
cases, there was every reason toexpect that A would die, and he
knew it, but he found ituseless to insist upon his own knowledge to
his friends. In these remarks,I am alluding neither to acute cases which
terminate rapidly, nor to nervous cases. By the first much interest in their

(02:40:35):
own danger is very rarely felt inwritings of fiction, whether novels or biographies.
These deathbeds are generally depicted as almostseraphic in lucidity of intelligence. Sadly
large has been my experience in deathbedsand I can only say that I have
seldom or never seen such indifference,excepting with regard to bodies suffering, or

(02:41:01):
to some duty the dying man desiresto perform. Is the far more usual
state. The nervous case, onthe other hand, delights in figuring to
himself and others a fictitious danger.But the long chronic case, who knows
too well himself, and who hasbeen told by his physician that he will

(02:41:22):
never enter active life again, whofeels that every month he has to give
up something he could do the monthbefore. Oh, spare such sufferers your
chattering hopes. You do not knowhow you worry and weary them. Such
real sufferers cannot bear to talk ofthemselves, still less to hope of what
they cannot at all expect. Soalso as to all the advice showered so

(02:41:48):
profusely upon such sick to leave offsome occupation, to try some other doctor,
some other house, climate, pill, powder, or specific I say
nothing of the inco consistency, forthese advisers are sure to be the same
persons who exhorted the sick person notto believe his own doctor's prognostics, because
doctors are always mistaken, but tobelieve some other doctor because this doctor is

(02:42:13):
always right. Sure also of theseadvisers to be the persons to bring the
sick man fresh occupation while exhorting himto leave his own. Wonderful is the
face with which friends lay and medicalwill come in and worry the patient with
recommendations to do something or other,having just as little knowledge as to its

(02:42:35):
being feasible or even safe for him, as if they were to recommend a
man to take exercise not knowing hehad broken his leg. What would the
friend say if he were the medicalattendant, and if the patient, because
some other friend had come in,because somebody, anybody, nobody had recommended

(02:42:56):
something anything, nothing, were todisregard his orders and take that other body's
recommendations. But people never think ofthis. A celebrated historical personage has related
to the commonplaces, which, whenon the eve of executing a remarkable resolution,

(02:43:16):
were showered in nearly the same wordsby everyone around successively for a period
of six months. To these,the personage states that it was found least
trouble always to reply the same thing, that is, that it could not
be supposed that such a resolution hadbeen taken without sufficient previous consideration to patients

(02:43:39):
enduring every day for years, fromevery friend or acquaintance, either by letter
or vivavice, some torment of thiskind, I would suggest the same answer.
It would indeed be spared if suchfriends and acquaintances would. But consider
for one moment that it is probablythat the patient has heard such advice at

(02:44:01):
least fifty times before, and thathad it been practicable, it would have
been practiced long ago. But ofsuch consideration there appears to be no chance.
Strange though true, that people shouldbe just the same in these things
as they were a few hundred yearsago. To me, these commonplaces leaving

(02:44:26):
their smear upon the cheerful, singlehearted, constant devotion to duty, which
is so often seen in a declineof such sufferers. Recall the slimy trail
left by the snail on the sunnysouthern garden wall, loaded with fruit.
No mockery in the world is sohollow as the advice showered upon the sick.

(02:44:48):
It is of no use for thesick to say anything, for what
the adviser wants is not to knowthe truth about the state of the patient,
but to turn whatever the sick maysay to the support of his his
own argument set forth, it mustbe repeated without any inquiry whatever into the
patient's real condition. But it wouldbe impertinent or indecent in me to make

(02:45:11):
such an inquiry, says the adviser. True, and how much more impertinent
is it to give your advice whenyou can know nothing about the truth,
and admit you could not inquire intoit. To nurses, I say,
these are the visitors who do yourpatient harm. When you hear him told
one that he has nothing the matterwith him, and that he wants cheering,

(02:45:35):
two that he is committing suicide,and that he wants preventing. Three
that he is the tool of somebodywho makes use of him for a purpose.
Four that he will listen to nobody, but is obstinately bent upon his
own way, and five that heought to be called to the sense of
duty and is flying in the faceof providence. Then know that your patient

(02:45:58):
is receiving all the injury that hecan receive from a visitor. How little
the real sufferings of illness unknown orunderstood. How little does anyone in good
health fancy him or even herself intothe life of a sick person. Do

(02:46:18):
you who are about the sick.Or who visit the sick, try and
give them some pleasure, remember totell them what will do so? How
often in such visits the sick personhas to do the whole conversation, exerting
his own imagination and memory, whileyou would take the visitor absorbed in his
own anxieties, making no effort ofmemory or imagination for the sick person.

(02:46:43):
Oh my dear, I have somuch to think of. I really quite
forgot to tell him that. Besides, I thought he would know it,
says the visitor to another friend.How could he know it? Depend upon
it? The people who say thisare really those who have little to think
of. There are many burdened withbusiness who always manage to keep a pigeon

(02:47:05):
hole in their minds full of thingsto tell the invalid. I do not
say don't tell him your anxieties.I believe it is good for him,
and good for you too. Butif you tell him what is anxious,
surely you can remember to tell himwhat is pleasant too. A sick person
does so enjoy hearing good news,for instance, of a love and courtship

(02:47:30):
while in progress to a good ending. If you tell him only when the
marriage takes place, he loses halfthe pleasure which God knows he has little
enough of, and ten to one, but you have told him of some
love making with a bad ending.A sick person also intensely enjoys hearing of
any material good, any positive orpractical success of the right. He has

(02:47:56):
so much of books and fiction,of principles and precepts and theories. Do
instead of advising him with the advicehe has heard at least fifty times before,
tell him of one benevolent act whichhas really succeeded practically. It is
like a day's health to him.You have no idea what the craving of

(02:48:16):
sick with undiminished power of thinking butlittle power of doing is to hear of
good practical action when they can nolonger partake in it. Do observe these
things with the sick? Do youremember how their life is to them disappointed
and incomplete. You can see themlying there with miserable disappointments from which they

(02:48:39):
can have no escape but death,And you can't remember to tell them of
what would give them so much pleasureor at least an hour's variety. They
don't want you to be lachrymose andwhining with them. They like you to
be fresh and active and interested,but they cannot bear absence of mind,
and they are so tired of theadvice and preaching they receive from everybody,

(02:49:03):
no matter who it is. Theysee. There is no better society than
babies and sick people for one another. Of course, you must manage this
so that neither shall suffer from it, which is perfectly possible. If you
think the air of the sickroom badfor the baby, why it is bad
for the invalid too, and therefore, of course you will correct it for

(02:49:26):
both. It freshens up a sickperson's whole mental atmosphere to see the baby,
and for a young child, ifunspoiled, will generally adapt itself wonderfully
to the ways of a sick person, if the time they spend together is
not too long. If you knewhow unreasonably sick people suffer from reasonable causes

(02:49:48):
of distress, you would take morepains about all these things. An infant
laid upon the sick bed will dothe sick person, thus suffering more good
than all your logic. A pieceof good news will do the same.
Perhaps you are afraid of disturbing him. You say there is no comfort for
his present cause of affliction. Itis perfectly reasonable. The distinction is this,

(02:50:15):
if he is obliged to act,do not disturb him with another subject
of thought. Just yet, helphim to do what he wants to do.
But if he has done this,or nothing can be done, then
disturb him by all means. Youwill relieve more effectually unreasonable suffering from reasonable

(02:50:35):
causes by telling him the news,showing him the baby, or giving him
something new to think of or tolook at, than by all the logic
in the world. It has beenvery justly said that the sick are like
children in this, that there isno proportion in events to them. Now
it is your business, as theirvisitor, to restore this right proportion for

(02:50:58):
them. They show them what therest of the world is doing. How
can they find it out? Otherwiseyou will find them far more open to
conviction than children in this, andyou will find that their unreasonable intensity of
suffering from unkindness, from want ofsympathy, et cetera. Will disappear with
their freshened interest in the big world'sevents. But then you must be able

(02:51:22):
to give them real interests, notgossip. Note there are two classes of
patients, which are unfortunately becoming morecommon every day, especially among women of
the richer orders, to whom allthese remarks are pre eminently inapplicable. One
those who make health an excuse fordoing nothing, and at the same time

(02:51:46):
allege that the being able to donothing is their only grief. Two,
those who have brought upon themselves illhealth by over pursuit of amusement, which
they and their friends have most unhappilycalled intellectual activity. I scarcely know a
greater injury that can be inflicted thanthe advice too often given to the first

(02:52:07):
class to vegetate, or the admirationtoo often bestowed on the latter class for
pluck. End of Section twelve,Section thirteen observation of the sick. There
is no more silly or universal questionscarcely asked than this, is he better

(02:52:31):
ask it of the medical attendant,if you please, But of whom else
if you wish for a real answerto your question, would you ask it?
Certainly not of the casual visitor,Certainly not of the nurse. While
the nurse's observation is so little exercisedas it is now what do you want
of facts, not opinions? Forwho can have any opinion of any value

(02:52:54):
as to whether the patient is betteror worse, excepting the constant medical attendant
or the really observing nurse. Themost important practical lesson that can be given
to nurses is to teach them whatto observe, how to observe, what
symptoms indicate improvement, what the reverse, Which are of importance, which are

(02:53:18):
of none, Which are the evidenceof neglect? And of what kind of
neglect? All this is what oughtto make part and an essential part of
the training of every nurse. Atpresent, how few there are, either
professional or unprofessional, who really knowat all whether any sick person they may

(02:53:39):
be with is better or worse.The vagueness and looseness of the information one
receives. An answer to that muchabused question, is he better? Would
be ludicrous if it were not painful. The only sensible answer in the present
state of knowledge about sickness would behow can I know? I cannot tell

(02:54:03):
how he was when I was notwith him. I can record but a
very few specimens of the answers whichI have heard made by friends and nurses,
and accepted by physicians and surgeons atthe very bedside of the patient who
could have contradicted every word but didnot, sometimes from amiability, often from

(02:54:24):
shyness, oftenest from langor how oftenhave the bowels acted? Nurse? Once,
sir? This generally means that theutensil has been emptied once, it
having been used perhaps seven or eighttimes. Do you think the patient is
much weaker than he was six weeksago? Oh? No, sir,

(02:54:46):
You know it is very long sincehe has been up and dressed, and
he can get across the room.Now. This means that the nurse has
not observed that whereas six weeks agohe sat up and occupied himself in bed,
he now lies still doing nothing,that although he can get across the
room, he cannot stand for fiveseconds. Another patient who is eating well,

(02:55:11):
recovering steadily, although slowly, fromfever, but cannot walk or stand
is represented to the doctor as makingno progress at all. Questions too,
as asked now, but too generallyof or about patients, would obtain no
information at all about them, evenif the person asked of had every information

(02:55:33):
to give. The question is generallya leading question, and it is singular
that people never think what must bethe answer to this question before they ask
it. For instance, has hehad a good night? Now? One
patient will think he has a badnight if he has not slept ten hours

(02:55:54):
without waking. Another does not thinkhe has a bad night if he has
had intervals of doseing regularly. Thesame answer has actually been given as regarded
two patients, one who had beenentirely sleepless for five times twenty four hours
and died of it, and anotherwho had not slept the sleep of a
regular night without waking. Why cannotthe question be asked, how many hours

(02:56:18):
sleep has had and at what hoursof the night? I have never closed
my eyes all night? An answeris frequently made when the speaker has had
several hours sleep, as when hehas had none would then be less often
said. Lies, intentional and unintentionalare much seldom are told in answer to

(02:56:41):
precise than leading questions. Another frequenterror is to inquire whether one cause remains,
and not whether the effect, whichmay be produced by a great many
different causes not inquired after remains,as when it is asked whether there was
noise in the street last night,and if there were not, the patient

(02:57:01):
is reported without more ado to havehad a good night. Patients are completely
taken aback by these kinds of leadingquestions and give only the exact amount of
information asked for, even when theyknow it to be completely misleading. The
shyness of patience is seldom allowed,for how few there are who by five

(02:57:26):
or six pointed questions can elicit thewhole case and get accurately to know and
to be able to report where thepatient is. I knew a very clever
physician of large dispensary and hospital practicewho invariably began his examination of each patient
with put your finger where you bebad. That man would never waste his

(02:57:50):
time with collecting inaccurate information from nurseor patient. Leading questions always collect inaccurate
information. A recent celebrated trial,the following leading question was put successively to
nine distinguished medical men, can youattribute these symptoms to anything else but poison?

(02:58:11):
And out of the nine, eightanswered no, without any qualification whatever.
It appeared upon cross examination one thatnone of them had ever seen a
case of the kind of poisoning supposed, two that none of them had ever
seen a case of the kind ofdisease to which the death if not to
poison was attributable. Three that noneof them were even aware of the main

(02:58:37):
fact of the disease and condition towhich the death was attributable. Surely nothing
stronger can be adduced to prove whatuse leading questions are of and what they
lead to. I had rather notsay how many instances I have known where
owing to this system of leading questions, the patient has done and the attendants

(02:59:01):
have been actually unaware of the principalfeature of the case. It is useless
to go through all the particulars besidessleep, in which people have a peculiar
talent for gleaning inaccurate information As tofood, for instance, I often think
that most common question how is yourappetite? Can only be put because the

(02:59:22):
questioner believes the question really has nothingthe matter with him, which is very
often the case. But when thereis the remark holds good which has been
made about sleep, the same answerwill often be made. As regards a
patient who cannot take two ounces ofsolid food per diem and a patient who
does not enjoy five meals a dayas much as usual. Again, the

(02:59:46):
question how is your appetite is oftenput when how is your digestion is the
question meant no doubt. The twothings depend on one another, but they
are quite different. Many a patientcan eat if you can only tempt his
appetite. The fault lies in yournot having got him the thing that he

(03:00:07):
fancies. But many another patient doesnot care. Between grapes and turnips.
Everything is equally distasteful to him.He would try to eat anything which would
do him good, but everything makeshim worse. The fault here generally lies
in the cooking. It is nothis appetite which requires tempting. It is

(03:00:30):
his digestion, which requires sparing,and good sick cookery will save the digestion
half its work. There may befour different causes, any one of which
will produce the same result, thatis, the patient slowly starving to death
from want of nutrition. One defectin cooking, two defect in choice of

(03:00:54):
diet, three defect in choice ofhours for taking diet, four defect of
appetite inpatient. Yet all these aregenerally comprehended in the one sweeping assertion that
the patient has no appetite. Surelymany lives might be saved by drawing a

(03:01:16):
closer distinction for the remedies are asdiverse as the causes. The remedy for
the first is to cook better,for the second, to choose other articles
of diet, for the third,to watch for the hours when the patient
is in want of food, forthe fourth to show him what he likes,
and sometimes unexpectedly. But no oneof these remedies will do for any

(03:01:41):
of the other defects not corresponding withit, I cannot too often repeat that
patients are generally either too languid toobserve these things or too shy to speak
about them. Nor is it wellthat they should be made to observe them.
It fixes their attention upon themselves.Again, I say, what is

(03:02:01):
the nurse or friend therefore, exceptto take notice of these things instead of
the patient doing so? Again,the question is sometimes put, is their
diarrhea? And the answer will bethe same, whether it is just merging
into cholera, whether it is atrifling degree brought on by some trifling indiscretion,

(03:02:22):
which will cease the moment the causeis removed, or whether there is
no diarrhea at all but simply relaxedbowels. It is useless to multiply instances
of this kind as long as observationis so little cultivated as it is now.
I do believe that it is betterfor the physician not to see the
friends of the patient at all.They will often a mislead him than not,

(03:02:46):
and as often by making the patientout worse as better than he really
is. In the case of infants, everything must depend on the accurate observation
of the nurse or mother who hasto report, and how seldom is this
condition of accuracy fulfilled. A celebratedman, though celebrated only for foolish things,

(03:03:09):
has told us that one of hismain objects in the education of his
son was to give him a readyhabit of accurate observation, a certainty of
perception, and that for this purposeone of his means was a month's course.
As follows, he took the boyrapidly past a toy shop. The
father and son then described to eachother as many of the objects as they
could which they had seen in passingthe windows, noting them down with pencil

(03:03:33):
and paper, and returning afterwards toverify their own accuracy. The boy always
succeeded best e g. If thefather described thirty objects, the boy did
forty, and scarcely ever made amistake. I have often thought, how
wise a piece of education this wouldbe for much higher objects. And in

(03:03:56):
our calling of nurses, the thingitself is essential. For it may safely
be said not that the habit ofready and correct observation will by itself make
us useful nurses, but that withoutit we shall be useless. With all
our devotion. I have known anurse in charge of a set of wards,

(03:04:16):
who not only carried in her headall the little varieties in the diets
which each patient was allowed to fixfor himself, but also exactly what each
patient had taken during each day.I have known another nurse in charge of
one single patient who took away hismeals day after day, all but untouched,
and never knew it. If youfind it helps you to note down

(03:04:39):
such things on a piece of paperin pencil, by all means do so,
I think it more often lames thanstrengthens the memory and observation. But
if you cannot get the habit ofobservation, one way or another, you
had better give up the being anurse, for it is not your calling.
However kind and anxious you may be, surely you can learn at least

(03:05:01):
to judge with the eye how muchan ounce of solid food is how much
an ounce of liquid. You willfind this helps your observation and memory very
much. You will then say toyourself, A took about an ounce of
his meat to day, B tookthree times in twenty four hours about a
quarter of a pint of beef tea, instead of saying B has taken nothing

(03:05:24):
all day, or I gave Ahis dinner as usual. I have known
several of our real old fashioned hospitalsisters who could, as accurately as a
measuring glass, measure out all theirpatients wine and medicine by the eye,
and never be wrong. I donot recommend this. One must be very

(03:05:45):
sure of one's self to do it. I only mention it, because if
a nurse can, by practice measuremedicine by the eye, surely she is
no nurse who cannot measure by theeye about how much food in ounces her
patient has taken. In hospitals,those who cut up the diets give with
quite sufficient accuracy to each patient histwelve ounces or his six ounces of meat,

(03:06:09):
without weighing. Yet a nurse willoften have patients loathing all food and
incapable of any will to get well, who just tumble over the contents of
the plate or dip the spoon inthe cup to deceive the nurse, And
she will take it away without everseeing that there is just the same quantity
of food as when she brought it. And she will tell the doctor too

(03:06:31):
that the patient has eaten all hisdiets as usual, when all she ought
to have meant is that she hastaken away his diets as usual. Now,
what kind of nurse is this?I would call attention to something else
in which nurses frequently fail in observation. There is a well marked distinction between

(03:06:52):
the excitable and what I will callthe accumulative temperament in patience. One will
blaze up at once under any shockor anxiety, and sleep very comfortably after
it. Another will seem quite calmand even torpid under the same shock,
And if people say he hardly feltit at all, yet you will find

(03:07:13):
him some time after slowly sinking.The same remark applies to the action of
narcotics of appariance, which in theone take effect directly in the other,
not perhaps for twenty four hours,a journey, a visit, an unwonted
exertion, will affect the one immediately, but he recovers after it. The

(03:07:37):
other bears it very well at thetime, apparently, and dies or is
prostrated for life by it. Peopleoften say how difficult the excitable temperament is
to manage. I say, howdifficult is the accumulative temperament. With the
first, you have an outbreak whichyou could anticipate, and it is all

(03:07:58):
over. With the second, younever know where you are, You never
know when the consequences are over,and it requires your closest observation to know
what are the consequences of what?For the consequent by no means follows immediately
upon the antecedent, and course observationis utterly at fault. Almost all superstitions

(03:08:20):
are owing to bad observation, tothe post hoc ergo propter hoc, and
bad observers are almost all superstitious.Farmers used to attribute disease among cattle to
witchcraft. Weddings have been attributed toseeing one magpie, deaths to seeing three,
and I have heard the most highlyeducated nowadays draw consequences for the sick

(03:08:43):
closely resembling these. Another remark,although there is unquestionably a physiognomy of disease
as well as of health. Ofall parts of the body, the face
is perhaps the one which tells theleast to the common observer or the casual
visitor, because of all parts ofthe body, it is the one most

(03:09:05):
exposed to other influences besides health,and people never or scarcely ever observe enough
to know how to distinguish between theeffect of exposure of robust health, of
a tender skin, of a tendencyto congestion, of suffusion, flushing,
or many other things. Again,the face is often the last to show

(03:09:31):
emaciation. I should say that thehand was a much surer test than the
face, both as to flesh,color, circulation, et cetera, et
cetera. It is true that thereare some diseases which are only betrayed at
all by something in the face,for example, the eye or the tongue,
as greater irritability of brain by theappearance of the pupil of the eye.

(03:09:54):
But we are talking of casual,not minute observation, and few minute
observers will hesitate to say that farmore untruth than truth is conveyed by the
oft repeated words. He looks wellor ill, or better or worse.
Wonderful is the way in which peoplewill go upon the slightest observation, or

(03:10:16):
often upon no observation at all,or upon some sore which the world's experience,
if it had any, would havepronounced utterly false. Long ago,
I have known patience dying of sheerpain, exhaustion, and want of sleep
from one of the most lingering andpainful diseases known, preserve till within a

(03:10:39):
few days of death, not onlythe healthy color of the cheek, but
the muttled appearance of a robust child. And scores of times have I heard
these unfortunate creatures assailed with I amglad to see you looking so well.
I see no reason why you shouldnot live till ninety years of age.
Why don't you take a little moreexercise and amusement. With all the other

(03:11:01):
commonplaces with which we are so familiar. There is unquestionably a physiognomy of disease.
Let the nurse learn it. Theexperienced nurse can always tell that a
person has taken a narcotic the nightbefore by the patchiness of the color about
the face. When the reaction ofdepression has set in that very color,

(03:11:24):
which the inexperienced will point to asa proof of health. There is again
a faintness which does not betray itselfby the color at all, or in
which the patient becomes brown instead ofwhite. There is a faintness of another
kind, which, it is true, can always be seen by the paleness,
but the nurse seldom distinguishes. Shewill talk to the patient who is

(03:11:48):
too faint to move without the leastscruple unless he is pale, and unless,
luckily for him, the muscles ofthe throat are affected and he loses
his voice. These two faintnesses areperfectly distinguishable by the mere countenance of the
patient. Again, the nurse mustdistinguish between the idiosyncrasies of patients. One

(03:12:11):
likes to suffer out all his sufferingalone, to be as little looked after
as possible. Another likes to beperpetually made much of and pitied, and
to have someone always by him.Both these peculiarities might be observed and indulged
much more than they are. Forquite as often does it happen that a
busy attendance is forced upon the firstpatient who wishes for nothing but to be

(03:12:37):
let alone, As that the secondis left to think himself neglected again.
I think that few things press soheavily on one's suffering from long and incurable
illness as the necessity of recording inwords from time to time for the information
of the nurse, who will nototherwise see that he cannot do this or

(03:12:58):
that which she could do a monthor a year ago. What is a
nurse there for if she cannot observethese things for herself? Yet I have
known, and known too among those, and chiefly among those whom money and
position put in possession of everything whichmoney and position could give. I have
known, I say, more accidentsfatal slowly or rapidly, arising from this

(03:13:24):
want of observation among nurses than fromalmost anything else. Because a patient could
get out of a warm bath alonea month ago, because a patient could
walk as far as his bell aweek ago, the nurse concludes that he
can do so now, she hasnever observed the change, and the patient
is lost from being left in ahelpless state of exhaustion till someone accidentally comes

(03:13:48):
in. And this not from anyunexpected apoplectic, paralytic, or fainting fit,
though even these could be expected.Far more, at least to them
they are now if we did,but observe no from the expected or to
be expected, inevitable, visible,calculable, uninterrupted increase of weakness, which

(03:14:13):
none need fail to observe again.A patient not usually confined to bed is
compelled by an attack of diarrhea,vomiting, or other accident to keep his
bed for a few days. Hegets up for the first time, and
the nurse lets him go into anotherroom without coming in a few minutes afterwards

(03:14:35):
to look after him. It neveroccurs to her that he is quite certain
to be faint or cold, orto want something. She says as her
excuse, Oh, he does notlike to be fidgeted after, Yes,
he said so some weeks ago,But he never said he did not like
to be fidgeted after when he isin the state he is in now,

(03:14:58):
And if he did, you oughtto make some excuse to go into him.
More patients have been lost in thisway than is at all generally known,
that is, from relapses brought onby being left for an hour or
two faint or cold or hungry aftergetting up for the first time. Yet
it appears that scarcely any improvement inthe faculty of observing is being made.

(03:15:26):
Vast has been the increase of knowledgein pathology, that science which teaches us
the final change produced by disease onthe human frame. Scarce any in the
art of observing the signs of thechange while in progress. Or rather,
is it not to be feared thatobservation as an essential part of medicine has
been declining. Which of us hasnot heard fifty times from one or another,

(03:15:52):
a nurse or a friend of thesick. I am a medical friend
too, the following remark, Soa is worse or be is dead?
I saw him the day before,I thought him so much better. There
certainly was no change from which onecould have expected so sudden a change I
have never heard any one say,though one would think it the more natural

(03:16:13):
thing. There must have been someappearance which I should have seen if I
had but looked. Let me tryand remember what there was that I may
observe another time. No, thisis not what people say. They boldly
assert that there was nothing to observe, not that their observation was at fault.

(03:16:35):
Let people who have to observe sicknessand death look back and try to
register in their observation the appearances whichhave preceded relapse, attack, or death,
and not assert that there were noneor that there were not the right
ones. A want of the habitof observing conditions, and an inveterate habit

(03:16:56):
of taking averages are each of themoften equally misleading. Men whose profession,
like that of medical men, leadsthem to observe only or chiefly palpable and
permanent organic changes are just as oftenwrong in their opinion of the result as
those who do not observe at all. For instance, there is a broken

(03:17:20):
leg. The surgeon has only tolook at it once to know it will
not be different if he sees itin the morning to what it would have
been had he seen it in theevening, And in whatever conditions the patient
is or as likely to be,there will still be the broken leg until
it is set. The same withmany organic diseases. An experienced physician has

(03:17:43):
but to feel the pulse once,and he knows that there is aneurysm which
will kill some time or other.But with the great majority of cases there
is nothing of the kind, andthe power of forming any correct opinion as
to the result must entirely depend uponan inquiry into all the conditions in which

(03:18:03):
the patient lives in a complicated stateof society in large towns. Death,
as every one of great experience knows, is far less often produced by any
one organic disease than by some illnessafter many other diseases, producing just the
sum of exhaustion necessary for death.There is nothing so absurd, nothing so

(03:18:26):
misleading as the verdict. One sooften hears so and so has no organic
disease. There is no reason whyhe should not live to extreme old age.
Sometimes the clause is added, sometimesnot, provided he has quiet,
good food, good air, etcetera, et cetera, et cetera.

(03:18:48):
The verdict is repeated by ignorant peoplewithout the latter clause, or there is
no possibility of the conditions of thelatter clause being obtained, and this the
only essential parts of the whole,is made of no effect. I have
heard a physician, deservedly eminent assurethe friends of a patient of his recovery.

(03:19:09):
Why because he had now prescribed acourse, every detail of which the
patient had followed for years, andbecause he had forbidden a course which the
patient could not by any possibility alter. Undoubtedly a person of no scientific knowledge
whatever, but of observation and experiencein these kinds of conditions, will be

(03:19:31):
able to arrive at a much truerguess as to the probable duration of life
of members of a family or inmatesof a house than the most scientific physician
to whom the same persons are broughtto have their pulse felt, no inquiry
being made into their conditions in lifeinsurance and such like societies. Why they,

(03:19:52):
instead of having the persons examined bya medical man, to have the
houses, conditions, ways of life, life of these persons examined, at
how much truer results would they arrive? W Smith appears a fine hailman,
but it might be known that thenext cholera epidemic he runs a bad chance.

(03:20:13):
Mister and missus j are a strong, healthy couple, but it might
be known that they live in sucha house, in such a part of
London, so near the river,that they will kill four fifths of their
children. Which of the children willbe the ones to survive might also be
known. Averages again seduce us awayfrom minute observation. Average mortalities merely tell

(03:20:37):
that so many percent die in thistown, and so many in that per
annum. But whether A or Bwill be among these the average rate,
of course, does not tell.We know, say that from twenty two
to twenty four per thousand will diein London next year. But minute in

(03:21:00):
marries into conditions enable us to knowthat in such a district, nay,
in such a street, or evenon one side of that street, in
such a particular house, or evenon one floor of that particular house,
will be the excess of mortality.That is, the person will die who
ought not to have died before oldage. Now would it not very materially

(03:21:24):
alter the opinion of whoever was endeavoringto form one if he knew that from
that floor of that house, ofthat street the man came. Much more
precise might be our observations even thanthis, and much more correct our conclusions.
It is well known that the samenames may be seen constantly recurring on

(03:21:48):
workhouse books for generations. That is, the persons were born and brought up,
and will be born and brought upgeneration after generation. In the conditions
which make paupers death and disease arelike the workhouse. They take from the
same family, the same house,or in other words, the same conditions,

(03:22:09):
Why will we not observe what theyare? The close observer may safely
predict that such a family, whetherits members marry or not, will become
extinct, that such another will degeneratemorally and physically. But who learns the
lesson? On the contrary, itmay be well known that the children die

(03:22:31):
in such a house at the rateof eight out of ten. One would
think that nothing more need be said, for how could providence speak more distinctly?
Yet nobody listens. The family goeson living there till it dies out,
and then some other family takes it. Neither would they listen if one
rose from the dead. In dwellingupon the vital importance of sound observation,

(03:22:56):
it must never be lost sight ofwhat observation is. It is not for
the sake of piling up miscellaneous informationor curious facts, but for the sake
of saving life and increasing health andcomfort. The caution may seem useless,
but it is quite surprising how manymen some women do it too, practically,

(03:23:20):
behave as if the scientific end werethe only one in view, or
as if the sick body were buta reservoir for stowing medicines into and the
surgical disease, only a curious casethe sufferer has made for the attendant's special
information. This is really no exaggeration. You think if you suspected your patient

(03:23:41):
was being poisoned, say by acopper kettle, you would instantly, as
you ought, cut off all possibleconnection between him and the suspected source of
the injury, without regard to thefact that a curious mine of observation is
therefore lost. But it is noteverybody who does so. And it has
actually been made a question of medicalethics. What should the medical man do

(03:24:05):
if he suspected poisoning? The answerseems a very simple one. Insist upon
a confidential nurse being placed with apatient, or give up the case.
And remember, every nurse should beone who is to be depended upon.
In other words, capable of beinga confidential nurse. She does not know

(03:24:28):
how soon she may find herself placedin such a situation. She must be
no gossip, no vain talker.She should never answer questions about her sick
except for those who have a rightto ask them. She must, i
need not say, be strictly soberand honest. But more than this,
she must be a religious and devotedwoman. She must have a respect for

(03:24:50):
her own calling, because God's preciousgift of life is often literally placed in
her hands. She must be asound and close and quick observer. And
she must be a woman of delicateand decent feeling. To return to the
question of what observation is, forit would really seem as if some had

(03:25:11):
considered it as its own end,as if detection, not cure, was
their business. Nay more, ina recent celebrated trial, three medical men,
according to their own account, suspectedpoison prescribed for dysentery and left the
patient to the poisoner. This isan extreme case, but in a small

(03:25:33):
way, the same manner of actingfalls under the cognisance of us all.
How often the attendants of a casehave stated that they knew perfectly well that
the patient could not get well insuch an air, in such a room,
or under such circumstances, yet havegone on dosing him with medicine,

(03:25:54):
and making no effort to remove thepoison from him, or him from the
poison which they knew was killing him. Nay more, have sometimes not so
much as mentioned their conviction in theright quarter, that is, to the
only person who could act in thematter. End of Section thirteen. Section

(03:26:15):
fourteen conclusion. The whole of thepreceding remarks apply even more to children and
to pure operal women than to patientsin general. They also apply to the
nursing of surgical quite as much asto that of medical cases. Indeed,
if it be possible, cases ofexternal injury require such care even more than

(03:26:39):
sick in surgical wards. One dutyof every nurse certainly is prevention fever or
hospital gangrene, or piemia, orpurulent discharge of some kind males supervene.
Has she a case of compound fracture, of amputation, or of chrysipelas,

(03:27:01):
it may depend very much on howshe looks upon the things enumerated in these
notes, whether one or other ofthese hospital diseases attacks her patient or not.
If she allows her ward to becomefilled with a peculiar close fetid smell
so apt to be produced among surgicalcases, especially where there is great suppuration
and discharge, she may see avigorous patient in the prime of life gradually

(03:27:26):
sink and die, where according toall human probability, he ought to have
recovered. The surgical nurse must,ever be on the watch, ever on
her guard against want of cleanliness,foul air, want of light, and
of warmth. Nevertheless, let noone think that, because sanitary nursing is

(03:27:48):
the subject of these notes, thereforewhat may be called the handicraft of nursing
is to be undervalued. A patientmay be left to bleed to death in
a sanitary palace. Another who cannotmove himself may die of bed sores because
the nurse does not know how tochange and clean him, while he has

(03:28:09):
every requisite of air, light andquiet. But nursing as a handicraft has
not been treated of here for threereasons. One that these notes do not
pretend to be a manual for nursingany more than for cooking for the sick.
Two that the writer, who hasherself seen more of what may be

(03:28:30):
called surgical nursing, that is practicalmanual nursing, than perhaps anyone in Europe,
honestly believes that it is impossible tolearn it from any book, and
that it can only be thoroughly learntin the wards of a hospital. And
she also honestly believes that the perfectionof surgical nursing may be seen practiced by

(03:28:50):
the old fashioned sister of a Londonhospital, as it can be seen nowhere
else in Europe. Three. Whilethousands die of et cetera, who have
this surgical nursing to perfection, theconverse is comparatively rare. To revert to
children. They are much more susceptiblethan grown people to all noxious influences.

(03:29:15):
They are affected by the same things, but much more quickly and seriously.
That is, by want of freshair, of proper warmth, want of
cleanliness in house, clothes, bedding, or body, by startling noises,
improper food, or want of punctuality, by dullness, and by want of

(03:29:35):
light, by too much or toolittle covering in bed or when up,
by want of the spirit of management, generally in those in charge of them.
One can therefore only press the importanceas being yet greater in the case
of children, greatest in the caseof sick children, of attending to these
things. That which, however,above all, is own to injure children

(03:30:01):
seriously is foul air, and mostseriously at night, keeping the rooms where
they sleep tight shut up is destructionto them. And if the child's breathing
be disordered by disease, a fewhours only of such foul air may endanger
its life, even where no inconvenienceis felt by grown up persons in the

(03:30:22):
same room. The following passages,taken out of an excellent lecture on sudden
death in infancy and childhood just published, show the vital importance of careful nursing
of children. In the great majorityof instances, when death suddenly befalls the

(03:30:43):
infant or young child, it isan accident. It is not a necessary
inevitable result of any disease from whichit is suffering. It may be here
added that it would be very desirableto know how often death is with adults
not unnecess inevitable result of any disease. Amid the words sudden, for sudden

(03:31:05):
death is comparatively rare in middle age, and the sentence is almost equally true
for all ages. The following causesof accidental death in sick children are enumerated.
Sudden noises which startle, a rapidchange of temperature which chills the surface,
though only for a moment. Arude awakening from sleep, or even

(03:31:28):
an over hasty or an over fullmeal, any sudden impression on the nervous
system, any hasty alteration of posture, in short, any cause whatever by
which the respiratory process may be disturbed. It may again be added that with
very weak adult patients these causes arealso not often suddenly fatal, it is

(03:31:52):
true, but very much oftener thanis at all generally known, irreparable in
their consequences children and for adults,both for sick and for well, although
more certainly in the case of sickchildren than in any others, I would
here again repeat the most frequent andmost fatal cause of all is sleeping,

(03:32:13):
even for a few hours, muchmore for weeks and months in foul air,
a condition which, more than anyother condition disturbs the respiratory process and
tends to produce accidental death in disease. I need hardly hear repeat the warning
against any confusion of ideas between coldand fresh air. You may chill a

(03:32:39):
patient fatally without giving him fresh airat all, and you can quite well,
nay much better, give him freshair without chilling him. This is
the test of a good nurse incases of long recurring faintnesses from disease,
for instance, especially disease which affectsthe old organs of breathing fresh air to

(03:33:01):
the lungs. Warmth to the surfaceand often as soon as the patient can
swallow hot drink. These are theright remedies, and the only ones yet
oftener than not. You see thenurse or mother just reversing this, shutting
up every cranny through which fresh aircan enter, and leaving the body cold,

(03:33:24):
or perhaps throwing a greater weight ofclothes upon it when already it is
generating too little heat. Breathing carefullyanxiously, as though respiration was a function
which required all the attention for itsperformance, is cited as a not unusual
state in children, and as onecalling for care in all the things enumerated

(03:33:46):
above. That breathing becomes an almostvoluntary act even in grown up patients who
are very weak must often have beenremarked disease having interfered with the perfect accomplishment
and of the respiratory function some suddendemand for its complete exercise issues in a
sudden standstill of the whole machinery isgiven as one process life goes out for

(03:34:11):
want of nervous power to keep thevital functions in activity is given as another
by which accidental death is most oftenbrought to pass in infancy, also in
middle age. Both these processes maybe seen ending in death, although generally
not suddenly, and I have seeneven in Middle Age the sudden standstill here

(03:34:35):
mentioned, and from the same causesto sum up the answer to two of
the commonest objections urged, one bywomen themselves, the other by men against
the desirableness of sanitary knowledge for women, plus a caution comprises the whole argument

(03:34:56):
for the art of nursing one.It is often said by men that it
is unwise to teach women anything aboutthese laws of health, because they will
take to physicking. That there isa great deal too much of amateur physicking
as it is, which is indeedtrue. One eminent physician told me that
he had known more calamel given bothat a pinch and for a continuance by

(03:35:20):
mothers, governesses, and nurses tochildren than he had ever heard of a
physician prescribing in all his experience.Another says that women's only idea in medicine
is calamel and appariance. This isundeniably too often the case. There is
nothing ever seen in any professional practicelike the reckless physicking by amateur females.

(03:35:46):
But this is just what the reallyexperienced and observing nurse does not do she
neither physics herself nor others. Andto cultivate in things pertaining to health,
observation and experience in women who aremothers, governesses, or nurses is just
the way to do away with amateurphysicking. And if the doctors did but

(03:36:07):
know it, to make the nursesobedient to them helps to them instead of
hinderances. Such education in women wouldindeed diminish the doctor's work, but no
one really believes that doctors wish thatthere should be more illnesses in order to
have more work. Two. Itis often said by women that they cannot

(03:36:30):
know anything of the laws of healthor what to do to preserve their children's
health, because they can know nothingof pathology or cannot dissect a confusion of
ideas which it is hard to attemptto disentangle. Pathology teaches the harm that
disease has done, but it teachesnothing more. We know nothing of the

(03:36:52):
principle of health, the positive ofwhich pathology is the negative, except from
observation and expel exvuriance, And nothingbut observation and experience will teach us the
ways to maintain or to bring backthe state of health. It is often
thought that medicine is the curative process. It is no such thing. Medicine

(03:37:16):
is the surgery of functions, assurgery proper is that of limbs and organs.
Neither can do anything but remove obstructions. Neither can cure. Nature alone
cures. Surgery removes the bullet outof the limb, which is an obstruction
to cure, but nature heals thewound. So it is with medicine the

(03:37:41):
function of an organ becomes obstructed.Medicine, so far as we know,
assists nature to remove the obstruction,but does nothing more. And what nursing
has to do in either case isto put the patient in the best condition
for nature to act upon him.Generally, just the contrary is done.
You think fresh air and quiet andcleanliness extravagant, perhaps dangerous, luxuries which

(03:38:07):
should be given to the patient onlywhen quite convenient, And medicine the sinequa,
not the panacea. If I havesucceeded in any measure in dispelling this
illusion, and in showing what truenursing is and what it is not,
my object will have been answered.Now for the caution three, It seems

(03:38:33):
a commonly received idea among men andeven among women themselves, that it requires
nothing but a disappointment in love,the want of an object, a general
disgust, or incapacity for other thingsto turn a woman into a good nurse.
This reminds one of the parish wherea stupid old man was set to
be schoolmaster because he was past keepingthe pigs. Apply the above receipt for

(03:38:58):
making a good nurse to making agood servant, and the receipt will be
found to fail. Yet popular novelistsof recent days have invented ladies disappointed in
love, or fresh out of thedrawing room, turning into the war hospitals
to find their wounded lovers, andwhen found forthwith abandoning their sick ward for
their lover. As might be expected. Yet in the estimation of the authors,

(03:39:24):
these ladies were none the worse forthat, But on the contrary,
were heroines of nursing. What cruelmistakes are sometimes made by benevolent men and
women in matters of business about whichthey can know nothing and think they know
a great deal the everyday management ofa large ward, let alone of a

(03:39:45):
hospital, The knowing what are thelaws of life and death for men?
And what the laws of health,for wards and wards are healthy or unhealthy
mainly according to the knowledge or ignoranceof the nurse. Are not these matters
of sufficient importance and difficulty to requirelearning by experience and careful inquiry, just
as much as any other art.They do not come by inspiration to the

(03:40:11):
lady disappointed in love, nor tothe poor workhouse drudge hard up for a
livelihood. And terrible is the injurywhich has followed to the sick from such
wild notions in this respect? Andwhy is it so? In Roman Catholic
countries both writers and workers are intheory, at least far before hours.

(03:40:35):
They would never think of such abeginning for a good working superior or sister
of charity, And many a superiorhas refused to admit a postulant who appear
to have no better vocation or reasonsfor offering herself than these. It is
true we make no vows, Butis a vow necessary to convince us that

(03:40:58):
the true spirit for learning any otherart, most especially an art of charity
a right, is not a disgustto everything or something else. Do we
really place the love of our kindand of nursing as one branch of it
so low as this, What wouldthe Mayor Angelique of Port Royal, What

(03:41:18):
would our own missus Frye have saidto this note, I would earnestly ask
my sisters to keep clear of boththe jargons now current everywhere, for they
are equally jargons. Of the jargon, namely about the rights of women,

(03:41:39):
which urges women to do all thatmen do, including the medical and other
professions, merely because men do it, and without regard to whether this is
the best that women can do.And of the jargon which urges women to
do nothing that men do, merelybecause they are women and should be recalled
to a sense of their duty aswomen, and because this is women's way,

(03:42:00):
and that is men's and these arethings which women should not do,
which is all assertion, and nothingmore. Surely woman should bring the best
she has, whatever that is,to the work of God's world, without
attending to either of these cries,for what are they both of them,
the one just as much as theother. But listening to the what will

(03:42:24):
people say to opinion, to thevoices from without? And as a wise
man has said, no one hasever done anything great or useful by listening
to the voices from without. Youdo not want the effect of your good
things to be how wonderful for awoman, Nor would you be deterred from

(03:42:46):
good things by hearing it said.Yes, but she ought not to have
done this, because it is notsuitable for a woman. But you want
to do the thing that is good, whether it is suitable for a woman
or not. It does not makea thing good that it is remarkable that
a woman should have been able todo it. Neither does it make a

(03:43:07):
thing bad which would have been goodhad a man done it, that it
has been done by a woman.Oh, leave these jargons and go your
way straight to God's work in simplicityand singleness of heart. End of Notes
on nursing What it is and whatit is not by Florence Nightingale