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Notes on Nursing · Notes on Nursing

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  Preface. The following notes are by no means intended as a rule of thought
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  by which nurses can teach themselves to nurse, still less as a manual to
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  teach nurses to nurse. They are meant simply to give hints for thought to
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  women who have personal charge of the health of others. Every woman, or
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  at least almost every woman in England, has, at one time or another
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  of her life, charge of the personal health of somebody, whether child or
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  invalid. In other words, every woman is a nurse every day. Sanitary
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  knowledge, or the knowledge of nursing, or in other words, how to
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  put the constitution in such a state as that it will have no disease or
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  that it can recover from disease, takes a higher place. It is recognized
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  as the knowledge which every one ought to have, distinct from medical knowledge,
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  which only a profession can have. If then every woman must, at some
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  time or other of her life become a nurse, i e. Have charge
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  of somebody's health, How immense and how valuable would be the produce of her
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  united experience. If every woman would think how to nurse? I do not
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  pretend to teach her how I ask her to teach herself, and for this
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  purpose I venture to give her some hints notes on nursing. What it is
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  and what it is not. Shall we begin by taking it as a general
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  principle that all disease, at some period or another of its course, is
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  more or less a reparative process, not necessarily accompanied with suffering, an effort
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  of nature to remedy a process of poisoning or of decay, which has taken
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  place weeks, months, sometimes the years beforehand unnoticed, the termination of the
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  disease being then while the antecedent process was going on determined. If we accept
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  this as a general principle, we shall be immediately met with anecdotes and instances
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  to prove the contrary. Just so, if we were to take as a
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  principle all the climates of the Earth are meant to be made habitable for man
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  by the efforts of man, the objection would immediately be raised, will the
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  top of Mount Blanc ever be made habitable? Our answer would be, it
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  will be many thousands of years before we have reached to the bottom of Mount
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  Blanc. In making the Earth healthy, wait till we have reached the bottom
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  before we discuss the top. In watching diseases, both in private houses and
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  in public hospitals, the thing which strikes the experienced observer most forcibly is this
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  that the symptoms or the sufferings generally considered to be inevitable and incident to the
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  disease are very often not symptoms of the disease at all, but of something
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  quite different, of the want of fresh air, or of light, or
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  of warmth, or of quiet, or of cleanliness, or of punctuality and
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  care in the administration of diet, of each or of all of these.
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  And this quite as much in private as in hospital nursing. The reparative process
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  which nature has instituted, and which we call disease, has been hindered by
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  some want of knowledge or attention in one or in all of these things.
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  And pain, suffering, or interruption of the whole process sets in. If
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  a patient is cold, if a patient is feverish, if a patient is
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  faint, if he is sick after taking food, if he has a bed
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  sore. It is generally the fault not of the disease, but of the
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  nursing. I use the word nursing for want of a better It has been
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  limited to signify little more than the administration of medicines and the application of poultices.
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  It ought to signify the proper use of fresh air, light, warmth,
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  cleanliness, quiet, and the proper selection and administration of diet, all
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  at the least expensive vital power to the patient. It has been said and
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  written scores of times that every woman makes a good nurse. I believe,
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  on the contrary, that the very elements of nursing are all but unknown.
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  By this, I do not mean that the nurse is always to blame.
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  Bad sanitary, bad architectural, and bad administrative arrangements often make it impossible to
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  nurse. But the art of nursing ought to include such arrangements as alone make
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  what I understand by nursing possible. The art of nursing as now practiced seems
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  to be expressly constituted to unmake what God had made disease to be. That
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  is a reparative process. To recur to the first objection, if we are
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  asked, is such and such a disease a reparative process? Can such an
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  illness be unaccompanied with suffering? Will any care prevent such a patient from suffering?
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  This or that? I humbly say I do not know. But when
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  you have done away with all that pain and suffering, which in patience are
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  the symptoms not of their disease, but of the absence of one or all
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  of the above mentioned essentials to the success of nature's reparative processes, we shall
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  then know what are the symptoms of and the sufferings inseparable from the disease Another,
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  and the commonest exclamation which will instantly be made is would you do nothing?
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  Then? In cholera, fever, et cetera. So deep rooted and
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  universal is the conviction that to give medicine is to be doing something, or
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  rather everything, To give air, warmth, cleanliness, et cetera, is
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  to do nothing. The reply is that in these and many other similar diseases,
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  the exact value of particular remedies and modes of treatment is by no means
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  ascertained. While there is universal experience as to the extreme importance of careful nursing
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  in determining the issue of the disease. Two, the very elements of what
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  constitutes good nursing are as little understood for the well as for the sick.
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  The same laws of health or of nursing, for they are in reality the
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  same obtain among the well as among the sick. The breaking of them produces
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  only a less violent consequence among the former than among the latter. And this
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  sometimes not always, it is constantly objected. But how can I obtain this
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  medical knowledge? I am not a doctor. I must leave this to doctors.
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  Oh mothers of families, you who say this, do you know that
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  one in every seven infants in this civilized land of England perishes before it is
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  one year old, That in London two in every five die before they are
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  five years old, and in the other great cities of England nearly one out
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  of two. The life duration of tender babies, as some saturn turned analytical
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  chemist says, is the most delicate test of sanitary conditions. Is all this
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  premature suffering and death necessary? Or did nature intend mothers to be always accompanied
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  by doctors? Or is it better to learn the pianoforte than to learn the
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  laws which subserve the preservation of offspring? Macaulay somewhere says that it is extraordinary
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  that, whereas the laws of the motions of the heavenly bodies, far removed
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  as they are from us, are perfectly well understood, the laws of the
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  human mind which are under our observation all day and every day, are no
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  better understood than they worth two thousand years ago. But how much more extraordinary
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  is it that, whereas what we might call the coxcomeries of education e g.
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  The elements of astronomy are now taught to every school girl, neither mothers
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  of families of any class, nor schoolmistresses of any class, nor nurses of
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  children, nor nurses of hospital are taught anything about those laws which God has
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  assigned to the relations of our bodies with the world in which he has put
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  them. In other words, the laws which which make these bodies into which
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  He has put our minds healthy or unhealthy. Organs of those minds are all
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  but unlearnt. Not but those laws, the laws of life, are in
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  a certain measure understood. But not even mothers think it worth their while to
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  study them, to study how to give their children healthy existences. They call
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  it medical or physiological knowledge, fit only for doctors. Another objection we are
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  constantly told, but the circumstances which govern our children's healths are beyond our control.
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  What can we do with winds? There is the east wind. Most
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  people can tell before they get up in the morning whether the wind is in
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  the east. To this one can answer with more certainty than to the former
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  objections. Who is it who knows when the wind is in the east.
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  Not the highland drover, certainly exposed to the east wind, but the young
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  lady, who is worn out with the want of exposure to fresh air,
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  to sunlight, et cetera. Put the latter under as good sanitary circumstances as
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  the former, and she too will not know when the wind is in the
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  east. End of preface and start Section one. Ventilation and warming, the
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  very first cannon of nursing, the first and the last thing upon which a
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  nurse's attention must be fixed. The first essential to a patient, without which
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  all the rest you can do for him is as nothing with which I had
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  almost said you may leave all the rest alone. Is this to keep the
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  air he breathes as pure as the external air, without chilling him. Yet,
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  what is so little attended to even where it is thought of at all?
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  The most extraordinary misconceptions rain about it. Even in admitting air into the
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  patient's room or ward, few people ever think where that air comes from.
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  It may come from a corridor into which other wards are ventilated from a hall,
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  always unaired, always full of the fumes of gas, dinner of various
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  kinds of mustiness, from an underground kitchen, sink, wash house, water
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  closet, or even as I myself have had sorrowful experience, from open sewers
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  loaded with filth. And with this the patient's room or ward is aired,
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  as it is called poisoned. It should rather be said, always air from
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  the air without, and that too through those windows through which the air comes
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  freshest. From a closed court, especially if the wind do not blow that
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  way, air may come as stagnant as any from a hall or corridor.
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  Again a thing I have often seen, both in private houses and institutions.
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  A room remains uninhabit. The fireplace is carefully fastened up with a board,
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  The windows are never opened, Probably the shutters are kept always shut. Perhaps
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  some kind of stores are kept in the room. No breath of fresh air
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  can by possibility enter into that room, nor any ray of sun. The
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  air is as stagnant, musty, and corrupt as it can by possibility be
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  made. It is quite ripe to breed smallpox, scarlet, fever, diphtheria,
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  or anything else you please. Yet the nursery ward or sick room adjoining
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  will be positively aired by having the door opened into that room. What children
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  will be put into that room without previous preparation to sleep? A short time
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  ago, a man walked into a back kitchen in Queen's Square and cut the
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  throat of a poor consumptive creature sitting by the fire. The murderer did not
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  deny the act, but simply said, if it's all right. Of course
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  he was mad, But in our case, the extraordinary thing is that the
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  victim says it's all right, and that we are not mad yet, though
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  he knows the murderers in the musty, unaired, unsunned room, the scarlet
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  fever which is behind the door, or the fever and hospital gangrene which are
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  stalking among the crowded beds of a hospital ward, we say it's all right.
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  With a proper supply of windows and a proper supply of fuel in open
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  fireplaces, fresh air is comparatively easy to secure when your patient or patients are
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  in bed. Never be afraid of open windows. Then people don't catch cold
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  in bed. This is a popular fallacy. With proper bedclothes and hot bottles
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  if necessary, you can always keep a patient warm in bed and well ventilate
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  him at the same time. But a carelessness, her rank and education what
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  it may, will stop up every cranny and keep a hot house heat when
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  her patient is in bed, and if he is able to get up,
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  leave him comparatively unprotected. The time when people take cold, and there are
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  many ways of taking cold besides a cold in the nose, is when they
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  first get up after the twofold exhaustion of dressing, and of having had the
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  skin relaxed by many hours perhaps days, in bed, and thereby rendered more
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  incapable of reaction. Then the same temperature which refreshes the patient in bed may
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  destroy the patient just risen, and common sense will point out that while purity
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  of air is essential, a temperature must be secured which shall not chill the
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  patient. Otherwise the best that can be expected will be a feverish reaction.
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  To have the air within as pure as the air without it is not necessary,
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  as often appears to be thought, to make it as cold in the
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  afternoon again without care, the patient, whose vital powers have then risen,
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  often finds the room as close and oppressive as he found it cold in the
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  morning, Yet the nurse will be terrified if a window is opened. I
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  know an intelligent humane house surgeon who makes practice of keeping the ward windows open.
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  The physicians and surgeons invariably close them while going their rounds, and the
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  house surgeon, very properly as invariably opens them whenever the doctors have turned their
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  backs. In a little book on nursing, published a short time ago,
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  we are told that with proper care, it is very seldom that the windows
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  cannot be opened for a few minutes twice in the day to admit fresh air
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  from without. I should think not nor twice in the hour either. It
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  only shows how little the subject has been considered. Of all methods of keeping
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  patients warm, the very worst certainly is to depend for heat on the breath
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  and bodies of the sick. I have known a medical officer keep his ward
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  windows hermetically closed, thus exposing the sick to all the dangers of an infected
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  atmosphere, because he was afraid that by admitting fresh air, the temperature of
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  the ward would be too much lowered. This is a destructive fallacy to attempt
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  to keep a ward warm at the expense of making the sick repeatedly breathe their
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  own hot humid putressing atmosphere is a certain way to delay recovery or to destroy
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  life. Do you ever go into the bedrooms of any persons of any class,
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  whether they hold one, two, or twenty people, whether they hold
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  sick or well, at night or before the windows are opened in the morning,
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  and ever find the air anything but unwholesomely close and foul? And why
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  should it be so? And of how much importance is it that it should
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  not be so? During sleep? The human body, even when in health,
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  is far more injured by the influence of foul air than when awake.
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  Why can't you keep the air all night then, as pure as the air
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  without in the rooms you sleep in? But for this you must have sufficient
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  outlet for the impure air you make yourselves to go out, sufficient inlet for
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  the pure air from without to come in. You must have open chimneys,
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  open windows or ventilators, No close curtains round your beds, no shutters or
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  curtains to your windows, none of the contrivances by which you undermine your own
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  health or destroy the chances of recovery of your sick. A careful nurse will
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  keep a constant watch over her sick, especially weak, protracted and collapsed cases,
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  to guard against the effects of the loss of vital heat by the patient
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  himself. In certain diseased states, much less heat is produced than in health,
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  and there is a constant tendency to the decline and ultimate extinction of the
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  vital powers by the care made upon them to sustain the heat of the body.
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  Cases where this occurs should be watched with the greatest care, from hour
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  to hour. I had almost said from minute to minute. The feet and
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  legs should be examined by the hand from time to time, and whenever a
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  tendency to chilling is discovered, hot bottles, hot bricks, or warm flannels
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  with some warm drink should be made use of until the temperature is restored.
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  The fire should be, if necessary, replenished. Patients are frequently lost in
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  the latter stages of disease from want of attention to such simple precautions. The
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  nurse may be trusting to the patient's diet, or to his medicine, or
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  to the occasional dose of stimulant which she is directed to give him, while
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  the patient is all the while sinking from want of a little external warmth.
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  Such cases happen at all times, even during the height of summer. This
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  fatal chill is most apt to occur towards early morning, at the period of
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  the lowest temperature of the twenty four hours, and at the time when the
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  effect of the preceding day's diets is exhausted. Generally speaking, you may expect
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  that weak patients will suffer cold much more in the morning than in the evening.
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  The vital powers are much lower. If they are feverish at night,
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  with burning hands and feet, they are almost sure to be chilly and shivering
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  in the morning. But nurses are very fond of heating the foot warmer at
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  night, and of neglecting it in the morning when they are busy. I
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  should reverse the matter. All these things require common sense and care. Yet
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  perhaps in no one single thing is so little common sense shown in all ranks
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  as in nursing. The extraordinary confusion between cold and ventilation, even in the
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  minds of well educated people, illustrates this. To make a room cold is
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  by no means necessary to ventilate it, nor is it at all necessary in
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  order to ventilate a room to chill it. Yet if a nurse finds a
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  room close, she will let out the fire, thereby making it closer,
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  or she will open the door into a cold room without a fire or an
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  open window in it, by way of improving the ventilation. The safest atmosphere
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  of all for a patient is a good fire and an open window, excepting
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  in extremes of temperature. Yet no nurse can ever be made to understand this.
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  To ventilate a small room without drafts, of course, requires more care
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  than to ventilate a large one. Another extraordinary fallacy is the dread of night
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  air. What air can we breathe at night but night air? The choice
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  is between pure night air from without and foul night air from within. Most
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  people prefer the latter, an unaccountable choice. What will they say if it
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  is proved to be true that fully one half of all the disease we suffer
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  from is occasioned by people sleeping with their windows shut. An open window most
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  nights in the year can never hurt anyone. This is not to say that
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  light is not necessary for recovery. In great cities, night air is often
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  the best and purest air to be had in the twenty four hours. I
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  could better understand in towns shutting the windows during the day than during the night,
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  for the same the sick, the absence of smoke, the quiet all
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  tends to making night the best time for airing the patients. One of our
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  highest medical authorities on consumption and climate has told me that the air in London
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  is never so good as after ten o'clock at night. Always air your room
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  then from the outside air. If possible, windows are made to open,
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  doors are made to shut, a truth which seems extremely difficult of apprehension.
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  I have seen a careful nurse airing her patient's room through the door near to
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  which were two gas lights, each of which consumes as much air as eleven
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  men, a kitchen, a corridor. The composition of the atmosphere in which
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  consisted of gas, paint, foul air, never changed, full of effluvia,
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  including a current of sewer air from an ill placed sink, ascending in
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  a continual stream by a well staircase, and just charging themselves constantly into the
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  patient's room. The window of the said room, if opened, was all
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  that was desirable to air it. Every room must be aired from without,
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  every passage from without, But the fewer passages there are in a hospital,
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  the better. If we are to preserve the air within as pure as the
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  air without. It is needless to say that the chimney must not smoke.
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  Almost all smoky chimneys can be cured from the bottom, not from the top.
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  Often it is only necessary to have an inlet for air to supply the
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  fire which is feeding itself for want of this from its own chimney. On
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  the other hand, almost all chimneys can be made to smoke by a careless
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  nurse who lets the fire get low and then overwhelms it with coal, not,
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  as we verily believe, in order to spare her self trouble. Rare
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  is unkindness to the sick, but from not thinking what she is about.
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  In laying down the principle that the first object of the nurse must be to
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  keep the air breathed by her patient as pure as the air without, it
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  must not be forgotten that everything in the 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
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  be nothing in the room excepting him, which can give off effluvia or moisture
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  out of all damp towels et cetera, which become dry in the room.
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  The damp, of course, goes into the patient's air. Yet this,
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  of course, seems as little thought of, as if it were an obsolete
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  fiction. How very seldom you see a nurse who acknowledges by her practice that
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  nothing at all ought to be aired in the patient's room, that nothing at
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  all ought to be cooked at the patient's fire. Indeed, the arrangements often
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  make this rule impossible to observe. If the nurse be a very careful one,
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  she will, when the patient leaves his bed but not his room,
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  open the sheets wide and throw the bed clothes back in order to air his
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  bed. And she will spread the wet towels or flannels carefully out upon a
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  horse in order to dry them. Now, either these bed clothes and towels
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  are not dried and aired, or the air and dry themselves into the patient's
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  air. And whether the damp and effluvia do him most harm in his air
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  or in his bed, I leave you to determine, for I cannot.
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  Even in health, people cannot repeatedly breathe air in which they live with impunity
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  on account of it becoming charged with unwholesome matter from the lungs and skin.
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  In disease where everything given off from the body is highly noxious and dangerous,
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  not only must there be plenty of ventilation to carry off the effluvia, but
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  everything which the patient passes must be instantly removed away, as being more noxious
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  than even the emanations from the sick of the fatal effects of the effluvia from
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  the excretia, it would seem unnecessary to speak were they not so constantly neglected.
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  Concealing the utensils behind the valence to the bed seems all the precaution which
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  is thought necessary for safety in private nursing. Did you but think for one
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  moment of the atmosphere under that bed, the saturation of the under side of
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  the mattress with the warm evaporations, you would be startled and frightened too.
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  The use of any chamber utensil without a lid should be utterly abolished, whether
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  among sick or well. You can easily convince yourself of the necessity of this
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  absolute rule by taking one with a lid and examining the under side of that
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  lid. It will be found always covered. Whenever the utensil is not empty
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  by condensed offensive moisture. Where does that go? When there is no lid
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  earthenware, or if there is any wood, 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
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  clothes stool is enough to breed a pestilence. It becomes saturated with offensive matter,
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  which scouring is only wanted to bring out. I prefer an earthenware lid
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  as being always cleaner, but there are various good, new fashioned arrangements.
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  A slop pail should never be brought into a sick room. It should be
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  a rule invariable, rather more important in the private house than elsewhere, that
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  the utensil should be carried directly to the water closet, emptied there, rinsed
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  there, and brought back. There should always be water and a cock in
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  every water closet for rinsing, but even if there is not, you must
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  carry water there to rinse with. I have actually seen in the private sick
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  room the utensils emptied into the footpan and put back unrinsed, under the bed.
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  I can hardly say which is most abominable, whether to do this or
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  to rinse the utensil in the sick room. In the best hospitals, it
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  is now a rule that no slop pail shall ever be brought into the wards,
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  but that the utensils should be carried direct to be emptied and rinsed at
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  the proper place. I would it were so in the private house. Let
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  no one ever depend on few migations, disinfectants and the like for purifying the
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  air. The offensive thing, not its smell, must be removed. A
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  celebrated medical lecturer began one day. Fewmigations, gentlemen, are of essential importance.
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  They make such an abominable smell that they compare you to open the window.
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  I wish all the disinfecting fluids invented made such an abominable smell that they
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  forced you to omit fresh air. That would be a useful invention. End
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  of Section one, Section two Health of houses. There are five essential points
• 29:22
  in securing the health of houses. One pure air, two pure water,
• 29:30
  three efficient drainage, four cleanliness five light. Without these, no house can
• 29:40
  be healthy, and it will be unhealthy just in proportion as they are deficient.
• 29:45
  One. To have pure air, your house be so constructed as that
• 29:51
  the outer atmosphere shall find its way with ease to every corner of it.
• 29:56
  House architects hardly ever consider this. The opt in building a house is to
• 30:00
  obtain the largest interest for the money, not to save doctor's bills to the
• 30:04
  tenants. But if tenants should ever become so wise as to refuse to occupy
• 30:11
  unhealthy constructed houses, and if insurance companies should ever come to understand their interests
• 30:15
  so thoroughly as to pay a sanitary surveyor to look after the houses where their
• 30:21
  clients live, speculative architects would speedily be brought to their senses. As it
• 30:27
  is, they build what pays best, and there are always people foolish enough
• 30:33
  to take the houses they build. And if in the course of time the
• 30:37
  families die off, as is so often the case, nobody ever thinks of
• 30:41
  blaming any but providence for the result. Ill informed medical men aid in sustaining
• 30:48
  the delusion by laying the blame on current contagions. Badly constructed houses do for
• 30:53
  the healthy what badly constructed hospitals do for the sick. Once in sure the
• 31:00
  the air and house is stagnant, and sickness is certain to follow. Two
• 31:07
  pure water is more generally introduced into houses than it used to be, thanks
• 31:11
  to the exertions of the sanitary reformers. Within the last few years. A
• 31:15
  large part of London was in the daily habit of using water polluted by the
• 31:19
  drainage of its sewers and water closets. This has happily been remedied, but
• 31:26
  in many parts of the country well water of a very impure kind is used
• 31:32
  for domestic purposes, and when epidemic disease shows itself, persons using such water
• 31:37
  are almost sure to suffer three. It would be curious to ascertain by inspection
• 31:47
  how many houses in London are really well drained. Many people would say surely
• 31:52
  all or most of them. But many people have no idea in what good
• 31:56
  drainage consists. They think that a sewer in the street and a pipe leading
• 32:01
  to it from the house is good drainage. All the while the sewer may
• 32:06
  be nothing but a laboratory from which epidemic disease and ill health is being distilled
• 32:10
  into the house. No house with any untapped drain pipe communicating immediately with a
• 32:16
  sewer, whether it be from water closet, sink or gully grate, can
• 32:22
  never be healthy, An untrapped sink may at times spread fever or piemia among
• 32:28
  the inmates. For palace, the ordinary oblong sink is an abomination. That
• 32:34
  great surface of stone, which is always left wet, is always exhaling into
• 32:38
  the air. I have known whole houses and hospitals smell of the sink.
• 32:45
  I have met just as strong a stream of sewer air coming up the back
• 32:49
  staircase of a grand London house from the sink as I have ever met at
• 32:52
  Scutari. And I have seen the rooms in that house all ventilated by the
• 32:58
  open doors and the passages, or unventilated by the closed windows, in order
• 33:02
  that as much of the sewer air as possible might be conducted into and retained
• 33:07
  in the bedrooms. It is wonderful. Another great evil in house construction is
• 33:14
  carrying drains underneath the house. Such drains are never safe. All house drains
• 33:21
  should begin and end outside the walls. Many people will readily admit as a
• 33:27
  theory the importance of these things. But how few are there who can intelligently
• 33:31
  trace disease in their households to such causes. Is it not a fact that
• 33:37
  when scarlet fever measles or small pox appear among the children, the very first
• 33:44
  thought which occurs is where the children can have caught the disease, and the
• 33:50
  parents immediately run over in their minds all the families with whom they may have
• 33:53
  been. They never think of looking at home for the source of the mischief.
• 34:00
  If the neighbor's child is seized with smallpox, the first question which occurs
• 34:04
  is whether it had been vaccinated. No one would undervalue vaccination, but it
• 34:08
  becomes of doubtful benefit to society when it leads people to look abroad for the
• 34:14
  source of evils which exist at home. Four. Without cleanliness within and without
• 34:23
  your house, ventilation is comparatively useless. In certain foul districts of London,
• 34:30
  poor people used to object to open their windows and doors because of the foul
• 34:34
  smells that came in. Rich people like to have their stables and dunghill near
• 34:39
  their houses, But does it ever occur to them that with many arrangements of
• 34:44
  this kind, it would be safer to keep the windows shut than open.
• 34:49
  You cannot have the air of the house pure with dung heaps under the windows.
• 34:53
  These are common all over London, and yet people are surprised that their
• 34:59
  children brought up in large, well aired nurseries and bedrooms suffer from children's epidemics.
• 35:06
  If they studied nature's laws in the matter of children's health, they would
• 35:09
  not be so surprised. There are other ways of having filth inside a house,
• 35:15
  besides having dirt in heaps. Old papered walls of years standing, dirty
• 35:22
  carpets, uncleansed furniture are just as ready sources of impurity to the air as
• 35:28
  if there were a dung heap in the basement. People are so unaccustomed from
• 35:32
  education and habits to consider how to make a home healthy that they either never
• 35:37
  think of it at all and take every disease as a matter of course to
• 35:40
  be resigned to when it comes as from the hand of providence, or if
• 35:46
  they ever entertain the idea of preserving the health of their household as a duty,
• 35:52
  they are very apt to commit all kinds of negligences and ignorances in performing
• 35:55
  it. A dark house is always an unhealthy house, always an ill aired
• 36:05
  house, always a dirty house. Want of light stops growth and promotes scrofula
• 36:12
  rickets, et cetera among the children. People lose their health in a dark
• 36:16
  house, and if they get ill they cannot get well again in it.
• 36:20
  More will be said about this farther on. Three. Out of many negligences
• 36:27
  and ignorances in managing the health of houses generally, I will here mentioned as
• 36:30
  specimens. One that the female head in charge of any building does not think
• 36:37
  it necessary to visit every hole and corner of it every day. How can
• 36:42
  she expect those who are under her to be more careful to maintain her house
• 36:45
  in a healthy condition than she who is in charge of it. Two That
• 36:52
  it is not considered essential to air, to sun and to clean rooms while
• 36:57
  uninhabited, which is simply ignoring the first elementary notion of sanitary things and laying
• 37:02
  the ground ready for all kinds of diseases. Three that the window and one
• 37:09
  window is considered enough to air a room. Have you never observed that any
• 37:15
  room without a fireplace is always close? And if you have a fireplace,
• 37:22
  would you cram it up not only with a chimney board, but perhaps with
• 37:24
  a great wisp of brown paper in the throat of the chimney to prevent the
• 37:29
  soot from coming down. You say, if your chimney is foul, sweep
• 37:34
  it, But don't expect that you can ever air a room with only one
• 37:37
  aperture. Don't suppose that to shut up a room is the way to keep
• 37:42
  it clean. It is the best way to foul the room and all that
• 37:45
  is in it. Don't imagine that if you, who are in charge,
• 37:50
  don't look to all these things yourself, those under you will be more careful
• 37:53
  than you are. It appears as if the part of a mistress now is
• 37:59
  to complain of her servants and to accept their excuses, not to show them
• 38:04
  how there need be neither complaints made, nor excuses. But again, to
• 38:09
  look to all these things yourself does not mean to do them yourself. I
• 38:15
  always open the windows. The head in charge often says, if you do
• 38:20
  it, it is by so much the better, certainly than if it were
• 38:22
  not done at all. But can you ensure that it is done when not
• 38:27
  done by yourself? Can you ensure that it is not undone when your back
• 38:31
  is turned. This is what being in charge means, and a very important
• 38:37
  meaning it is too. The former only implies that just what you can do
• 38:40
  with your own hands is done, the latter that what ought to be done
• 38:45
  is always done. And now you think these things trifles or at least exaggerated.
• 38:53
  But what you think or what I think, matters little. Let us
• 38:58
  see what God thinks of them. God always justifies his ways while we are
• 39:04
  thinking, He has been teaching. I have known cases of hospital piemia quite
• 39:08
  as severe in handsome private houses as in any of the worst hospitals, and
• 39:14
  from the same cause, that is foul air. Yet nobody learnt the lesson.
• 39:21
  Nobody learned anything at all from it. They went on thinking, thinking
• 39:25
  that the sufferer had scratched his thumb, or that it was singular that all
• 39:30
  the servants had whitlows, or that something was much about this year. There
• 39:35
  is always sickness in our house. This is a favorite mode of thought,
• 39:38
  leading not to inquire what is the uniform cause of these general whitlows, but
• 39:44
  a stifle all inquiry. In what sense is sickness being always there? A
• 39:51
  justification of its being there at all? I will tell you what was the
• 39:55
  cause of this hospital piemia being in that large private house. It was that
• 40:00
  the sewer air from an ill placed sink was carefully conducted into all the rooms
• 40:06
  by sedulously opening all of the doors and closing all the passage windows. It
• 40:12
  was that the slops were emptied into the footpans. It was that the utensils
• 40:15
  were never properly rinsed. It was that the chamber crockery was rinsed with dirty
• 40:21
  water. It was that the beds were never properly shaken, aired, picked
• 40:25
  to pieces, or changed. It was that the carpets and curtains were always
• 40:30
  musty. It was that the furniture was always dusty. It was that the
• 40:35
  papered walls were saturated with dirt. It was that the floors were never cleaned.
• 40:40
  It was that the uninhabited rooms were never sunned or cleaned or aired.
• 40:46
  It was that the cupboards were always reservoirs of foul air. It was that
• 40:51
  the windows were always tight shut up at night. It was that no window
• 40:55
  was ever systematically opened even in the day, or that the right window was
• 41:00
  not opened. A person gasping for air might open a window for himself.
• 41:06
  But the servants were not taught to open the windows to shut the doors.
• 41:09
  Or they opened the windows upon a dank well between high walls, not upon
• 41:15
  the area court, or they opened the room doors into the unaired halls and
• 41:20
  passages by way of airing the rooms. Now, all of this is not
• 41:25
  fancy but fact. In that handsome house, I have known in one summer
• 41:30
  three cases of hospital piemia, one of phlebitis, two of consumptive cough,
• 41:37
  all the immediate products of foul air. When in temperate climates a house is
• 41:44
  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.
• 41:54
  He is teaching while you are not learning. This poor body loses his
• 42:00
  finger, that one loses his life, and all from the most easily preventable
• 42:05
  causes. The houses of the grandmothers and great grandmothers of this generation, at
• 42:10
  least the country houses with front door and back door always standing open winter and
• 42:16
  summer, and a thorough draft always blowing through with all the scrubbing and cleaning
• 42:22
  and polishing and scouring which used to go on the grandmothers, and still more,
• 42:28
  the great grandmothers always out of doors, and never with a bonnet on,
• 42:31
  except to go to church. These things entirely account for the fact so
• 42:37
  often seen of a great grandmother who was a tower of physical vigor, descending
• 42:42
  into a grandmother, perhaps a little less vigorous, but still sound as a
• 42:45
  bell and healthy to the core, into a mother languid and confined to her
• 42:50
  carriage and house, and lastly into a daughter sickly and confined to her bed.
• 42:57
  For remember, even with a general decrease of immortality, you may often
• 43:00
  find a race thus degenerating and still oftener a family. You may see poor
• 43:07
  little feeble, washed out rags, children of a noble stock, suffering morally
• 43:12
  and physically throughout their useless, degenerate lives. And yet people who are going
• 43:17
  to marry and bring more such into the world will consult nothing but their own
• 43:22
  convenience as to where they are to live or how they are to live.
• 43:28
  With regard to the health of houses where there is a sick person, it
• 43:31
  often happens that the sickroom is made of ventilating shaft for the rest of the
• 43:35
  house. For while the house is kept as close, unaired and dirty as
• 43:39
  usual, the window of the sickroom is kept a little open always, and
• 43:44
  the door occasionally. Now, there are certainly sacrifices which a house with one
• 43:50
  sick person in it does make to that sick person. It ties up its
• 43:53
  knocker, it lays straw before it in the street. Why can't it keep
• 43:58
  itself thoroughly clean and unusually well aired, indeferent to the sick person. We
• 44:05
  must not forget what inordinary language is called infection, a thing of which people
• 44:12
  are generally so afraid that they frequently follow the very practice in regard to it
• 44:15
  which they ought to avoid. Nothing used to be considered so infectious or contagious
• 44:22
  as small pox, and people not very long ago used to cover up patients
• 44:27
  with heavy bedclothes while they kept up large fires and shut the windows. Smallpox,
• 44:32
  of course, under this regime, is very infectious. People are somewhat
• 44:37
  wiser now in their management of this disease. They have ventured to cover the
• 44:42
  patients lightly and to keep the windows open. And we hear much less of
• 44:45
  the infection of small pox than we used to do. But do people in
• 44:51
  our days act with more wisdom on the subject of infection in fevers, scarlet
• 44:55
  fever, measles, et cetera. Than their forefathers did with small does not?
• 45:01
  The popular idea of infection involve that people should take greater care of themselves
• 45:07
  than of the patient, that, for instance, it is safer not to
• 45:10
  be too much with the patient, not to attend too much to his wants.
• 45:16
  Perhaps the best illustration of the utter absurdity of this view of duty in
• 45:21
  attending on infectious diseases is afforded by what was very recently the practice, if
• 45:27
  it is not so even now, in some of the European lazarettes, in
• 45:30
  which the plague patient youth be condemned to the horrors of filth, overcrowding,
• 45:35
  and want of ventilation, while the medical attendant was ordered to examine the patient's
• 45:39
  tongue through an opera glass and to toss him a lancet to open his absesses.
• 45:45
  With true nursing ignores infection except to prevent it. Cleanliness and fresh air
• 45:52
  from open windows with unremitting attention to the patient are the only defense a true
• 45:59
  nurse, either or needs wise and humane management of the patient is the best
• 46:06
  safeguard against infection. There are not a few popular opinions in regards to which
• 46:13
  it is useful at times to ask a question or two. For example,
• 46:17
  it is commonly thought that children must have what are commonly called children's epidemics,
• 46:22
  current contagions, etc. In other words, that they are born to have
• 46:28
  measles, hooping cough, perhaps even scarlet fever, just as they are born
• 46:31
  to cut their teeth if they live. Now, do tell us why must
• 46:38
  a child have measles? Oh, because you say we cannot keep it from
• 46:45
  infection? Other children have measles, and it must take them, and it
• 46:47
  is safer that it should. But why must other children have measles? And
• 46:53
  if they have, why must yours have them too? If you believed in
• 46:59
  and observed the laws for preserving the health of houses which inculcate cleanliness, ventilation,
• 47:06
  whitewashing, and other means, and which, by the way, are
• 47:08
  laws as implicitly as you believe in the popular opinion, For it is nothing
• 47:15
  more than an opinion that your child must have children's epidemics. Don't you think
• 47:20
  that, upon the whole your child would be more likely to escape altogether?
• 47:28
  End of Section two. Section three petty management. All the results of good
• 47:36
  nursing as detailed in these notes may be spoiled or utterly negatived by one defect,
• 47:44
  that is in petty management, or in other words, by not knowing
• 47:50
  how to manage that what you do when you are there shall be done when
• 47:53
  you are not there. The most devoted friend or nurse cannot always be there,
• 48:00
  nor is it desirable that she should, and she may give up her
• 48:05
  health all her other duties. And yet, for want of a little management,
• 48:09
  be not one half so efficient as another, who is not one half
• 48:14
  so devoted, but who has this art of multiplying herself. That is to
• 48:19
  say, the patient of the first will not be really so well cared for
• 48:23
  as the patient of the second. It is as impossible in a book to
• 48:29
  teach of person in charge of sick how to manage, as it is to
• 48:32
  teach her how to nurse. Circumstances must vary with each different case. But
• 48:38
  it is possible to press upon her to think for herself, Now, what
• 48:43
  does happen during my absence? I am obliged to be away on Tuesday,
• 48:47
  But fresh air or punctuality is not less important to my patient on Tuesday than
• 48:52
  it was on Monday. Or at ten p m. I am never with
• 48:57
  my patient, but quiet, as of no less consequence to him at ten
• 49:00
  than it was at five minutes to ten. Curious as it may seem,
• 49:07
  this very obvious consideration occurs comparatively to few, or if it does occur,
• 49:13
  it is only to cause the devoted friend or nurse to be absent. Fewer
• 49:15
  hours or fewer minutes from her patient, not to arrange so as that no
• 49:21
  minute and no hour shall be for her patient without the essentials of her nursing.
• 49:28
  A very few instances will be sufficient, not as precepts, but as
• 49:32
  illustrations. A strange washerwoman, coming late at night for the things, will
• 49:38
  burst in by mistake, to the patient's sick room after he has fallen into
• 49:43
  his first doze, giving him a shock, the effects of which are irremediable,
• 49:47
  though he himself laughs at the cause and probably never even mentions it.
• 49:52
  The nurse, who is and is quite right to be at her supper,
• 49:58
  has not provided that the washer a woman shall not lose her way and go
• 50:01
  into the wrong room. The patient's room may always have the window open,
• 50:07
  but the passage outside the patient's room, though provided with several large windows,
• 50:13
  may never have one open, because it is not understood that the charge of
• 50:16
  the sick room extends to the charge of the passage, and thus, as
• 50:22
  often happens, the nurse makes it her business to turn the patient's room into
• 50:25
  a ventilating shaft for the foul air of the whole house. An uninhabited room,
• 50:32
  a newly painted room, an uncleaned closet or cupboard may often become a
• 50:37
  reservoir of foul air for the whole house. Because the person in charge never
• 50:43
  thinks of arranging that these places shall always be aired, always cleaned. She
• 50:47
  merely opens the window herself when she goes in. An agitating letter or message
• 50:54
  may be delivered, or an important letter or message not delivered. A visit
• 51:00
  whom it was of consequence to see may be refused, or one whom it
• 51:04
  was of still more consequence not to see may be admitted. Because the person
• 51:08
  in charge has never asked herself this question, what is done when I am
• 51:14
  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,
• 51:23
  all at one and the same time. Nevertheless, the person in charge
• 51:30
  never seems to look the impossibility in the face. Add to this that the
• 51:35
  attempting this impossibility does more to increase the poor patient's hurry and nervousness than anything
• 51:40
  else. It is never thought that the patient remembers these things. If you
• 51:45
  do not, he has not only to think whether the visit or letter may
• 51:51
  arrive, but whether you will be in the way at the particular day and
• 51:53
  hour when it may arrive, so that your partial measures for being in the
• 51:58
  way yourself only increase the necessity for his thought. Whereas if you could but
• 52:04
  arranged that the thing should always be done, whether you were there or not,
• 52:07
  he need never think at all about it. For the above reasons,
• 52:13
  whatever a patient can do for himself, it is better that is less anxiety
• 52:17
  for him to do for himself, unless the person in charge has the spirit
• 52:22
  of management. It is evidently much less exertion for a patient to answer a
• 52:28
  letter for himself by return of post than to have four conversations, wait five
• 52:32
  days, have six anxieties before it is off his mind before the person who
• 52:37
  is to answer it has done so. Apprehension, uncertainty, waiting, expectation,
• 52:45
  fear of surprise do a patient more harm than any exertion. Remember,
• 52:52
  he has face to face with his enemy all the time, internally wrestling with
• 52:55
  him, having long imaginary conversations with him you are thinking of something else.
• 53:04
  Rid him of his adversary quickly is a first rule with the sick. For
• 53:08
  the same reasons, always tell a patient, and tell him beforehand when you
• 53:14
  are going out and when you will be back, whether it is for a
• 53:16
  day, an hour, or ten minutes. You fancy perhaps that it is
• 53:22
  better for him if he does not find out your going at all, better
• 53:25
  for him if you do not make yourself of too much importance to him,
• 53:30
  or else you cannot bear to give him the pain or the anxiety of the
• 53:34
  temporary separation. No such thing you ought to go, we will suppose health
• 53:40
  or duty requires it. Then say so to the patient openly. If you
• 53:46
  go without his knowing it and he finds it out, he will never feel
• 53:52
  secure again that the things which depend upon you will be done when you are
• 53:54
  away, And in nine times out of ten he will be right. If
• 54:00
  you go out without telling him when you will be back, he can take
• 54:04
  no measures nor precautions as to the things which concern you both, or which
• 54:07
  you do for him. If you look into the reports of trials or accidents,
• 54:15
  and especially of suicides, or into the medical history of fatal cases,
• 54:20
  it is almost incredible how often the whole thing turns upon something which has happened
• 54:24
  because he or still oftener she was not there. But it is still more
• 54:30
  incredible, how often, how almost always, this is accepted as a sufficient
• 54:36
  reason A justification. Why the very fact of a thing having happened is the
• 54:40
  proof of its not being a justification. The person in charge was quite right
• 54:45
  not to be there. He was called away for quite sufficient reason, or
• 54:50
  he was away for a daily, recurring and unavoidable cause. Yet no provision
• 54:53
  was made to supply his absence. The fault was not in his being away,
• 55:00
  but in there being no management to supplement his being away. When the
• 55:05
  sun is under a total eclipse, or during his nightly absence, we light
• 55:09
  candles. But it would seem as if it did not occur to us that
• 55:14
  we must also supplement the person in charge of sick or of children, whether
• 55:19
  under an occasional eclipse or during a regular absence. In institutions where many lives
• 55:25
  would be lost, and the effect of such want of management would be terrible
• 55:30
  and patent, there is less of it than in the private house. But
• 55:35
  in both, Let whoever is in charge keep this simple question in her head,
• 55:39
  Not how can I always do this right thing myself? But how can
• 55:44
  I provide for this right thing to be always done? Then when anything wrong
• 55:50
  has actually happened in consequence of her absence, which absence we will suppose to
• 55:54
  have been quite right. Let her question still be not how can I provide
• 56:00
  against any more of such absences, which is neither possible nor desirable, but
• 56:06
  how can I provide against anything wrong arising out of my absence? How few
• 56:13
  men or even women understand, either in great or in little things, what
• 56:19
  it is the being in charge, I mean, know how to carry out
• 56:23
  a charge, from the most colossal calamities down to the most trifling accidents.
• 56:31
  Results are often traced, or rather not traced, to such want of someone
• 56:37
  being in charge, or of his knowing how to be in charge. A
• 56:43
  short time ago, the bursting of a funnel casing on board the finest and
• 56:47
  strongest ship that was ever built on her trial trip destroyed several lives and put
• 56:53
  several hundreds in jeopardy, not from any undetected floor in her new and untried
• 56:59
  work, but from a tap being closed which ought not to have been closed,
• 57:05
  from what every child knows, would make its mother's tea kettle burst.
• 57:09
  And this simply because no one seemed to know what it is to be in
• 57:14
  charge or who was in charge. Nay more, the jury at the inquest
• 57:20
  actually altogether ignored the same, and apparently considered the tap in charge, for
• 57:25
  they gave us a verdict accidental death. This is the meaning of the word
• 57:31
  on a large scale. On a much smaller scale, it happened a short
• 57:37
  time ago that an insane person burnt herself slowly and intentionally to death while in
• 57:44
  her doctor's charge and almost in his nurse's presence. Yet neither was considered at
• 57:50
  all to blame. The very fact of the accident happening proves its own case.
• 57:55
  There is nothing more to be said. Either they did not know their
• 58:00
  business, or they did not know how to perform it. To be in
• 58:05
  charge is certainly not only to carry out the proper measures yourself, but to
• 58:10
  see that everyone else does so too, to see that no one, either
• 58:15
  wilfully or ignorantly thwarts or prevents such measures. It is neither to do everything
• 58:22
  yourself, nor to appoint a number of people to each duty, but to
• 58:27
  ensure that each does that duty to which he is appointed. This is the
• 58:31
  meaning which must be attached to the word by above all those in charge of
• 58:36
  sick, whether of numbers or of individuals. And indeed, I think it
• 58:40
  is with individual sick that it is least understood. One sick person is often
• 58:46
  waited on by four with less precision, and is less really well cared for
• 58:51
  than ten who are waited on by one, or at least than forty who
• 58:54
  are waited on by four, and all for want of this one person in
• 59:00
  charge. It is often said that there are few good servants. Now,
• 59:07
  I say there are few good mistresses. Now, as the jury seems to
• 59:10
  have thought the tap was in charge of the ship's safety, so mistresses now
• 59:15
  seem to think the house is in charge of itself. They neither know how
• 59:20
  to give orders, nor how to teach their servants to obey orders, that
• 59:24
  is, to obey intelligently, which is the real meaning of all discipline.
• 59:30
  Again, people who are in charge often seem to have a pride in feeling
• 59:35
  that they will be missed, that no one can understand or carry on their
• 59:37
  arrangements, their system, books, accounts, et cetera, but themselves.
• 59:44
  It seems to me that the pride is rather in carrying on a system,
• 59:47
  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
• 59:58
  illness, one can deliver everything up to others and know that all will go
• 1:00:02
  on as usual, and that one shall never be missed. End of Section
• 1:00:09
  three. Section four. Noise, unnecessary noise or noise that creates an expectation
• 1:00:19
  in the mind is that which hurts a patient. It is rarely the loudness
• 1:00:23
  of the noise, the effect upon the organ of the air itself, which
• 1:00:28
  appears to affect the sick how well a patient will generally bear, for example,
• 1:00:32
  the putting up of a scaffolding close to the house, when he cannot
• 1:00:37
  bear the talking, still less the whispering, especially if it be of a
• 1:00:42
  familiar voice outside his door. There are certain patients, no doubt, especially
• 1:00:47
  where there is slight concussion or other disturbance of the brain, who are affected
• 1:00:52
  by mere noise. But intermittent noise, or sudden and sharp noise in these
• 1:00:59
  as in all other cases, affects far more than continuous noise. Noise with
• 1:01:04
  jar far more than noise. Without of one thing, you may be certain
• 1:01:09
  that anything which wakes a patient suddenly out of his sleep will invariably put him
• 1:01:15
  into a state of greater excitement to him, more serious aye and lasting mischief
• 1:01:21
  than any continuous noise. However loud never to allow A patient to be waked,
• 1:01:29
  intentionally or accidentally is a sine qua non of all good nursing. If
• 1:01:35
  he is roused out of his first sleep, he is almost certain that to
• 1:01:37
  have no more sleep. It is a curious but quite intelligible fact that if
• 1:01:44
  a patient is waked after a few hours instead of a few minutes sleep,
• 1:01:47
  he is much more likely to sleep again, because pain, like irritability of
• 1:01:52
  brain, perpetuates and intensifies itself. If you have gained a respite of either
• 1:02:00
  in sleep, you have gained more than the mere respite. Both the probability
• 1:02:05
  of recurrence and of the same intensity will be diminished, whereas both will be
• 1:02:09
  terribly increased by want of sleep. This is the reason why sleep is so
• 1:02:15
  all important. This is the reason why a patient waked in the early part
• 1:02:20
  of his sleep loses not only his sleep but his power to sleep. A
• 1:02:24
  healthy person who allows himself to sleep during the day will lose his sleep at
• 1:02:30
  night, but it is exactly the reverse with the sick. Generally, the
• 1:02:35
  more they sleep, the better will they be able to sleep. I have
• 1:02:40
  often been surprised at the thoughtlessness resulting in cruelty, quite unintentionally of friends or
• 1:02:46
  of doctors who will hold a long conversation just in a room or passage adjoining
• 1:02:52
  to the room of the patient, who is either every moment expecting them to
• 1:02:54
  come in, or who has just seen them and knows they are talking about
• 1:03:00
  him. If he is an amiable patient, he will try to occupy his
• 1:03:04
  attention elsewhere and not to listen, and this makes matters worse, for the
• 1:03:08
  strain upon his attention and the effort he makes are so great that it is
• 1:03:14
  well if he is not worse for hours after. If it is a whispered
• 1:03:17
  conversation in the same room, then it is absolutely cruel, for it is
• 1:03:22
  impossible that the patient's attention should not be involuntarily strained to hear walking on tiptoe
• 1:03:30
  doing anything in the room very slowly are injurious for exactly the same reasons.
• 1:03:36
  A firm, light quick step, a steady quick hand at the deciderata not
• 1:03:42
  the slow lingering, shuffling foot, the timid, uncertain touch. Slowness is
• 1:03:47
  not gentleness, though it is often mistaken for such quickness. Lightness and gentleness
• 1:03:54
  are quite compatible. Again, if friends and doctors did but watch as nurses
• 1:04:01
  can and should watch, the features sharpening the eyes growing almost wild of fever.
• 1:04:08
  Patients who were listening for the entrance from the corridor of the persons whose
• 1:04:13
  voices they are hearing there These would never run the risk again of creating such
• 1:04:17
  unnecessary noise as undoubtedly induced or aggravated delirium in many cases I have known such.
• 1:04:26
  In one case, death ensued. It is but fair to say that
• 1:04:30
  this death was attributed to fright. It was the result of a long whispered
• 1:04:34
  conversation within sight of the patient about an impending operation. But anyone who has
• 1:04:41
  known the more than stoicism, the cheerful coolness with which the certainty of an
• 1:04:45
  operation will be accepted by any patient capable of bearing an operation at all,
• 1:04:50
  if it is properly communicated to him, will hesitate to believe that it was
• 1:04:56
  mere fear which produced, as was Averred, the fatal result. In this
• 1:05:00
  instance, it was rather the uncertainty, the strained expectation as to what was
• 1:05:05
  to be decided upon. I need hardly say that the other common cause,
• 1:05:12
  namely for a doctor or friend to leave the patient and communicate his opinion on
• 1:05:15
  the result of his visit to the friends just outside the patient's doore or in
• 1:05:19
  the adjoining room after the visit, but within hearing or knowledge of the patient,
• 1:05:26
  is, if possible, worst of all. It is, I think,
• 1:05:30
  alarming peculiarly at this time, when the female ink bottles are perpetually impressing
• 1:05:35
  upon us woman's particular worth than general missionariness, to see that the dress of
• 1:05:42
  women is daily more and more unfitting them for any mission or usefulness at all.
• 1:05:47
  It is equally unfitted for all poetic and all domestic purposes. A man
• 1:05:53
  is now a more handy and far less objectionable being in a sick room than
• 1:05:57
  a woman. Compelled by her address, every woman now either shuffles or waddles.
• 1:06:02
  Only a man can cross the floor of a sick room without shaking it.
• 1:06:08
  What is become of women's light step, the firm, light quick step
• 1:06:13
  we have been asking for. Unnecessary noise, then is the most cruel absence
• 1:06:18
  of care which can be inflicted either on sick or well. For in all
• 1:06:24
  these remarks, the sick are only mentioned as suffering in a greater proportion than
• 1:06:28
  the well from precisely the same causes unnecessary Although slight noise injures a sick person
• 1:06:36
  much more than necessary noise of a much greater amount. All doctrines about mysterious
• 1:06:44
  affinities and aversions will be found to resolve themselves very much, if not entirely,
• 1:06:49
  into presence or absence of care in these things. A nurse who rustles,
• 1:06:57
  I'm speaking of nurses professional and unprefers, is the horror of a patient,
• 1:07:01
  though perhaps he does not know why. The fidget of silk and of
• 1:07:06
  crinoline, the rattling of keys, the creaking of stays and of shoes will
• 1:07:13
  do a patient more harm than all the medicines in the world will do him
• 1:07:16
  good. The noiseless step of women, the noiseless drapery of women, a
• 1:07:23
  mere figures of speech in this day as skats, and well, if they
• 1:07:28
  do not throw down, some piece of furniture will at least brush against every
• 1:07:32
  article in the room as she moves again. One nurse cannot open the door
• 1:07:39
  without making everything rattle, or she opens the door unnecessarily, often for want
• 1:07:44
  of remembering all the articles that might be brought in at once. A good
• 1:07:48
  nurse will always make sure that no door or window in her patient's room shall
• 1:07:53
  rattle or creak, that no blind or curtain shell by any change of wind
• 1:07:58
  through the open window be made to flap. Especially, will she be careful
• 1:08:02
  of all this before she leaves her patience for the night. If you wait
• 1:08:08
  till your patients tell you or remind you of these things, where is the
• 1:08:12
  use of their having a nurse. There are more shy than exacting patients in
• 1:08:16
  all classes, and many a patient passes a bad night time after time,
• 1:08:23
  rather than remind his nurse every night of all the things she has forgotten.
• 1:08:28
  If there are blinds to your windows, always take care to have them well
• 1:08:32
  up when they are not being used. A little piece slipping down and flapping
• 1:08:36
  with every draft will distract a patient. All hurry or bustle is peculiarly painful
• 1:08:45
  to the sick. And when a patient has compulsory occupations to engage him,
• 1:08:49
  instead of having simply to amuse himself, it becomes doubly injurious. The friend
• 1:08:56
  who remains standing and fidgeting about while a patient is to looking business to him,
• 1:09:00
  or the friend who sits and proses, the one from an idea of
• 1:09:03
  not letting the patient talk, the other from an idea of amusing him,
• 1:09:09
  Each is equally inconsiderate. Always sit down when a sick person is talking business
• 1:09:15
  to you, show no signs of hurry, give complete attention and full consideration
• 1:09:19
  if your advice is wanted, and go away the moment the subject is ended.
• 1:09:26
  Always sit within the patient's view, so that when you speak to him,
• 1:09:30
  he has not painfully to turn his head round in order to look at
• 1:09:32
  you. Everybody involuntarily looks at the person speaking. If you make this act
• 1:09:39
  a wearisome one on the part of the patient, you would doing him harm.
• 1:09:44
  So also, if by continuing to stand you make him continuously raise his
• 1:09:47
  eyes to see you, be as motionless as possible, and never gesticulate in
• 1:09:54
  speaking to the sick. Never make a patient repeat a message your request is
• 1:10:00
  especially if it be some time after occupied Patients are often accused of doing too
• 1:10:04
  much of their own business. They are instinctively right. How often you hear
• 1:10:11
  the person charged with the request of giving the message or writing the letter say
• 1:10:15
  half an hour afterwards to the patient, did you appoint twelve o'clock? Or
• 1:10:19
  what did you say was the address? Or ask perhaps some much more agitating
• 1:10:25
  question, thus causing the patient the effort of memory or worse still, of
• 1:10:30
  decision all over again. It is really less exertion to him to write his
• 1:10:34
  letters himself. This is the almost universal experience of occupied invalids. This brings
• 1:10:44
  us to another caution. Never speak to an invalid from behind, nor from
• 1:10:48
  the door, nor from any distance from him, nor when he is doing
• 1:10:51
  anything. The official politeness of servants in these things is so grateful to invalids
• 1:10:59
  that many, without knowing why, having none but servants about them. These
• 1:11:05
  things are not fancy. If we consider that with sick, as with well,
• 1:11:12
  every thought decomposes some nervous matter. That decomposition, as well as recomposition
• 1:11:17
  of nervous matter, is always going on, and more quickly with the sick
• 1:11:20
  than with the well. That to obtrude abruptly another thought upon the brain,
• 1:11:27
  while it is in the act of destroying nervous matter, by thinking, is
• 1:11:30
  calling upon it to make a new exertion. If we consider these things,
• 1:11:34
  which are facts, not fancies, we shall remember that we are doing positive
• 1:11:40
  injury by interrupting, by startling a fanciful person, as it is called alas
• 1:11:46
  it is no fancy. If the invalid is forced by his allocations to continue
• 1:11:53
  occupations requiring much thinking, the injury is doubly great in feeding a patient suffering
• 1:12:00
  under delirium or stupor. You may suffocate him by giving him his food suddenly.
• 1:12:05
  But if you rub his lips gently with a spoon, and thus attract
• 1:12:10
  his attention, he will swallow the food unconsciously, but with perfect safety.
• 1:12:15
  Thus it is with the brain. If you offer it a thought, especially
• 1:12:19
  one requiring a decision abruptly, you do it a real, not fanciful injury.
• 1:12:26
  Never speak to a sick person suddenly, but at the same time,
• 1:12:29
  do not keep his expectation on the tiptoe. This rule indeed applies to the
• 1:12:34
  well quite as much as to the sick. I have never known persons who
• 1:12:39
  exposed themselves for years to constant interruption who did not muddle away their intellects by
• 1:12:45
  it. At last, the process with them may be accomplished without pain.
• 1:12:49
  With the sick, pain gives warning of the injury. Do not meet or
• 1:12:56
  overtake a patient who is moving about in order to speak to him, or
• 1:13:00
  to give him any message or letter. You might just as well give him
• 1:13:04
  a box on the ear. I have seen a patient fall flat on the
• 1:13:09
  ground who was standing when his nurse came into the room. This was an
• 1:13:14
  accident which might have happened to the most careful nurse, but the other is
• 1:13:17
  done with intention. A patient in such a state is not going to the
• 1:13:23
  East Indies. If you would wait ten seconds or walk ten yards further,
• 1:13:28
  any promenade he could make would be over. You do not know the effort
• 1:13:32
  it is to a patient to remain standing for even a quarter of a minute
• 1:13:36
  to listen to you. If I had not seen a thing done by the
• 1:13:40
  kindest nurses and friends, I should have thought this caution quite superfluous. Patients
• 1:13:46
  are often accused of being able to do much more when nobody is by.
• 1:13:51
  It is quite true that they can unless nurses can be brought to attend to
• 1:13:57
  considerations of the kind of which we have given here Feu specimens. A very
• 1:14:00
  weak patient finds it really much less exertion to do things for himself than to
• 1:14:05
  ask for them, and he will, in order to do them, very
• 1:14:11
  innocently and from instinct, calculate the time his nurse is likely to be absent,
• 1:14:15
  from a fear of her coming in upon him or speaking to him,
• 1:14:19
  just at the moment when he finds it quite as much as he can do
• 1:14:24
  to crawl from his bed to his chair, or from one room to another,
• 1:14:28
  or downstairs or out of doors for a few minutes. Some extra call
• 1:14:32
  made upon his attention at that moment will quite upset him. In these cases,
• 1:14:39
  you may be sure that a patient in the state we have described does
• 1:14:42
  not make such exertions more than once or twice a day, and probably much
• 1:14:45
  about the same hour every day. And it is hard, indeed, if
• 1:14:50
  nurse and friends cannot calculate so as to let him make them undisturbed. Remember
• 1:14:57
  that many patients can walk who cannot stand or even sit up. Standing is,
• 1:15:02
  of all positions the most trying to a weak patient. Everything you do
• 1:15:10
  in a patient's room after he is put up for the night increases tenfold the
• 1:15:15
  risk of his having a bad night. But if you rouse him up after
• 1:15:19
  he has fallen asleep, you do not risk you secure him a bad night.
• 1:15:26
  One hint I would give to all who attend or visit the sick,
• 1:15:30
  To all who have to pronounce an opinion upon sickness or its progress, Come
• 1:15:34
  back and look at your patient after he has had an hour's animated conversation with
• 1:15:40
  you. It is the best test of his real state. We know,
• 1:15:45
  but never pronounce upon him from merely seeing what he does or how he looks
• 1:15:49
  during such a conversation, learn also carefully and exactly, if you can,
• 1:15:56
  how he passed the night after it. People, if ever faint while making
• 1:16:01
  an exertion, it is after it is over. Indeed, almost every effect
• 1:16:08
  of over exertion appears after, not during such exertion. It is the highest
• 1:16:14
  folly to judge of the sick, as is so often done, when you
• 1:16:17
  see them merely during a period of excitement. People have very often died of
• 1:16:23
  that which, it has been proclaimed at the time, has done them no
• 1:16:26
  harm. Remember never to lean against, sit upon, or unnecessarily shake or
• 1:16:33
  even touch the bed in which a patient lies. This is invariably a painful
• 1:16:39
  annoyance. If you shake the chair on which he sits, he has a
• 1:16:43
  point by which to steady himself in his feet. But on a bed or
• 1:16:47
  sofa, he is entirely at your mercy, and he feels every jar you
• 1:16:51
  give him all through him. In all that we have said, both here
• 1:16:58
  and elsewhere, let it be distinctly understood that we are not speaking of hypochondriacs.
• 1:17:03
  To distinguish between real and fancied disease forms, an important branch of the
• 1:17:09
  education of a nurse to manage fancy patients forms an important branch of her duties.
• 1:17:15
  But the nursing which real and that which fancied patients require is of different,
• 1:17:21
  or rather of opposite character, and the latter will not be spoken of
• 1:17:26
  here. Indeed, many of the symptoms which are here mentioned are those which
• 1:17:30
  distinguish real from fancied disease. It is true that hypochondriacs very often do that
• 1:17:36
  behind a nurse's back, which they would not do before her face. Many
• 1:17:42
  such I have had as patients who scarcely ate anything at their regular meals,
• 1:17:45
  but if you concealed food for them in a drawer, they would take it
• 1:17:49
  at night or in secret. But this is from quite a different motive.
• 1:17:55
  They do it from the wish to conceal, whereas the real patient will often
• 1:17:59
  boast to his nurse or doctor if these do not shake their heads at him
• 1:18:02
  of how much he has done, or eaten or walked To return to real
• 1:18:09
  disease. Conciseness and decision are above all things necessary with the sick. Let
• 1:18:16
  your thought express to them be concisely and decidedly expressed. What doubt and hesitation
• 1:18:23
  there may be in your own mind, must never be communicated to theirs,
• 1:18:27
  not even I would rather say, especially not in little things. Let your
• 1:18:32
  doubt be to yourself, your decision to them. People who think outside their
• 1:18:39
  heads, the whole process of whose thought appears like Homer's in the act of
• 1:18:44
  secretion, who tell everything that led them towards this conclusion and away from that
• 1:18:49
  ought, never to be with the sick. Irresolution is what all patients most
• 1:18:55
  dread. Rather than meet this in others, they will collect all their data
• 1:19:00
  and make up their minds for themselves. A change of mind in others,
• 1:19:03
  whether it is regarding an operation or rewriting a letter, always injures the patient
• 1:19:09
  more than the being called upon to make up his mind to the most dreaded
• 1:19:13
  or difficult decision. Farther than this, In very many cases, the imagination
• 1:19:18
  in disease is far more active and vivid than it is in health. If
• 1:19:24
  you propose to the patient change of air to one place one hour and to
• 1:19:28
  another the next, he has, in each case immediately constituted himself in imagination,
• 1:19:33
  the tenant of the place gone over the whole premises in idea, and
• 1:19:39
  you have tired him as much by displacing his imagination as if you had actually
• 1:19:43
  carried him over both places. Above all, leave the sick room quickly and
• 1:19:49
  come into it quickly, not suddenly, not with a rush. But don't
• 1:19:55
  let the patient be wearily waiting for when you will be out of the room
• 1:19:58
  or when you will be in it. Conciseness and decision in your movements,
• 1:20:02
  as well as your words, are necessary in the sick room, as necessary
• 1:20:06
  as absence of hurry and bustle. To possess yourself entirely will ensure you from
• 1:20:14
  either failing, either loitering or hurrying. If a patient has to see not
• 1:20:19
  only to his own but also to his nurse's punctuality or perseverance, or readiness
• 1:20:26
  or calmness, to any or all of these things, he is far better
• 1:20:30
  without that nurse than with her, however valuable and handy her services may otherwise
• 1:20:35
  be to him, and however incapable he may be of rendering them to himself.
• 1:20:42
  With regard to reading aloud in the sick room, my experience is that
• 1:20:46
  when the sick too ill to read to themselves, they can seldom bear to
• 1:20:49
  be read to children. Eye patience and uneducated persons are exceptions, or when
• 1:20:58
  there is any mechanical difficulty reading. People who like to be read to have
• 1:21:02
  generally not much the matter with them, while in fevers, or where there
• 1:21:08
  is much irritability of brain, the effort of listening to reading aloud has often
• 1:21:12
  brought on delirium. I speak with great diffidence because there is an almost universal
• 1:21:17
  impression that it is sparing the sick to read aloud to them. But two
• 1:21:23
  things are certain. One, if there is some matter which must be read
• 1:21:28
  to a sick person, do it slowly. People often think that the way
• 1:21:32
  to get it over with least fatigue to him is to get it over in
• 1:21:36
  least time. They gabble, they plunge, and gallop through the reading.
• 1:21:42
  There never was a greater mistake. Houdin the Conjurer says that the way to
• 1:21:47
  make a story seem short is to tell it slowly. So it is with
• 1:21:53
  reading to the sick. I have often heard a patient say to such a
• 1:21:57
  mistaken reader, don't read it to me, tell it me. Unconsciously.
• 1:22:02
  He is aware that this will regulate the plunging the reading with unequal paces,
• 1:22:08
  slurring over one part instead of leaving it out altogether. If it is unimportant
• 1:22:13
  and mumbling. Another. If the reader lets his own attention wander and then
• 1:22:17
  stops to read up to himself, or finds he has read the wrong bit,
• 1:22:23
  then it is all over with the poor patient's chance of not suffering.
• 1:22:28
  Very few people know how to read to the sick. Very few people read
• 1:22:31
  aloud as pleasantly even as they speak. In reading, they sing, they
• 1:22:38
  hesitate, they stammer, they hurry, they mumble, when in speaking they
• 1:22:44
  do none of these things. Reading aloud to the sick ought always to be
• 1:22:48
  rather slow and exceedingly distinct, but not mouthing, rather monotonous, but not
• 1:22:55
  sing song, rather loud, but not noisy, and above all not too
• 1:23:01
  long. Be very sure of what your patient can bear. Two. The
• 1:23:09
  extraordinary habit of reading to one's self in a sick room, and reading aloud
• 1:23:13
  to the patient any bits which will amuse him or more often, the reader
• 1:23:17
  is unaccountably thoughtless. What do you think the patient is thinking of during your
• 1:23:23
  gaps of non reading? Do you think that he amuses himself upon what you
• 1:23:28
  have read for precisely the time it pleases you to go on reading to yourself,
• 1:23:31
  and that his attention is ready for something else at precisely the time it
• 1:23:35
  pleases you to begin reading again. Whether the person thus read to be sick
• 1:23:41
  or well, whether he be doing nothing or doing something else while thus being
• 1:23:45
  read to the self absorption and want of observation, the person who does it
• 1:23:50
  is equally difficult to understand, although very often the read is too amiable to
• 1:23:57
  say how much it hurts him. One thing more, from the flimsy manner
• 1:24:02
  in which most modern houses are built, where every step on the stairs and
• 1:24:08
  along the floors is felt all over the house. The higher the story,
• 1:24:13
  the greater the vibration, it is inconceivable how much the sick suffer by having
• 1:24:18
  anybody overhead. In the solidly built old houses, which fortunately most hospitals are,
• 1:24:27
  the noise and shaking is comparatively trifling, but it is a serious cause
• 1:24:31
  of suffering in lightly built houses, and with the irritability peculiar to some diseases,
• 1:24:38
  better far put such patients at the top of the house, even with
• 1:24:41
  the additional fatigue of stairs. If you cannot secure the room above them,
• 1:24:45
  being untenanted, you may otherwise bring on a state of restlessness which no opium
• 1:24:50
  will subdue. Do not neglect the warning when a patient tells you that he
• 1:24:57
  feels every step above him to cross his head. Remember that every noise a
• 1:25:01
  patient cannot see partakes of the character of suddenness to him. And I am
• 1:25:08
  persuaded that patients with these peculiarly irritable nerves are positively less injured by having persons
• 1:25:14
  in the same room with them than overhead or separated by only a thin compartment.
• 1:25:19
  Any sacrifice to secure silence for these cases is worth while, because no
• 1:25:26
  heir, however good, no attendance, however careful, will do anything for
• 1:25:30
  such cases without quiet end of Section four, Section five variety. To any
• 1:25:43
  but an old nurse or an old patient, the degree would be quite inconceivable
• 1:25:47
  to which the nerves of the sick suffer from seeing the same walls, the
• 1:25:53
  same ceiling, the same surroundings during a long confinement to one or two rooms.
• 1:26:00
  The superior cheerfulness of persons suffering severe paroxysms of pain over that of persons
• 1:26:06
  suffering from nervous stability has often been remarked upon and attributed to the enjoyment of
• 1:26:13
  the former of their intervals of respite. I incline to think to the majority
• 1:26:17
  of cheerful cases is to be found among those patients who are not confined to
• 1:26:23
  one room, whatever their suffering, and that the majority of depressed cases will
• 1:26:28
  be seen among those subjected to a long monotony of objects about them. The
• 1:26:33
  nervous frame really suffers as much from this as the digestive organs from long monotony
• 1:26:39
  of diet, as for example the soldier from his twenty one years boiled beef.
• 1:26:45
  The effect in sickness of beautiful objects, a variety of objects, and
• 1:26:50
  especially of brilliancy of colour, is hardly at all appreciated. Such cravings are
• 1:26:58
  usually called the fancy of patience, and often doubtless patients have fancies, as
• 1:27:04
  for example, when they desire too contradictions. But much more often there so
• 1:27:11
  called fancies are the most valuable indications of what is necessary for their recovery.
• 1:27:16
  And it would be well if nurses would watch these so called fancies closely.
• 1:27:24
  I have seen in fevers and felt when I was a fever patient myself,
• 1:27:30
  the most acute suffering produced from the patient in a hut not being able to
• 1:27:33
  see out of window, and the knots in the wood being the only view.
• 1:27:40
  I shall never forget the rapture of fever patients over a bunch of bright
• 1:27:44
  colored flowers. I remember in my own case, and those gay of wild
• 1:27:48
  flowers being sent me, and from that moment recovery becoming more rapid. People
• 1:27:55
  say the effect is only on the mind. It is no such thing.
• 1:28:00
  The effect is on the body. Too. Little as we know about the
• 1:28:03
  way in which we are affected by form, by color and light, we
• 1:28:09
  do know this that they have an actual physical effect. Variety of form and
• 1:28:15
  brilliancy of color in the objects presented to patients are actual means of recovery.
• 1:28:23
  But it must be slow variety. That is, if you show a patient
• 1:28:28
  ten or twelve engravings successively, tend to one that he does not become cold
• 1:28:32
  and faint, or feverish, or even sick. But hang one up opposite
• 1:28:38
  him, one on each successive day or week or month, and he will
• 1:28:43
  revel in the variety. The folly and ignorance which reign too often supreme over
• 1:28:50
  the sick room cannot be better exemplified than by this. While the nurse will
• 1:28:56
  leave the patient stewing in a corrupting atmosphere, the best ingredient of which is
• 1:29:00
  carbonic acid, she will deny him on the plea of unhealthiness a glass of
• 1:29:05
  cut flowers or a growing plant. Now, no one ever saw overcrowding by
• 1:29:13
  plants in a room or ward, and the carbonic acid they give off at
• 1:29:17
  nights would not poison a fly. Nay, in overcrowded rooms, they actually
• 1:29:24
  absorb carbonic acid and give off oxygen. Cut flowers also decompose water and produce
• 1:29:31
  oxygen gas. It is true there are certain flowers, for example, lilies,
• 1:29:36
  the smell of which is said to depress the nervous system. These are
• 1:29:41
  easily known by the smell and can be avoided. Volumes are now written and
• 1:29:47
  spoken upon the effect of the mind upon the body. Much of it is
• 1:29:51
  true, But I wish a little more was thought of the effect of the
• 1:29:57
  body on the mind. You who believe yourselves overwhelmed with anxieties, but are
• 1:30:02
  every day able to walk up Regent Street or out in the country, to
• 1:30:08
  take your meals with others in other rooms, et cetera, et cetera,
• 1:30:12
  You little know how much your anxieties are thereby lightened. You little know how
• 1:30:16
  intensified they become to those who can have no change. How the very walls
• 1:30:23
  of their sick rooms seem hung with their cares, how the ghosts of their
• 1:30:28
  troubles haunt their beds, how impossible it is for them to escape from a
• 1:30:32
  pursuing thought without some help from variety. A patient can just as much move
• 1:30:40
  his leg when it is fractured as change his thoughts when no external help from
• 1:30:45
  variety is given him. This is indeed one of the main sufferings of sickness,
• 1:30:49
  just as the fixed posture is one of the main sufferings of the broken
• 1:30:54
  limb. It is an ever recurring wonder to see educated people who call themselves
• 1:31:00
  nurses acting thus they vary their own objects, their own employments, many times
• 1:31:06
  a day, and while nursing some bed ridden sufferer, they let him lie
• 1:31:12
  there staring at a dead wall, without any change of object to enable him
• 1:31:15
  to vary his thoughts. And it never even occurs to them, at least
• 1:31:20
  to move his bed so that he can look out of window. No,
• 1:31:25
  the bed is always to be left in the darkest, dullest, remotest part
• 1:31:29
  of the room. I think it is a very common error among the well
• 1:31:34
  to think that with a little more self control, the sick might, if
• 1:31:38
  they choose dismiss painful thoughts which aggravate their disease, et cetera. Believe me,
• 1:31:45
  almost any sick person who behaves decently well exercises more self control every moment
• 1:31:53
  of his day than you will ever know till you are sick yourself. Almost
• 1:31:58
  every step that cross his room is painful to him. Almost every thought that
• 1:32:02
  crosses his brain is painful to him. And if he can speak without being
• 1:32:06
  savage and look without being unpleasant, he is exercising self control. Suppose you
• 1:32:15
  have been up all night, and instead of being allowed to have your cup
• 1:32:17
  of tea, you were to be told that you ought to exercise self control.
• 1:32:23
  What should you say now? The nerves of the sick are always in
• 1:32:28
  the state that yours are in after you have been up all night. We
• 1:32:33
  will suppose the diet of the sick to be cared for. Then this state
• 1:32:39
  of nerves is most frequently to be relieved by care in affording them a pleasant
• 1:32:43
  view. A judicious variety as to flowers and pretty things, light by itself,
• 1:32:49
  will often relieve it. The craving for the return of day, which
• 1:32:55
  the six so constantly evince, is generally nothing but the desire for lofe ight,
• 1:33:00
  the remembrance of the relief which a variety of objects before the eye affords
• 1:33:04
  to the harassed sick mind. Again, every man and every woman has some
• 1:33:13
  amount of manual employment, excepting a few fine ladies who do not even dress
• 1:33:17
  themselves, and who are virtually in the same category as to nerves as the
• 1:33:21
  sick. Now you can have no idea of the relief which manual labor is
• 1:33:28
  to you, of the degree to which the deprivation of manual employment increases the
• 1:33:32
  peculiar irritability from which many sick suffer. A little needlework, a little writing,
• 1:33:40
  a little cleaning, would be the greatest relief the sick could have,
• 1:33:44
  if they could do it. These are the greatest relief to you, though
• 1:33:47
  you do not know it. Reading, although it is often the only thing
• 1:33:53
  the sick can do, is not this relief. Bearing this in mind,
• 1:33:59
  bearing in mind, and that you have all these varieties of employment which the
• 1:34:02
  sick cannot have, bear also in mind to obtain for them all the varieties
• 1:34:08
  which they can enjoy. I need hardly say that I am well aware that
• 1:34:14
  excess in needlework, in writing, in any other continuous employment, will produce
• 1:34:19
  the same irritability that defect in manual employment as one cause produces in the sick.
• 1:34:29
  End of Section five, Section six taking food. Every careful observer of
• 1:34:38
  the sick will agree in this that thousands of patients are annually starved in the
• 1:34:43
  midst of plenty, from want of attention to the ways which alone make it
• 1:34:46
  possible for them to take food. This want of attention is as remarkable in
• 1:34:53
  those who urge upon the sick to do what is quite impossible to them as
• 1:34:57
  in the sick themselves, who will not make them the effort to do what
• 1:35:00
  is perfectly possible to them. For instance, to the large majority of very
• 1:35:06
  weak patients, it is quite impossible to take any solid food before eleven a
• 1:35:12
  m. Nor then if their strength is still further exhausted by fasting till that
• 1:35:15
  hour. For weak patients have generally feverish nights and in the morning dry mouths,
• 1:35:24
  and if they could eat with those dry mouths, it would be the
• 1:35:28
  worse for them. A spoonful of beef, tea of arrowroot, and wine
• 1:35:33
  of egg flip every hour will give them the requisite nourishment and prevent them being
• 1:35:40
  too much exhausted to take at a later hour the solid food which is necessary
• 1:35:43
  for their recovery. And every patient who can swallow at all can swallow these
• 1:35:48
  liquid things if he chooses. But how often do we hear a mutton chop,
• 1:35:55
  an egg a bit of bacon ordered to a patient for breakfast, to
• 1:35:59
  who boom, As a moment's consideration would show us, it must be quite
• 1:36:03
  impossible to masticate such things at that hour. Again, a nurse is ordered
• 1:36:10
  to give a patient a teacupful of some article of food every three hours.
• 1:36:15
  The patient's stomach rejects it. If so, try a tablespoonful every hour.
• 1:36:20
  If this will not do, a teaspoonful every quarter of an hour, I
• 1:36:27
  am bound to say that I think more patients are lost by want of care
• 1:36:30
  and ingenuity in these momentous minutii in private nursing than in public hospitals. And
• 1:36:38
  I think there is more of the entente cordial to assist one another's hands between
• 1:36:44
  the doctor and his head nurse in the latter institutions than between the doctor and
• 1:36:47
  the patient's friends in the private house. If we did but know the consequences
• 1:36:54
  which may ensue in very weak patients from ten minutes fasting or repletion. I
• 1:37:00
  call it repletion when they are obliged to let too small an interval elapse between
• 1:37:04
  taking food and some other exertion owing to the nurse's unpunctuality. We should be
• 1:37:11
  more careful never to let this occur. In very weak patients, there is
• 1:37:16
  often a nervous difficulty of swallowing, which is so much increased by any other
• 1:37:20
  call upon their strength, that unless they have their food punctually at the minute,
• 1:37:26
  which minute again must be arranged so as to fall in with no other
• 1:37:30
  minute's occupation, they can take nothing until the next respite occurs, so that
• 1:37:35
  an unpunctuality or delay of ten minutes may very well turn out to be one
• 1:37:41
  of two or three hours. And why is it not as easy to be
• 1:37:45
  punctual to a minute? Life often literally hangs upon these minutes in acute cases
• 1:37:54
  where life or death is to be determined in a few hours. These matters
• 1:37:58
  are very generally attended to, especially in hospitals, and the number of cases
• 1:38:02
  is large where the patient is, as it were, brought back to life
• 1:38:06
  by exceeding care on the part of the doctor or nurse or both in ordering
• 1:38:12
  and giving nourishment with minute selection and punctuality. But in chronic cases lasting over
• 1:38:19
  months and years, where the fatal issue is often determined at last by mere
• 1:38:25
  protracted starvation, I had rather not enumerate the instances which I have known where
• 1:38:30
  a little ingenuity and a great deal of perseverance might, in all probability have
• 1:38:36
  averted the result. The consulting the hours when the patient can take food,
• 1:38:43
  the observation of the times, often varying when he is most faint, the
• 1:38:47
  altering seasons of taking food in order to anticipate and prevent such times. All
• 1:38:54
  this which requires observation, ingenuity, and perseverance, and these really constitute the
• 1:39:00
  good nurse might save more lives than we what of. To leave the patient's
• 1:39:08
  untasted food by his side from meal to meal, in hopes that he will
• 1:39:13
  eat it in the interval is simply to prevent him from taking any food at
• 1:39:15
  all. I have known patience literally incapacitated from taking one article of food after
• 1:39:21
  another by this piece of ignorance. Let the food come at the right time
• 1:39:28
  and be taken away, eaten or uneaten at the right time. But never
• 1:39:31
  let a patient have something always standing by him. If you don't wish to
• 1:39:35
  disgust him of everything. On the other hand, I have known a patient's
• 1:39:42
  life saved he was sinking for want of food, by the simple question put
• 1:39:46
  to him by the doctor. But is there no hour when you feel you
• 1:39:50
  could eat? Oh? Yes, he said, I could always take something
• 1:39:55
  at a clock and o'clock. The thing was tried and succeeded. Patients very
• 1:40:03
  seldom, however, can tell you this. It is for you to watch
• 1:40:06
  and find it out. A patient should, if possible, not see or
• 1:40:13
  smell either the food of others, or a greater amount of food than he
• 1:40:16
  himself can consume at one time, or even hear food talked about, or
• 1:40:21
  see it in the raw state. I know of no exception to the above
• 1:40:26
  rule. The breaking of it always induces a greater or less incapacity of taking
• 1:40:30
  food. In hospital wards, it is of course impossible to observe all this,
• 1:40:36
  and in single wards, where a patient must be continuously and closely watched,
• 1:40:41
  it is frequently impossible to relieve the attendant so that his or her own
• 1:40:45
  meals can be taken out of the ward. But it is not the less
• 1:40:49
  true that in such cases, even where the patient is not himself aware of
• 1:40:54
  it, his possibility of taking food is limited by seeing the attendant eating meals
• 1:40:59
  under him observation. In some cases the sick are aware of it and complain.
• 1:41:05
  A case where the patient was supposed to be insensible but complained as soon
• 1:41:10
  as able to speak, is now present to my recollection. Remember, however,
• 1:41:15
  that the extreme punctuality in well ordered hospitals, the rule that nothing shall
• 1:41:20
  be done in the ward while the patients are having their meals, go far
• 1:41:25
  to counterbalance what unavoidable evil there is in having patients together. I have often
• 1:41:30
  seen the private nurse go on dusting or fidgeting about in a sick room all
• 1:41:34
  the while the patient is eating or trying to eat. That the more alone
• 1:41:41
  an invalid can be when taking food, the better is unquestionable. And even
• 1:41:46
  if he must be fed, the nurse should not allow him to talk or
• 1:41:49
  to talk to him, especially about food while eating. When a person is
• 1:41:56
  compelled by the pressure of occupation to cantinue his business while sick, it ought
• 1:42:01
  to be a rule, without any exception whatever, that no one shall bring
• 1:42:06
  business to him or talk to him while he is taking food, nor go
• 1:42:11
  on talking to him on interesting subjects up to the last moment before his meals,
• 1:42:16
  nor make an engagement with him immediately after, so that there can be
• 1:42:19
  any hurry of mind while taking them. Upon the observance of these rules,
• 1:42:26
  especially the first, often depends the patient's capability of taking food at all,
• 1:42:30
  or if he is amiable and forces himself to take food, of deriving any
• 1:42:35
  nourishment from it. A nurse should never put before a patient milk that is
• 1:42:43
  sour, meat or soup that is turned, an egg that is bad,
• 1:42:46
  or vegetables underdone. Yet often I have seen these things brought into the sick
• 1:42:53
  in a state perfectly perceptible to every nose or eye except the nurses. It
• 1:43:00
  is here that the clever nurse appears. She will not bring in the peccant
• 1:43:03
  article, but not to disappoint the patient, she will whip up something else
• 1:43:08
  in a few minutes. Remember that sick cookery should half do the work of
• 1:43:13
  your poor patient's weak digestion. But if you further impair it with your bad
• 1:43:17
  articles, I know not what is to become of him or of it.
• 1:43:23
  If the nurse is an intelligent being and not a mere carrier of diets too
• 1:43:27
  and from the patient, let her exercise her intelligence in these things. How
• 1:43:32
  often we have known a patient eat nothing at all in the day because one
• 1:43:36
  meal was left untasted at that time he was incapable of eating. At another,
• 1:43:42
  the milk was sour, the third was spoiled by some other accident.
• 1:43:45
  And it never occurred to the nurse to extemporize some expedient. It never occurred
• 1:43:50
  to her that, as he had had no solid food that day, he
• 1:43:54
  might eat a bit of toast, say, with his tea in the evening,
• 1:43:58
  or he might have some meal an hour early. A patient who cannot
• 1:44:01
  touch his dinner at two will often accept it gladly if brought to him at
• 1:44:05
  seven. But somehow nurses never think of these things. One would imagine they
• 1:44:13
  did not consider themselves bound to exercise their judgment. They leave it to the
• 1:44:16
  patient. Now, I am quite sure that it is better for a patient
• 1:44:21
  rather to suffer these neglects than to try to teach his nurse to nurse him
• 1:44:26
  if she does not know how it ruffles him, and if he is ill,
• 1:44:30
  he is in no condition to teach, especially upon himself. The above
• 1:44:35
  remarks apply much more to private nursing than to hospitals. I would say to
• 1:44:42
  the nurse, have a rule of thought about your patient's diet. Consider remember
• 1:44:46
  how much he has had and how much he ought to have today. Generally,
• 1:44:51
  the only rule of the private patient's diet is what the nurse has to
• 1:44:56
  give. It is true she cannot give him what she has not got,
• 1:45:00
  but his stomach does not wait for her convenience or even her necessity. If
• 1:45:04
  it is used to having its stimulus at one hour to day, and tomorrow
• 1:45:09
  it does not have it because she has failed in getting it, he will
• 1:45:13
  suffer. She must be always exercising her ingenuity to supply defects and to remedy
• 1:45:18
  accidents which will happen among the best contrivers, but from which the patient does
• 1:45:24
  not suffer the less because they cannot be helped. One very minute caution,
• 1:45:30
  take care not to spill into your patient's saucer. In other words, take
• 1:45:35
  care that the outside bottom rim of his cup should be quite dry and clean.
• 1:45:42
  If every time he lifts his cup to his lips, he has to
• 1:45:45
  carry the saucer with it, or else to drop the liquid upon and to
• 1:45:48
  soil his sheet or his bed gown or pillow, or if he is sitting
• 1:45:53
  up his dress, you have no idea. What a difference this minute want
• 1:45:57
  of care on your part makes to his comfort and even to his willingness for
• 1:46:00
  food. End of Section six, Section seven what food? I will mention
• 1:46:13
  One or two of the most common errors among women in charge of sick respecting
• 1:46:17
  sick diet. One is the belief that beef tea is the most nutritive of
• 1:46:23
  all articles. Now, just try and boil down a pound of beef into
• 1:46:28
  beef tea. Evaporate your beef tea, and see what is left of your
• 1:46:31
  beef. You will find that there is barely a teaspoonful of solid nourishment to
• 1:46:38
  half a pint of water in beef tea. Nevertheless, there is a certain
• 1:46:43
  reparative quality in it. We do not know what as there is in tea,
• 1:46:47
  but it may be safely given in almost any inflammatory disease, and is
• 1:46:51
  as little to be depended upon with the healthy or convalescent, where much nourishment
• 1:46:57
  is required. Again, it is an ever ready saw that an egg is
• 1:47:01
  equivalent to a pound of meat, whereas it is not so at all.
• 1:47:08
  Also, it is seldom noticed with how many patients, particularly of nervous or
• 1:47:13
  billious temperament, eggs disagree, all puddings made with eggs are distasteful to them.
• 1:47:18
  In consequence, an egg whipped up with wine is often the only form
• 1:47:24
  in which they can take this kind of nourishment. Again, if the patient
• 1:47:29
  has attained to eating meat, it is supposed that to give him meat is
• 1:47:31
  the only thing needful for his recovery. Whereas scorbutic saws have been actually known
• 1:47:38
  to appear among sick persons living in the midst of plenty in England, which
• 1:47:42
  could be traced to no other sauce than this. That is that the nurse,
• 1:47:46
  depending on meat alone, had allowed the patient to be without vegetables for
• 1:47:50
  considerable time, these latter being so badly cooked that he always left them untouched.
• 1:47:58
  Arrowroot is another grand day dependence of the nurse as a vehicle for wine
• 1:48:02
  and as a restorative quickly prepared. It is all very well, but it
• 1:48:08
  is nothing but starch and water. Flour is both more nutritive and less liable
• 1:48:13
  to ferment, and is preferable wherever it can be used. Again, Milk
• 1:48:19
  and the preparations from milk are a most important article of food for the sick.
• 1:48:25
  Butter is the lightest kind of animal fat. And though it wants the
• 1:48:29
  sugar and some of the other elements which there are in milk, yet it
• 1:48:32
  is most valuable both in itself and in enabling the patient to eat more.
• 1:48:36
  Bread. Flour, oats, groats, barley, and their kind are as
• 1:48:43
  we have already said, preferable in all their preparations to all the preparations of
• 1:48:47
  arrowroot, sago, tapiocre and their kind. Cream, in many long chronic
• 1:48:55
  diseases is quite irreplaceable by any other article whatever. It seems to act in
• 1:49:00
  the same manner as beef tea, and to most it is much easier of
• 1:49:04
  digestion than the milk. In fact, it seldom disagrees. Cheese is not
• 1:49:11
  usually digestible by the sick, but it is pure nourishment for repairing waste.
• 1:49:15
  And I have seen sick, and not a few either whose craving for cheese
• 1:49:19
  showed how much it was needed by them. But if fresh milk is so
• 1:49:25
  valuable a food for the sick, the least change or sourness in it makes
• 1:49:30
  it. Of all articles, perhaps the most Injurious diarrhea is a common result
• 1:49:35
  of fresh milk allowed to become a tall sour The nurse therefore ought to exercise
• 1:49:43
  her utmost care in this In large institutions for the sick, even the poorest,
• 1:49:48
  the utmost care is exercised whenham lake ice is used for this express purpose
• 1:49:55
  every summer. While the private patient perhaps never tastes a drop of milk that
• 1:50:00
  is not sour all through the hot weather, so little does the private nurse
• 1:50:04
  understand the necessity of such care. Yet, if you consider that the only
• 1:50:10
  drop of real nourishment in your patient's tea is the drop of milk, and
• 1:50:15
  how much almost all English patients depend upon their tea, you will see the
• 1:50:19
  great importance of not depriving your patient of this drop of milk. Buttermilk,
• 1:50:26
  a totally different thing, is often very useful, especially in fevers, in
• 1:50:31
  laying down rules of diet by the amounts of solid nutriment in different kinds of
• 1:50:38
  food. It is constantly lost sight of what the patient requires to repair his
• 1:50:42
  waist, what he can take and what he cannot. You cannot diet a
• 1:50:46
  patient from a book. You cannot make up the human body as you would
• 1:50:50
  make up a prescription. So many parts carboniferous, so many parts nitrogenous,
• 1:50:56
  will constitute a perfect diet for the patient. The nurse's observation here will materially
• 1:51:02
  assist the doctor. The patients fancies will materially assist the nurse. For instance,
• 1:51:11
  sugar is one of the most nutritive of all articles, being pure carbon,
• 1:51:15
  and is particularly recommended in some books. But the vast majority of all
• 1:51:19
  patients in England, young and old, male and female, rich and poor,
• 1:51:26
  hospital and private, dislike sweet things. And while I have never known
• 1:51:30
  a person take to sweets while he was ill, who disliked them when he
• 1:51:34
  was well, I have known many fond of them when in health, who
• 1:51:39
  in sickness would leave off anything sweet, even to sugar in tea, sweet
• 1:51:44
  puddings, sweet drinks are their aversion. The furred tongue almost always likes what
• 1:51:49
  is sharp or pungent scorbutic patients are an exception. They often crave for sweetmeats
• 1:51:57
  and jams. Jelly is another article of diet in great favor with nurses and
• 1:52:03
  friends of the sick. Even if it could be eaten solid, it would
• 1:52:06
  not nourish. But it is simply the height of folly to take an eighth
• 1:52:11
  of an ounce of gelatine and make it into a certain bulk by dissolving it
• 1:52:15
  in water, and then to give it to the sick, as if the
• 1:52:17
  mere bulk represented nourishment. It is now known that jelly does not nourish,
• 1:52:24
  that it has a tendency to produce diarrhea, and to trust to it to
• 1:52:28
  repair the waste of a diseased constitution is simply to starve the sick under the
• 1:52:32
  guise of feeding them. If a hundred spoonfuls of jelly were given in the
• 1:52:38
  course of the day, you would have given one spoonful of gelatine, which
• 1:52:42
  spoonful has no nutritive power whatever, And nevertheless, gelatine contains a large quantity
• 1:52:48
  of nitrogen, which is one of the most powerful elements in nutrition. On
• 1:52:54
  the other hand, beef tea may be chosen as an illustration of great nutrient
• 1:52:58
  power in sickness, coexisting with a very small amount of solid nitrogenous matter.
• 1:53:04
  Doctor Christensen says that everyone will be struck with the readiness with which certain classes
• 1:53:10
  of patience will often take diluted meat, juice or beef tea repeatedly when they
• 1:53:15
  refuse all other kinds of food. This is particularly remarkable in cases of gastric
• 1:53:21
  fever, in which he says, little or nothing else besides beef tea or
• 1:53:26
  diluted meat juice has been taken for weeks or even months, and yet a
• 1:53:30
  pint of beef tea contains scarcely a quarter of an ounce of anything but water.
• 1:53:36
  The result is so striking that he asks what is its mode of action?
• 1:53:43
  Not simply nutrient? A quarter ounce of the most nutritive material cannot nearly
• 1:53:47
  replace the daily wear and tear of the tissues in any circumstances. Possibly,
• 1:53:53
  he says it belongs to a new denomination of remedies. It has been observed
• 1:54:00
  that a small quantity of beef tea added to other articles of nutrition augments their
• 1:54:04
  power out of all proportion to the additional amount of solid matter. The reason
• 1:54:11
  why jelly should be innutritious and beef tea nutritious to the sick is a secret
• 1:54:15
  yet undiscovered, but it clearly shows that careful observation of the sick is the
• 1:54:20
  only clue to the best dietary chemistry has yet afford a little insight into the
• 1:54:27
  dieting of the sick. All that chemistry can tell us is the amount of
• 1:54:31
  carboniferous or nitrogenous elements discoverable in different dietic articles. It has given us lists
• 1:54:39
  of dietic substances arranged in the order of their richness in one or other of
• 1:54:43
  these principles, but that is all. In the great majority of cases,
• 1:54:47
  the stomach of the patient is guided by other principles of selection than merely the
• 1:54:51
  amount of carbon or nitrogen in the diet. No doubt in this, as
• 1:54:58
  in other things, Nature has very definite rules for her guidance. But these
• 1:55:02
  rules can only be ascertained by the most careful observation at the bedside. She
• 1:55:09
  there teaches us that living chemistry, the chemistry of reparation, is something different
• 1:55:15
  from the chemistry of the laboratory. Organic chemistry is useful, as all knowledge
• 1:55:20
  is, when we come face to face with nature, but it by no
• 1:55:25
  means follows that we should learn in the laboratory any one of the reparative processes
• 1:55:29
  going on in disease. Again, the nutritive power of milk and of the
• 1:55:35
  preparations from milk, is very much undervalued. There is nearly as much nourishment
• 1:55:41
  in half a pint of milk as there is in quarter a pound of meat.
• 1:55:45
  But this is not the whole question. Or nearly the whole. The
• 1:55:48
  main question is what the patient's stomach can assimilate or derive nourishment from, and
• 1:55:55
  of this the patient's stomach is the sole judge. Chemistry cannot tell us this.
• 1:56:00
  The patient's stomach must be its own chemist. The diet which will keep
• 1:56:06
  the healthy man healthy will kill the sick one. The same beef, which
• 1:56:12
  is the most nutritive of all meat, and which nourishes the healthy man,
• 1:56:15
  is the least nourishing of all food to the sick man, whose half dead
• 1:56:19
  stomach can assimilate no part of it, that is, make no food out
• 1:56:25
  of it. On a diet of beef tea. Healthy men, on the
• 1:56:29
  other hand, speedily lose their strength. I have known patients live for many
• 1:56:35
  months without touching bread because they could not eat baker's bread. These were mostly
• 1:56:42
  country patients, but not all. Homemade bread or brown bread is a most
• 1:56:47
  important article of diet for many patients. The use of asperians may be entirely
• 1:56:54
  superseded by it. Oatcake is another. To watch for the opinions, then,
• 1:57:00
  which the patient's stomach gives, rather than to read analyzes of foods,
• 1:57:05
  is the business of all those who have to settle what the patient is to
• 1:57:09
  eat, perhaps the most important thing to be provided for him, after the
• 1:57:14
  air he is to breathe. Now, the medical man who sees the patient
• 1:57:18
  only once a day, or even only once or twice a week, cannot
• 1:57:23
  possibly tell this without the assistance of the patient himself, or of those who
• 1:57:27
  are in constant observation on the patient. The utmost the medical man can tell
• 1:57:32
  is whether the patient is weaker or stronger at this visit than he was the
• 1:57:36
  last visit. I should therefore say that, incomparably, the most important office
• 1:57:44
  of the nurse, after she has taken care of the patient's heir, is
• 1:57:47
  to take care to observe the effect of his food, and to report it
• 1:57:51
  to the medical attendant. It is quite incalculable the good that would certainly come
• 1:57:58
  from such sound and close observation in this almost neglected branch of nursing, or
• 1:58:03
  the help it would give to the medical man. A great deal too much
• 1:58:10
  against tea is said by wise people, and a great deal too much of
• 1:58:15
  tea is given to the sick by foolish people. When you see the natural
• 1:58:19
  and almost universal craving in English sick for their tea, you cannot but feel
• 1:58:26
  that nature knows what she is about. But a little tea or coffee restores
• 1:58:30
  them quite as much as a great deal, and a great deal of tea,
• 1:58:33
  and especially of coffee impairs the little power of digestion they have. Yet
• 1:58:40
  a nurse, because she sees how one or two cups of tea or coffee
• 1:58:44
  restores her patient, thinks that three or four cups will do twice as much.
• 1:58:48
  It is, however, certain that there is nothing yet discovered which is
• 1:58:53
  a substitute to the English patient for his cup of tea. He can take
• 1:58:57
  it when he can take nothing else, and he often can't take anything else
• 1:59:00
  if he has it not. I should be very glad if any of the
• 1:59:04
  abuses of tea would point out what to give to an English patient after a
• 1:59:10
  sleepless night instead of tea, If you give it at five or six o'clock
• 1:59:15
  in the morning, he may even sometimes fall asleep after it and get perhaps
• 1:59:19
  his only two or three hours sleep during the twenty four At the same time,
• 1:59:26
  you should never give tea or coffee to the sick as a rule after
• 1:59:29
  five o'clock in the afternoon. Sleeplessness in the early night is from excitement generally,
• 1:59:35
  and is increased by tea or coffee. Sleeplessness, which continues to the
• 1:59:41
  early morning, is from exhaustion often and is relieved by tea. The only
• 1:59:47
  English patients I have ever known refuse tea have been typhus cases, and the
• 1:59:53
  first sign of their getting better was their craving again for tea. In general,
• 1:59:59
  the dry and dirty tongue always prefers tea to coffee, and will quite
• 2:00:03
  decline milk unless with tea. Coffee is a better restorative than tea, but
• 2:00:11
  a greater impairer of the digestion. Let the patient's taste decide. You will
• 2:00:17
  say that in cases of great thirst, the patient's craving decides that it will
• 2:00:23
  drink a great deal of tea, and that you cannot help it. But
• 2:00:28
  in these cases be sure that the patient requires diluents for quite other purposes than
• 2:00:32
  quenching the thirst. He wants a great deal of some drink, not only
• 2:00:36
  of tea, and the doctor will order what he is to have barley water
• 2:00:41
  or lemonade, or soda water and milk, as the case may be.
• 2:00:46
  Lemon quoted by doctor Christensen, says that among the well and active, the
• 2:00:51
  infusion of one ounce of roasted coffee daily will diminish the waste going on in
• 2:00:57
  the body by one fourth, and doctor Christensen adds that tea has the same
• 2:01:02
  property. Now this is actual experiment. Lemon weighs the man and finds the
• 2:01:10
  fact from his weight. It is not deduced from any analysis of food.
• 2:01:15
  All experience among the sick shows the same thing. Coco is often recommended to
• 2:01:21
  the sick in lieu of tea or coffee, but independently of the fact that
• 2:01:26
  English sick very generally dislike coco. It has quite a different effect from tea
• 2:01:31
  or coffee. It is an oily, starchy nut, having no restorative power
• 2:01:36
  at all, but simply increasing fat. It is pure mockery of the sick.
• 2:01:41
  Therefore, to call it a substitute for tea, for any renovating stimulus
• 2:01:45
  it has, you might just as well offer them chestnuts instead of tea.
• 2:01:50
  An almost universal error among nurses is in the bulk of the food and especially
• 2:01:57
  the drinks they offer to their patients. Suppose a patient ordered four ounces of
• 2:02:01
  brandy during the day, How is he to take this if you make it
• 2:02:05
  into four pints with diluting it the same with tea and beef tea with arrowroot
• 2:02:12
  milk, et cetera. You have not increased the nourishment. You have not
• 2:02:16
  increased the renovating power of these articles. By increasing their bulk, you have
• 2:02:21
  very likely diminished both by giving the patient's digestion more to do. And most
• 2:02:28
  likely of all, the patient will leave half of what he has been ordered
• 2:02:30
  to take because he cannot swallow the bulk with which you have been pleased to
• 2:02:34
  invest it. It requires very nice observation and care, and meets with hardly
• 2:02:41
  any to determine what will not be too thick or strong for the patient to
• 2:02:45
  take, while giving him no more than the bulk which he is able to
• 2:02:48
  swallow. End of Section seven. Section eight. Bed and bedding. A
• 2:02:58
  few words upon bedsteads and bedding, and principally as regards patients who are entirely
• 2:03:03
  or almost entirely confined to bed feverishness is generally supposed to be a symptom of
• 2:03:10
  fever. In nine cases out of ten, it is a symptom of bedding.
• 2:03:15
  The patient has had reintroduced into the body the emanations from himself, which
• 2:03:21
  day after day and week after week saturate his unaired bedding. How can it
• 2:03:27
  be otherwise? Look at the ordinary bed in which a patient lies. If
• 2:03:32
  I were looking out for an example, in order to show what not to
• 2:03:35
  do, I should take the specimen of an ordinary bed in a private house,
• 2:03:41
  a wooden bedstead, two or even three mattresses piled up to above the
• 2:03:45
  height of a table, a valance attached to the frame. Nothing but a
• 2:03:49
  miracle could ever thoroughly dry or air such a bed and bedding. The patient
• 2:03:55
  must inevitably alternate between cold damp after his bed is made and warm damp before,
• 2:04:00
  both saturated with organic matter. And this from the time the mattresses are
• 2:04:05
  put under him till the time they are picked to pieces, if this is
• 2:04:09
  ever done. If you consider that an adult in health exhales by the lungs
• 2:04:15
  and skin in the twenty four hours three pints at least of moisture loaded with
• 2:04:19
  organic matter ready to enter into putrefaction, that in sickness the quantity is often
• 2:04:25
  greatly increased, the quality is always more noxious. Just ask yourself next,
• 2:04:30
  where does all this moisture go to? Chiefly into the bedding, because it
• 2:04:36
  cannot go anywhere else, and it stays there because except perhaps a weekly change
• 2:04:43
  of sheets. Scarcely any other airing is attempted. A nurse will be careful
• 2:04:47
  to fidgetiness about airing the clean sheets from clean damp, but airing the dirty
• 2:04:53
  sheets from noxiou stamp will never even occur to her. Besides this, the
• 2:05:00
  most dangerous affluvia we know of are from the excretia of the sick. These
• 2:05:03
  are placed, at least temporarily, where they must throw their affluvia into the
• 2:05:09
  underside of the bed, and the space under the bed is never aired.
• 2:05:13
  It cannot be with our arrangements. Must not such a bed be always saturated,
• 2:05:19
  and be always the means of reintroducing into the system of the unfortunate patient
• 2:05:24
  who lies in it that excrementitious matter, to eliminate which from the body nature
• 2:05:30
  had expressly appointed the disease. My heart always sinks within me when I hear
• 2:05:35
  the good housewife of every class say, I assure you the bed has been
• 2:05:41
  well slept in, And I can only hope it is not true. What
• 2:05:45
  is the bed already saturated with somebody else's damp before my patient comes to exhale
• 2:05:50
  into it his own damp? Has it not had a single chance to be
• 2:05:55
  aired. No, not one. It has been slept in every name.
• 2:06:01
  The only way of really nursing a real patient is to have an iron bedstead
• 2:06:06
  with reoclined springs, which are permeable by the air up to the very mattress
• 2:06:12
  no valence, of course, the mattress to be a thin hair one,
• 2:06:16
  the beds to be not above three and a half feet wide. If the
• 2:06:20
  patient be entirely confined to his bed, there should be two such bedsteads,
• 2:06:26
  each beds to be made with mattress, sheets, blankets, et cetera.
• 2:06:30
  Complete the patient to pass twelve hours in each bed, on no account to
• 2:06:34
  carry his sheets with him, the whole of the bedding to be hung up
• 2:06:39
  to air for each intermediate twelve hours. Of course, there are many cases
• 2:06:45
  where this cannot be done at all, many more where only an approach to
• 2:06:48
  it can be made. I am indicating the ideal of nursing and what I
• 2:06:53
  have actually had done. But about the kind of bedstead, there can be
• 2:06:58
  no doubt whether there be one or two. Provided there is a prejudice in
• 2:07:03
  favor of a wide bed, I believe it to be a prejudice. All
• 2:07:08
  the refreshment of moving a patient from one side to the other of his bed
• 2:07:12
  is far more effectually secured by putting him into a fresh bed, And a
• 2:07:16
  patient who is really very ill does not stray far in bed. But it
• 2:07:21
  is said there is no room to put down a tray on a narrow bed.
• 2:07:26
  No goodness will ever put a tray on a bed at all. If
• 2:07:30
  the patient can turn on his side, he will eat more comfortably from a
• 2:07:34
  bedside table. And on no account whatever should a bed ever be higher than
• 2:07:39
  a sofa. Otherwise the patient feels himself out of humanity's reach. He can
• 2:07:45
  get at nothing for himself, he can move nothing for himself. If the
• 2:07:50
  patient cannot turn a table over, the bed is a better thing. I
• 2:07:56
  need hardly say that a patient's bed should never have its side against the wall.
• 2:08:01
  The nurse must be able to get easily to both sides of the bed,
• 2:08:03
  and to reach easily every part of the patient without stretching. A thing
• 2:08:09
  impossible if the bed be either too wide or too high. When I see
• 2:08:13
  a patient in a room nine or ten feet high upon a bed between four
• 2:08:18
  and five feet high, with his head when he is sitting up in bed
• 2:08:22
  actually within two or three feet of the ceiling, I ask myself, is
• 2:08:28
  this expressly planned to produce that peculiarly distressing feeling common to the sick? That
• 2:08:33
  is, as if the walls and ceiling were closing in upon them, and
• 2:08:37
  they becoming sandwiches between floor and ceiling, which imagination is not indeed here so
• 2:08:43
  far from the truth. If over and above this the window stops short of
• 2:08:50
  the ceiling, then the patient's head may literally be raised above the stratum of
• 2:08:54
  fresh air, even when the window is open. Can human perversity any farther
• 2:09:00
  go in unmaking the process of restoration which God has made. The fact is
• 2:09:07
  that the heads of sleepers or of sick should never be higher than the throat
• 2:09:11
  of the chimney, which ensures their being in the current of best air.
• 2:09:16
  And we will not suppose it possible that you have closed your chimney with a
• 2:09:18
  chimney board. If a bed is higher than a sofa, the difference of
• 2:09:24
  the fatigue of getting in and out of bed will just make the difference very
• 2:09:28
  often to the patient who can get in and out of bed at all,
• 2:09:33
  of being able to take a few minutes exercise, either in the open air
• 2:09:37
  or in another room. It is so very odd that people never think of
• 2:09:41
  this, or of how many more times a patient who is in bed for
• 2:09:46
  the twenty four hours is obliged to get in and out of bed than they
• 2:09:50
  are who only it is to be hoped get into bed once and out of
• 2:09:54
  bed once during the twenty four hours. A patient's bed should all be in
• 2:10:00
  the lightest spot in the room, and he should be able to see out
• 2:10:03
  of window. I need scarcely say that the old four post bed with curtains
• 2:10:09
  is utterly inadmissible, whether for sick or well. Hospital bedsteads are, in
• 2:10:15
  many respects very much less objectionable than private ones. There is reason to believe
• 2:10:22
  that not a few of the apparently unaccountable cases of scrofula among children proceed from
• 2:10:28
  the habit of sleeping with a head under the bedclothes, and so inhaling air
• 2:10:31
  already breathed, which is farther contaminated by exhalations from the skin. Patients are
• 2:10:39
  sometimes given to a similar habit, and it often happens that the bed clothes
• 2:10:43
  are so disposed that the patient must necessarily breathe air more or less contaminated by
• 2:10:48
  exhalations from his skin. A good nurse will be careful to attend to this.
• 2:10:54
  It is an important part. So to speak of ventilation. It may
• 2:10:58
  be worth while to remark that where there is any danger of bed saws,
• 2:11:03
  a blanket should never be placed under the patient. It retains damp and acts
• 2:11:09
  like a poultice. Never use anything but light whitney blankets as bed covering for
• 2:11:16
  the sick. The heavy cotton impervious counterpane is bad for the very reason that
• 2:11:20
  it keeps in the emanations from the sick person, while the blanket allows them
• 2:11:26
  to pass through. Weak patients are invariably distressed by a great weight of bedclothes,
• 2:11:31
  which often prevents their getting any sound sleep. Whatever, note one word
• 2:11:39
  about pillows. Every weak patient, be his illness, what it may suffers
• 2:11:43
  more or less from difficulty in breathing. To take the weight of the body
• 2:11:48
  off the poor chest, which is hardly up to its work. As it
• 2:11:50
  is ought therefore to be the object of the nurse in arranging his pillows.
• 2:11:56
  Now, what does she do and what are the consequences? She piles the
• 2:12:01
  pillows one atop the other like a wall of bricks. The head is thrown
• 2:12:05
  upon the chest, and the shoulders are pushed forward so as not to allow
• 2:12:09
  the lung's room to expand. The pillows in fact lean upon the patient,
• 2:12:13
  not the patient upon the pillows. It is impossible to give a rule for
• 2:12:18
  this because it must vary with the figure of the patient, and tall patients
• 2:12:22
  suffer much more than short ones because of the drag of the long limbs upon
• 2:12:28
  the waist. But the object is to support with the pillows the back below
• 2:12:33
  the breathing apparatus, to allow the shoulders room to fall back, and to
• 2:12:37
  support the head without throwing it forward. The suffering of dying patients is immensely
• 2:12:43
  increased by neglect of these points, and many an invalid, too weak to
• 2:12:48
  drag about his pillows himself slips his book or anything at hand behind the lower
• 2:12:54
  part of his back to support it. End of Section eight. Section nine.
• 2:13:01
  Light. It is the unqualified result of all my experience with the sick
• 2:13:09
  that second only to their need of fresh air is their need of light.
• 2:13:13
  That after a close room, what hurts the most is a dark room,
• 2:13:18
  and that it is not only light but direct sunlight they want. I had
• 2:13:24
  rather have the power of carrying my patient about after the sun. According to
• 2:13:30
  the aspect of the rooms. If circumstances permit, than let him linger in
• 2:13:33
  a room when the sun is off. People think the effect is upon the
• 2:13:37
  spirits only. This is by no means the case. The sun is not
• 2:13:43
  only a painter, but a sculptor. You admit that he does the photograph.
• 2:13:50
  Without going into any scientific exposition, we must admit that light has quite
• 2:13:54
  as real and tangible effects upon the human body. But this is not all
• 2:14:01
  who has not observed the purifying effect of light, and especially of direct sunlight
• 2:14:07
  upon the air of a room. Here is an observation within everybody's experience.
• 2:14:13
  Go into a room where the shutters are always shut, in a sick room
• 2:14:16
  or a bedroom, there should never be shutters shut. And though the room
• 2:14:20
  be uninhabited, though the air has never been polluted by the breathing of human
• 2:14:24
  beings, you will observe a close, musty smell of corrupt air, of
• 2:14:30
  air that is unpurified by the effect of the sun's rays. The mustiness of
• 2:14:35
  dark rooms and corners, indeed, is proverbial. The cheerfulness of a room,
• 2:14:41
  the usefulness of light in treating disease is all important. A very high
• 2:14:48
  authority in hospital construction has said that people do not enough consider the difference between
• 2:14:54
  wards and dormitories in planning their buildings. But I go farther and say that
• 2:15:00
  healthy people never remember the difference between bedrooms and sick rooms in making arrangements for
• 2:15:05
  the sick. To a sleeper in health, it does not signify what the
• 2:15:11
  view is from his bed. He ought never to be in it, excepting
• 2:15:15
  when asleep and at night. Aspect does not very much signify either, provided
• 2:15:20
  the sun reach his bedroom at some time in every day to purify the air,
• 2:15:26
  because he ought never to be in his bedroom except during the hours when
• 2:15:28
  there is no sun. But the case is exactly reversed with the sick,
• 2:15:33
  even should they be as many hours out of their beds as you are in
• 2:15:37
  the oars, which probably they are not. Therefore that they should be able
• 2:15:43
  without raising themselves or turning in bed, to see out of window from their
• 2:15:48
  beds, to see sky and sunlight, at least if you can show them
• 2:15:52
  nothing else, I assert to be, if not of the very first importance
• 2:15:56
  for recovery, at least something very near it. And you should therefore look
• 2:16:01
  to the position of the beds of your sick. One of the very first
• 2:16:05
  things if they can see out of two windows instead of one, so much
• 2:16:11
  the better. Again, the morning sun and the midday sun, the hours
• 2:16:16
  when they are quite certain not to be up, are of more importance to
• 2:16:20
  them. If a choice must be made than the afternoon sun, perhaps you
• 2:16:24
  can take them out of bed in the afternoon and set them by the window
• 2:16:28
  where they can see the sun. But the best rule is, if possible,
• 2:16:33
  to give them direct sunlight from the moment he rises till the moment he
• 2:16:37
  sets. Another great difference between the bedroom and the sick room is that the
• 2:16:45
  sleeper has a very large balance of fresh air to begin with when he begins
• 2:16:48
  the night. If his room has been open all day, as it ought
• 2:16:52
  to be, the sick man has not, because all day he has been
• 2:16:56
  breathing the air in the same room and dirte it by the emanations from himself.
• 2:17:03
  Far more care is therefore necessary to keep up a constant change of air
• 2:17:07
  in the sick room. It is hardly necessary to add that there are acute
• 2:17:13
  cases, particularly a few ophthalmic cases and diseases where the eye is morbidly sensitive,
• 2:17:18
  where a subdued light is necessary, but a dark north room is inadmissible
• 2:17:24
  even for these you can always moderate the light by blinds and curtains. Heavy
• 2:17:31
  thick, dark window or bed curtains should, however, hardly ever be used
• 2:17:37
  for any kind of sick in this country. A light white curtain at the
• 2:17:41
  head of the bed is in general all that is necessary, and a green
• 2:17:46
  blind to the window to be drawn down only when necessary. One of the
• 2:17:52
  greatest observers of human things, not physiological, says in another language, where
• 2:17:58
  there is there is thought, all physiology goes to confirm this. Where is
• 2:18:05
  the shady side of deep valleys there is cretinism, where as sellers and the
• 2:18:11
  unsunned sides of narrow streets there is the degeneracy and weakliness of the human race,
• 2:18:18
  mind and body equally degenerating. Put the pale, withering plant and human
• 2:18:24
  being into the sun, and if not too far gone, each will recover
• 2:18:28
  health and spirit. It is a curious thing to observe how almost all patients
• 2:18:35
  lie with their faces turned towards the light, exactly as plants always make their
• 2:18:41
  way towards the light. A patient will even complain that it gives him pain
• 2:18:46
  lying on that side. Then why do you lie on that side? He
• 2:18:50
  does not know but we do. It is because it is the side towards
• 2:18:54
  the window. A fashionable physician has recently published in a government report that he
• 2:19:01
  always turns his patient's faces from the light. Yes, but nature is stronger
• 2:19:07
  than fashionable physicians, and depend upon it. She turns the phases back and
• 2:19:13
  towards such light as she can get. Walk through the wards of a hospital.
• 2:19:18
  Remember the bedsides of private patients you have seen, and count how many
• 2:19:22
  sick you ever saw lying with their faces towards the wall. End of Section
• 2:19:31
  nine, Section ten cleanliness of rooms and walls. It cannot be necessary to
• 2:19:39
  tell on us that she should be clean, or that she should keep her
• 2:19:43
  patient clean, seeing that the greater part of nursing consists in preserving cleanliness.
• 2:19:50
  No ventilation can freshen a room or ward where the most scrupulous cleanliness is not
• 2:19:54
  observed unless the wind be blowing through the windows at the rate of twenty miles
• 2:20:00
  an hour. Dusty carpets, dirty wainscots, musty curtains and furniture will infallibly
• 2:20:07
  produce a close smell. I have lived in a large and expensively furnished London
• 2:20:13
  house where the only constant inmate in two very lofty rooms with opposite windows was
• 2:20:18
  myself, And yet owing to the above mentioned dirty circumstances, no opening of
• 2:20:24
  windows could ever keep those rooms from closeness. But the carpet and curtains having
• 2:20:31
  been turned out of the rooms altogether, they became instantly as fresh as could
• 2:20:35
  be wished. It is pure nonsense to say that in London a room cannot
• 2:20:39
  be kept clean. Many of our hospitals show the exact reverse. But no
• 2:20:46
  particle of dust is ever or can ever be removed or really got rid of,
• 2:20:52
  by the present system of dusting. Dusting in these days means nothing but
• 2:20:56
  flapping the dust from one part of a room on to another, with doors
• 2:21:01
  and windows closed. What you do it for? I cannot think you had
• 2:21:05
  much better leave the dust alone if you are not going to take it away
• 2:21:09
  altogether. For from the time a room begins to be a room up to
• 2:21:15
  the time when it ceases to be one, no one atom of dust ever
• 2:21:18
  actually leaves its precincts. Tidying a room means nothing now but removing a thing
• 2:21:26
  from one place, which it has kept clean for itself, on to another,
• 2:21:30
  and a dirtier one, flapping by way of cleaning is only admissible in
• 2:21:35
  the case of pictures or anything made of paper. The only way I know
• 2:21:41
  to remove dust, the plague of all lovers of fresh air, is to
• 2:21:45
  wipe everything with a damp cloth. And all furniture ought to be so made
• 2:21:50
  as that it may be wiped with a damp cloth without injury to itself,
• 2:21:54
  and so polished as that it may be damped without injury to others. To
• 2:21:58
  dust, as it is now practiced, truly means to distribute dust more equally
• 2:22:03
  over a room as to floors. The only really clean floor I know is
• 2:22:11
  the Berlin lacquered floor, which is wet rubbed and dry rubbed every morning to
• 2:22:16
  remove the dust. The French parquet is always more or less dusty, although
• 2:22:22
  infinitely superior in point of cleanliness and healthiness to our absorbent floor. For a
• 2:22:28
  sick room, a carpet is perhaps the worst expedient which could, by any
• 2:22:33
  possibility have been invented. If you must have a carpet, the only safety
• 2:22:39
  is to take it up two or three times a year instead of once.
• 2:22:43
  A dirty carpet literally infects the room, and if you consider the enormous quantity
• 2:22:50
  of organic matter from the feet of people coming in, which must saturate it.
• 2:22:54
  This is by no means surprising. As for walls, the worst is
• 2:23:00
  the papered wall. The next worst is plaster. But the plaster can be
• 2:23:05
  redeemed by frequent lime washing. The paper requires frequent renewing. A glazed paper
• 2:23:11
  gets rid of a good deal of the danger. But the ordinary bedroom paper
• 2:23:16
  is all that it ought not to be. The close connection between ventilation and
• 2:23:22
  cleanliness is shown in this. An ordinary light paper will last clean much longer
• 2:23:30
  if there is an Arnot's ventilator in the chimney than it otherwise would. The
• 2:23:35
  best wall, now extant is oil paint. From this you can wash the
• 2:23:39
  animal exuvii. These are what make a room musty. The best wall for
• 2:23:46
  a sick room or ward that could be made is pure white, non absorbent
• 2:23:52
  cement, or glass or glazed tiles, if they were made slightly enough.
• 2:23:58
  Air can be soiled, just like water. If you blow into water,
• 2:24:03
  you will soil it with the animal matter from your breath. So it is
• 2:24:07
  with air. Air is always soiled. In a room where walls and carpets
• 2:24:11
  are saturated with animal exhalations, want of cleanliness, then in rooms and wards
• 2:24:18
  which you have to guard against, may arise in three ways. One dirty
• 2:24:24
  air coming in from without, soiled by sewer emanations, the evaporation from dirty
• 2:24:31
  streets, smoke, bits of unburnt fuel, bits of straw, bits of
• 2:24:35
  horse dung. If people would but cover the outside walls of their houses with
• 2:24:41
  plain or encaustic tiles, what an incalculable improvement would there be in light,
• 2:24:48
  cleanliness, dryness, warmth, and consequently economy. The play of a fire
• 2:24:54
  engine would then effectually wash the outside of a house. This kind of walling
• 2:25:00
  would stand next to paving in improving the health of towns. Two dirty air
• 2:25:07
  coming from within from dust which you often displace but never remove. And this
• 2:25:13
  recalls what ought to be a sineque. Non have as few ledges in your
• 2:25:18
  room or ward as possible, and under no pretense have any ledge whatever out
• 2:25:22
  of sight. Dust accumulates there and will never be wiped off. This is
• 2:25:28
  a certain way to soil the air. Besides this, the animal exhalations from
• 2:25:35
  your inmates saturate your furniture. And if you never clean your furniture properly,
• 2:25:41
  how can your rooms or wards be anything but musty? Ventilate as you please,
• 2:25:46
  the rooms will never be sweet. Besides this, there is a constant
• 2:25:52
  degradation, as it is called, taking place from everything except polished or glazed
• 2:25:58
  articles. Example, in coloring certain green papers, arsenic is used. Now
• 2:26:05
  in the very dust even which is lying about rooms hung with this kind of
• 2:26:09
  green paper, arsenic has been distinctly detected. You see, your dust is
• 2:26:16
  anything but harmless. Yet you will let such dust lie about your ledges for
• 2:26:20
  months, your rooms forever. Again the fire fills the room with coal dust.
• 2:26:28
  Three. Dirty air coming from the carpet. Above all, take care
• 2:26:35
  of the carpets that the animal dirt left there by the feet of visitors does
• 2:26:39
  not stay there. Floors unless the grain is filled up and polished, are
• 2:26:45
  just as bad. The smell from the floor of a schoolroom or ward,
• 2:26:50
  when any moisture brings out the organic matter by which it is saturated, might
• 2:26:54
  alone be enough to warn us of the mischief that is going on. The
• 2:27:00
  Air, then, can only be kept clean by sanitary improvements and by consuming
• 2:27:05
  smoke. The expense in soap which this single improvement would save is quite incalculable.
• 2:27:13
  The inside air can only be kept clean by excessive care in the ways
• 2:27:16
  mentioned above to rid the walls, carpets, furniture, ledges, et cetera,
• 2:27:22
  of the organic matter and dust dust consisting greatly of this organic matter with
• 2:27:28
  which they become saturated, and which is what really makes the room musty.
• 2:27:35
  Without cleanliness, you cannot have all the effect of ventilation. Without ventilation,
• 2:27:41
  you can have no thorough cleanliness. Very few people, be they of what
• 2:27:46
  class they may, have any idea of the exquisite cleanliness required in the sick
• 2:27:52
  room. For much of what I have said applies less to the hospital than
• 2:27:56
  to the private sickroom. The smoky chimney, the dusty furniture, the utensils
• 2:28:03
  emptied, but once a day often keep the air of the sick constantly dirty.
• 2:28:09
  In the best private houses, the well have a curious habit of forgetting
• 2:28:13
  that what is to them but a trifling inconvenience to be patiently put up with,
• 2:28:20
  is to the sick a source of suffering, delaying recovery, if not
• 2:28:24
  actually hastening death. The well are scarcely ever more than eight hours at most
• 2:28:30
  in the same room. Some change they can always make, if only for
• 2:28:33
  a few minutes. Even during the supposed eight hours they can change their posture
• 2:28:39
  or their position in the room. But the sick man who never leaves his
• 2:28:43
  bed, who cannot change by any movement of his own, his air,
• 2:28:48
  or his light, or his warmth, who cannot obtain quiet or get out
• 2:28:54
  of the smoke or the smell or the dust, he is really poisoned or
• 2:28:58
  depressed by what is to you the merest trifle. What can't be cured,
• 2:29:05
  must be endured. Is the very worst and most dangerous maxim for a nurse,
• 2:29:09
  which ever was made. Patience and resignation in her are but other words
• 2:29:15
  for carelessness or indifference, contemptible if in regard to herself, culpable if in
• 2:29:22
  regard to her sick. End of Section ten, Section eleven personal cleanliness.
• 2:29:33
  In almost all diseases, the function of the skin is more or less disordered,
• 2:29:39
  and in many most important diseases, nature relieves herself almost entirely by the
• 2:29:43
  skin. This is particularly the case with children. But the excretion which comes
• 2:29:50
  from the skin is left there unless removed by washing or by the clothes.
• 2:29:56
  Every nurse should keep this fact constantly in mind, for if she allow her
• 2:30:01
  sick to remain unwashed, or their clothing to remain on them after being saturated
• 2:30:07
  with perspiration or other excretion. She is interfering injuriously with the natural processes of
• 2:30:13
  health, just as effectually as if she were to give the patient a dose
• 2:30:16
  of slow poison by the mouth. Poisoning by the skin is no less certain
• 2:30:22
  than poisoning by the mouth, only it is slower in its operation. The
• 2:30:28
  amount of relief and comfort experienced by sick after the skin has been carefully washed
• 2:30:35
  and dried is one of the commonest observations made at a sick bed. But
• 2:30:39
  it must not be forgotten that the comfort and relief so obtained are not all.
• 2:30:45
  They are, in fact, nothing more than a sign that the vital
• 2:30:48
  powers have been relieved by removing something that was oppressing them. The nurse therefore
• 2:30:54
  must never put off attending to the personal cleanliness of her patient under the Please
• 2:31:00
  see that all that is to be gained is a little relief, which can
• 2:31:03
  be quite as well given later. In all well regulated hospitals this ought to
• 2:31:07
  be and generally is attended to, but it is very generally neglected with private
• 2:31:13
  sick Just as it is necessary to renew the air round a sick person,
• 2:31:20
  frequently to carry off morbid effluvia from the lungs and skin by maintaining free ventilation.
• 2:31:26
  So is it necessary to keep the pores of the skin free from all
• 2:31:30
  obstructing excretions. The object both of ventilation and of skin cleanliness is pretty much
• 2:31:37
  the same, to it removing noxious matter from the system as rapidly as possible.
• 2:31:46
  Care should be taken in all these operations of sponging, washing and cleansing
• 2:31:50
  the skin not to expose too great a surface at once, so as to
• 2:31:54
  check the perspiration which would renew the evil in another form. The various ways
• 2:32:01
  of washing the sick need not here be specified, the less so as the
• 2:32:05
  doctors ought to say which is to be used. In several forms of diarrhea,
• 2:32:11
  dysentery, et cetera. Where the skin is hard and harsh, the
• 2:32:16
  relief afforded by washing with a great deal of soft soap is incalculable. In
• 2:32:22
  other cases, sponging with tepid soap and water, then with tepid water and
• 2:32:28
  drying with a hot towel will be ordered. Every nurse ought to be careful
• 2:32:33
  to wash her hands very frequently during the day, if her face too,
• 2:32:37
  so much the better. One word as to cleanliness merely as cleanliness, Compare
• 2:32:46
  the dirtiness of the water in which you have washed. When it is cold
• 2:32:50
  without soap, cold with soap, hot with soap. You will find the
• 2:32:56
  first has hardly removed any dirt at all, the second a little more,
• 2:33:01
  the third a great deal more. But hold your hand over a cup of
• 2:33:05
  hot water for a minute or two, and then by merely rubbing with the
• 2:33:09
  finger, you will bring off flakes of dirt or dirty skin. After a
• 2:33:15
  vapor bath, you may peel your whole self clean. In this way.
• 2:33:20
  What I mean is that by simply washing or sponging with water, you do
• 2:33:24
  not really clean your skin. Take a rough towel, dip one corner in
• 2:33:30
  very hot water. If little spirit be added to it, it will be
• 2:33:33
  more effectual, and then rub as if you were rubbing the towel into your
• 2:33:37
  skin with your fingers. The black flakes which will come off will convince you
• 2:33:43
  that you were not clean before. However much soap and water you have used,
• 2:33:48
  these flakes are what require removing, and you can really keep yourself cleaner
• 2:33:54
  with a tumbler of hot water and a rough towel and rubbing than with a
• 2:33:58
  whole apparatus of bath and soap and sponge without rubbing. It is quite nonsense
• 2:34:05
  to say that anybody need be dirty. Patients have been kept clean by these
• 2:34:11
  means on a long voyage when a basin full of water could not be afforded,
• 2:34:15
  and when they could not be moved out of their berths, as if
• 2:34:18
  all the appertinences of home had been at hand. Washing, however, with
• 2:34:24
  a large quantity of water, has quite other effects than those of mere cleaniness.
• 2:34:30
  The skin absorbs the water and becomes softer and more perspirable to wash with
• 2:34:35
  soap and soft water is therefore desirable from other points of view than that of
• 2:34:41
  cleanliness. End of Section eleven, Section twelve. Chattering hopes and advices the
• 2:34:54
  sick man to his advisers, My advisers, the name is Legion. Somehow
• 2:35:01
  or other, it seems a provision of the universal destinies that every man,
• 2:35:05
  woman and child should consider hymn her or itself privileged, especially to advise me.
• 2:35:13
  Why that is precisely what I want to know, and this is what
• 2:35:20
  I have to say to them. I have been advised to go to every
• 2:35:24
  place extant in and out of England to take every kind of exercise by every
• 2:35:28
  kind of cart carriage, Yes, and even swing and dumb bell in existence,
• 2:35:35
  to imbibe every different kind of stimulus that ever has been invented. And
• 2:35:41
  this when those best fitted to know that his medical men, after long and
• 2:35:46
  close attendants, had declared any journey out of the question, had prohibited any
• 2:35:52
  kind of motion whatever, had closely laid down the diet and drink. What
• 2:35:58
  would my advisers say, were they the medical attendants, and I the patient,
• 2:36:03
  left their advice and took the casual advisers. But the singularity in Legion's
• 2:36:09
  mind is this. It never occurs to him that everybody else is doing the
• 2:36:15
  same thing, and that I, the patient must perforce say in sheer defense
• 2:36:20
  like Rosalind I could not do with all chattering hopes may seem an odd heading,
• 2:36:28
  but I really believe there is scarcely a greater worry which invalids have to
• 2:36:33
  endure than the incurable hopes of their friends. There is no one practice against
• 2:36:39
  which I can speak more strongly from actual personal experience, wide and long of
• 2:36:45
  its effects during sickness, observed both upon others and upon myself. I would
• 2:36:52
  appeal most seriously to all friends, visitors, and attendants of the sick to
• 2:36:58
  leave off this practice of attempting to cheer the sick by making light of their
• 2:37:01
  danger and by exaggerating their probabilities of recovery. Far more now than formerly does
• 2:37:09
  the medical attendant tell the truth to the sick, who are really desirous to
• 2:37:13
  hear it about their own state. How intense is the folly, then,
• 2:37:18
  to say the least of it of the friend, be he even a medical
• 2:37:22
  man who thinks that his opinion, given after cursory observation, will weigh with
• 2:37:28
  the patient against the opinion of the medical attendant, given perhaps after years of
• 2:37:33
  observation, after using every help to diagnosis afforded by the stethoscope, the examination
• 2:37:39
  of pulse, tongue, etc. And certainly after much more observation than the
• 2:37:43
  friend can possibly have had. Supposing the patient to be possessed of common sense,
• 2:37:50
  how can the favorable opinion, if it is to be called an opinion
• 2:37:54
  at all, of the casual visitor, cheer him when different from that of
• 2:37:58
  the experienced deay tenant. Unquestionably, the latter may and often does turn out
• 2:38:05
  to be wrong, But which is most likely to be wrong the fact is
• 2:38:11
  that the patient is not cheered at all by these well meaning, most tiresome
• 2:38:15
  friends. On the contrary, he is depressed and wearied. If, on
• 2:38:20
  the one hand, he exerts himself to tell each successive member of this too
• 2:38:26
  numerous conspiracy, whose name is Legion, why he does not think as they
• 2:38:31
  do, in what respect he is worse? What symptoms exist that they know
• 2:38:35
  nothing of? He is fatigued instead of cheered, and his attention is fixed
• 2:38:39
  upon himself. In general, patients who are really ill do not want to
• 2:38:46
  talk about themselves. Hypochondriacs do. But again I say, we are not
• 2:38:52
  on the subject of hypochondriacs. If, on the other hand, and which
• 2:38:56
  is much more frequently the case, the patient says nothing but the shakespearian oh
• 2:39:03
  ah, go too, and in good sooth, in order to escape from
• 2:39:09
  the conversation about himself. The sooner he is depressed by want of sympathy.
• 2:39:13
  He feels isolated in the midst of friends. He feels what convenience it would
• 2:39:20
  be if there were any single person to whom he could speak simply and openly,
• 2:39:24
  without pulling the string upon himself of this shower bath of silly hopes and
• 2:39:30
  encouragements to whom he could express his wishes and directions without that person persisting in
• 2:39:37
  saying, I hope that it will please God yet to give you twenty years,
• 2:39:41
  or you have a long life of activity before you. How often we
• 2:39:46
  see, at the end of biographies or of cases recorded in medical papers,
• 2:39:50
  after a long illness, a died rather suddenly or unexpectedly, both to himself
• 2:39:56
  and to others, unexpectedly to others perhaps who did not see because they did
• 2:40:03
  not look, but by no means unexpectedly to himself. As I feel entitled
• 2:40:07
  to believe, both from the internal evidence in such stories and from watching similar
• 2:40:13
  cases, there was every reason to expect that A would die, and he
• 2:40:18
  knew it, but he found it useless to insist upon his own knowledge to
• 2:40:22
  his friends. In these remarks, I am alluding neither to acute cases which
• 2:40:28
  terminate rapidly, nor to nervous cases. By the first much interest in their
• 2:40:35
  own danger is very rarely felt in writings of fiction, whether novels or biographies.
• 2:40:41
  These deathbeds are generally depicted as almost seraphic in lucidity of intelligence. Sadly
• 2:40:48
  large has been my experience in deathbeds and I can only say that I have
• 2:40:52
  seldom or never seen such indifference, excepting with regard to bodies suffering, or
• 2:41:01
  to some duty the dying man desires to perform. Is the far more usual
• 2:41:05
  state. The nervous case, on the other hand, delights in figuring to
• 2:41:09
  himself and others a fictitious danger. But the long chronic case, who knows
• 2:41:16
  too well himself, and who has been told by his physician that he will
• 2:41:22
  never enter active life again, who feels that every month he has to give
• 2:41:26
  up something he could do the month before. Oh, spare such sufferers your
• 2:41:31
  chattering hopes. You do not know how you worry and weary them. Such
• 2:41:37
  real sufferers cannot bear to talk of themselves, still less to hope of what
• 2:41:41
  they cannot at all expect. So also as to all the advice showered so
• 2:41:48
  profusely upon such sick to leave off some occupation, to try some other doctor,
• 2:41:54
  some other house, climate, pill, powder, or specific I say
• 2:41:58
  nothing of the inco consistency, for these advisers are sure to be the same
• 2:42:03
  persons who exhorted the sick person not to believe his own doctor's prognostics, because
• 2:42:07
  doctors are always mistaken, but to believe some other doctor because this doctor is
• 2:42:13
  always right. Sure also of these advisers to be the persons to bring the
• 2:42:18
  sick man fresh occupation while exhorting him to leave his own. Wonderful is the
• 2:42:24
  face with which friends lay and medical will come in and worry the patient with
• 2:42:31
  recommendations to do something or other, having just as little knowledge as to its
• 2:42:35
  being feasible or even safe for him, as if they were to recommend a
• 2:42:39
  man to take exercise not knowing he had broken his leg. What would the
• 2:42:45
  friend say if he were the medical attendant, and if the patient, because
• 2:42:50
  some other friend had come in, because somebody, anybody, nobody had recommended
• 2:42:56
  something anything, nothing, were to disregard his orders and take that other body's
• 2:43:01
  recommendations. But people never think of this. A celebrated historical personage has related
• 2:43:11
  to the commonplaces, which, when on the eve of executing a remarkable resolution,
• 2:43:16
  were showered in nearly the same words by everyone around successively for a period
• 2:43:20
  of six months. To these, the personage states that it was found least
• 2:43:26
  trouble always to reply the same thing, that is, that it could not
• 2:43:31
  be supposed that such a resolution had been taken without sufficient previous consideration to patients
• 2:43:39
  enduring every day for years, from every friend or acquaintance, either by letter
• 2:43:46
  or vivavice, some torment of this kind, I would suggest the same answer.
• 2:43:52
  It would indeed be spared if such friends and acquaintances would. But consider
• 2:43:56
  for one moment that it is probably that the patient has heard such advice at
• 2:44:01
  least fifty times before, and that had it been practicable, it would have
• 2:44:07
  been practiced long ago. But of such consideration there appears to be no chance.
• 2:44:13
  Strange though true, that people should be just the same in these things
• 2:44:18
  as they were a few hundred years ago. To me, these commonplaces leaving
• 2:44:26
  their smear upon the cheerful, single hearted, constant devotion to duty, which
• 2:44:31
  is so often seen in a decline of such sufferers. Recall the slimy trail
• 2:44:35
  left by the snail on the sunny southern garden wall, loaded with fruit.
• 2:44:43
  No mockery in the world is so hollow as the advice showered upon the sick.
• 2:44:48
  It is of no use for the sick to say anything, for what
• 2:44:52
  the adviser wants is not to know the truth about the state of the patient,
• 2:44:56
  but to turn whatever the sick may say to the support of his his
• 2:45:00
  own argument set forth, it must be repeated without any inquiry whatever into the
• 2:45:05
  patient's real condition. But it would be impertinent or indecent in me to make
• 2:45:11
  such an inquiry, says the adviser. True, and how much more impertinent
• 2:45:16
  is it to give your advice when you can know nothing about the truth,
• 2:45:20
  and admit you could not inquire into it. To nurses, I say,
• 2:45:26
  these are the visitors who do your patient harm. When you hear him told
• 2:45:31
  one that he has nothing the matter with him, and that he wants cheering,
• 2:45:35
  two that he is committing suicide, and that he wants preventing. Three
• 2:45:41
  that he is the tool of somebody who makes use of him for a purpose.
• 2:45:45
  Four that he will listen to nobody, but is obstinately bent upon his
• 2:45:48
  own way, and five that he ought to be called to the sense of
• 2:45:52
  duty and is flying in the face of providence. Then know that your patient
• 2:45:58
  is receiving all the injury that he can receive from a visitor. How little
• 2:46:03
  the real sufferings of illness unknown or understood. How little does anyone in good
• 2:46:11
  health fancy him or even herself into the life of a sick person. Do
• 2:46:18
  you who are about the sick. Or who visit the sick, try and
• 2:46:20
  give them some pleasure, remember to tell them what will do so? How
• 2:46:26
  often in such visits the sick person has to do the whole conversation, exerting
• 2:46:31
  his own imagination and memory, while you would take the visitor absorbed in his
• 2:46:37
  own anxieties, making no effort of memory or imagination for the sick person.
• 2:46:43
  Oh my dear, I have so much to think of. I really quite
• 2:46:46
  forgot to tell him that. Besides, I thought he would know it,
• 2:46:50
  says the visitor to another friend. How could he know it? Depend upon
• 2:46:56
  it? The people who say this are really those who have little to think
• 2:47:01
  of. There are many burdened with business who always manage to keep a pigeon
• 2:47:05
  hole in their minds full of things to tell the invalid. I do not
• 2:47:11
  say don't tell him your anxieties. I believe it is good for him,
• 2:47:15
  and good for you too. But if you tell him what is anxious,
• 2:47:20
  surely you can remember to tell him what is pleasant too. A sick person
• 2:47:24
  does so enjoy hearing good news, for instance, of a love and courtship
• 2:47:30
  while in progress to a good ending. If you tell him only when the
• 2:47:35
  marriage takes place, he loses half the pleasure which God knows he has little
• 2:47:39
  enough of, and ten to one, but you have told him of some
• 2:47:43
  love making with a bad ending. A sick person also intensely enjoys hearing of
• 2:47:50
  any material good, any positive or practical success of the right. He has
• 2:47:56
  so much of books and fiction, of principles and precepts and theories. Do
• 2:48:03
  instead of advising him with the advice he has heard at least fifty times before,
• 2:48:07
  tell him of one benevolent act which has really succeeded practically. It is
• 2:48:11
  like a day's health to him. You have no idea what the craving of
• 2:48:16
  sick with undiminished power of thinking but little power of doing is to hear of
• 2:48:22
  good practical action when they can no longer partake in it. Do observe these
• 2:48:28
  things with the sick? Do you remember how their life is to them disappointed
• 2:48:33
  and incomplete. You can see them lying there with miserable disappointments from which they
• 2:48:39
  can have no escape but death, And you can't remember to tell them of
• 2:48:43
  what would give them so much pleasure or at least an hour's variety. They
• 2:48:50
  don't want you to be lachrymose and whining with them. They like you to
• 2:48:54
  be fresh and active and interested, but they cannot bear absence of mind,
• 2:48:58
  and they are so tired of the advice and preaching they receive from everybody,
• 2:49:03
  no matter who it is. They see. There is no better society than
• 2:49:09
  babies and sick people for one another. Of course, you must manage this
• 2:49:13
  so that neither shall suffer from it, which is perfectly possible. If you
• 2:49:18
  think the air of the sickroom bad for the baby, why it is bad
• 2:49:22
  for the invalid too, and therefore, of course you will correct it for
• 2:49:26
  both. It freshens up a sick person's whole mental atmosphere to see the baby,
• 2:49:33
  and for a young child, if unspoiled, will generally adapt itself wonderfully
• 2:49:39
  to the ways of a sick person, if the time they spend together is
• 2:49:41
  not too long. If you knew how unreasonably sick people suffer from reasonable causes
• 2:49:48
  of distress, you would take more pains about all these things. An infant
• 2:49:54
  laid upon the sick bed will do the sick person, thus suffering more good
• 2:49:58
  than all your logic. A piece of good news will do the same.
• 2:50:03
  Perhaps you are afraid of disturbing him. You say there is no comfort for
• 2:50:07
  his present cause of affliction. It is perfectly reasonable. The distinction is this,
• 2:50:15
  if he is obliged to act, do not disturb him with another subject
• 2:50:18
  of thought. Just yet, help him to do what he wants to do.
• 2:50:22
  But if he has done this, or nothing can be done, then
• 2:50:26
  disturb him by all means. You will relieve more effectually unreasonable suffering from reasonable
• 2:50:35
  causes by telling him the news, showing him the baby, or giving him
• 2:50:39
  something new to think of or to look at, than by all the logic
• 2:50:43
  in the world. It has been very justly said that the sick are like
• 2:50:48
  children in this, that there is no proportion in events to them. Now
• 2:50:54
  it is your business, as their visitor, to restore this right proportion for
• 2:50:58
  them. They show them what the rest of the world is doing. How
• 2:51:01
  can they find it out? Otherwise you will find them far more open to
• 2:51:07
  conviction than children in this, and you will find that their unreasonable intensity of
• 2:51:11
  suffering from unkindness, from want of sympathy, et cetera. Will disappear with
• 2:51:18
  their freshened interest in the big world's events. But then you must be able
• 2:51:22
  to give them real interests, not gossip. Note there are two classes of
• 2:51:31
  patients, which are unfortunately becoming more common every day, especially among women of
• 2:51:35
  the richer orders, to whom all these remarks are pre eminently inapplicable. One
• 2:51:41
  those who make health an excuse for doing nothing, and at the same time
• 2:51:46
  allege that the being able to do nothing is their only grief. Two,
• 2:51:52
  those who have brought upon themselves ill health by over pursuit of amusement, which
• 2:51:56
  they and their friends have most unhappily called intellectual activity. I scarcely know a
• 2:52:03
  greater injury that can be inflicted than the advice too often given to the first
• 2:52:07
  class to vegetate, or the admiration too often bestowed on the latter class for
• 2:52:13
  pluck. End of Section twelve, Section thirteen observation of the sick. There
• 2:52:24
  is no more silly or universal question scarcely asked than this, is he better
• 2:52:31
  ask it of the medical attendant, if you please, But of whom else
• 2:52:35
  if you wish for a real answer to your question, would you ask it?
• 2:52:39
  Certainly not of the casual visitor, Certainly not of the nurse. While
• 2:52:43
  the nurse's observation is so little exercised as it is now what do you want
• 2:52:50
  of facts, not opinions? For who can have any opinion of any value
• 2:52:54
  as to whether the patient is better or worse, excepting the constant medical attendant
• 2:53:00
  or the really observing nurse. The most important practical lesson that can be given
• 2:53:07
  to nurses is to teach them what to observe, how to observe, what
• 2:53:13
  symptoms indicate improvement, what the reverse, Which are of importance, which are
• 2:53:18
  of none, Which are the evidence of neglect? And of what kind of
• 2:53:24
  neglect? All this is what ought to make part and an essential part of
• 2:53:30
  the training of every nurse. At present, how few there are, either
• 2:53:35
  professional or unprofessional, who really know at all whether any sick person they may
• 2:53:39
  be with is better or worse. The vagueness and looseness of the information one
• 2:53:46
  receives. An answer to that much abused question, is he better? Would
• 2:53:52
  be ludicrous if it were not painful. The only sensible answer in the present
• 2:53:58
  state of knowledge about sickness would be how can I know? I cannot tell
• 2:54:03
  how he was when I was not with him. I can record but a
• 2:54:07
  very few specimens of the answers which I have heard made by friends and nurses,
• 2:54:13
  and accepted by physicians and surgeons at the very bedside of the patient who
• 2:54:18
  could have contradicted every word but did not, sometimes from amiability, often from
• 2:54:24
  shyness, oftenest from langor how often have the bowels acted? Nurse? Once,
• 2:54:31
  sir? This generally means that the utensil has been emptied once, it
• 2:54:37
  having been used perhaps seven or eight times. Do you think the patient is
• 2:54:43
  much weaker than he was six weeks ago? Oh? No, sir,
• 2:54:46
  You know it is very long since he has been up and dressed, and
• 2:54:50
  he can get across the room. Now. This means that the nurse has
• 2:54:54
  not observed that whereas six weeks ago he sat up and occupied himself in bed,
• 2:55:00
  he now lies still doing nothing, that although he can get across the
• 2:55:05
  room, he cannot stand for five seconds. Another patient who is eating well,
• 2:55:11
  recovering steadily, although slowly, from fever, but cannot walk or stand
• 2:55:16
  is represented to the doctor as making no progress at all. Questions too,
• 2:55:24
  as asked now, but too generally of or about patients, would obtain no
• 2:55:30
  information at all about them, even if the person asked of had every information
• 2:55:33
  to give. The question is generally a leading question, and it is singular
• 2:55:39
  that people never think what must be the answer to this question before they ask
• 2:55:43
  it. For instance, has he had a good night? Now? One
• 2:55:50
  patient will think he has a bad night if he has not slept ten hours
• 2:55:54
  without waking. Another does not think he has a bad night if he has
• 2:55:58
  had intervals of doseing regularly. The same answer has actually been given as regarded
• 2:56:05
  two patients, one who had been entirely sleepless for five times twenty four hours
• 2:56:09
  and died of it, and another who had not slept the sleep of a
• 2:56:13
  regular night without waking. Why cannot the question be asked, how many hours
• 2:56:18
  sleep has had and at what hours of the night? I have never closed
• 2:56:26
  my eyes all night? An answer is frequently made when the speaker has had
• 2:56:30
  several hours sleep, as when he has had none would then be less often
• 2:56:35
  said. Lies, intentional and unintentional are much seldom are told in answer to
• 2:56:41
  precise than leading questions. Another frequent error is to inquire whether one cause remains,
• 2:56:48
  and not whether the effect, which may be produced by a great many
• 2:56:52
  different causes not inquired after remains, as when it is asked whether there was
• 2:56:58
  noise in the street last night, and if there were not, the patient
• 2:57:01
  is reported without more ado to have had a good night. Patients are completely
• 2:57:09
  taken aback by these kinds of leading questions and give only the exact amount of
• 2:57:13
  information asked for, even when they know it to be completely misleading. The
• 2:57:18
  shyness of patience is seldom allowed, for how few there are who by five
• 2:57:26
  or six pointed questions can elicit the whole case and get accurately to know and
• 2:57:31
  to be able to report where the patient is. I knew a very clever
• 2:57:37
  physician of large dispensary and hospital practice who invariably began his examination of each patient
• 2:57:43
  with put your finger where you be bad. That man would never waste his
• 2:57:50
  time with collecting inaccurate information from nurse or patient. Leading questions always collect inaccurate
• 2:57:56
  information. A recent celebrated trial, the following leading question was put successively to
• 2:58:05
  nine distinguished medical men, can you attribute these symptoms to anything else but poison?
• 2:58:11
  And out of the nine, eight answered no, without any qualification whatever.
• 2:58:18
  It appeared upon cross examination one that none of them had ever seen a
• 2:58:24
  case of the kind of poisoning supposed, two that none of them had ever
• 2:58:28
  seen a case of the kind of disease to which the death if not to
• 2:58:31
  poison was attributable. Three that none of them were even aware of the main
• 2:58:37
  fact of the disease and condition to which the death was attributable. Surely nothing
• 2:58:45
  stronger can be adduced to prove what use leading questions are of and what they
• 2:58:50
  lead to. I had rather not say how many instances I have known where
• 2:58:56
  owing to this system of leading questions, the patient has done and the attendants
• 2:59:01
  have been actually unaware of the principal feature of the case. It is useless
• 2:59:07
  to go through all the particulars besides sleep, in which people have a peculiar
• 2:59:11
  talent for gleaning inaccurate information As to food, for instance, I often think
• 2:59:18
  that most common question how is your appetite? Can only be put because the
• 2:59:22
  questioner believes the question really has nothing the matter with him, which is very
• 2:59:26
  often the case. But when there is the remark holds good which has been
• 2:59:31
  made about sleep, the same answer will often be made. As regards a
• 2:59:37
  patient who cannot take two ounces of solid food per diem and a patient who
• 2:59:41
  does not enjoy five meals a day as much as usual. Again, the
• 2:59:46
  question how is your appetite is often put when how is your digestion is the
• 2:59:52
  question meant no doubt. The two things depend on one another, but they
• 2:59:58
  are quite different. Many a patient can eat if you can only tempt his
• 3:00:03
  appetite. The fault lies in your not having got him the thing that he
• 3:00:07
  fancies. But many another patient does not care. Between grapes and turnips.
• 3:00:13
  Everything is equally distasteful to him. He would try to eat anything which would
• 3:00:18
  do him good, but everything makes him worse. The fault here generally lies
• 3:00:24
  in the cooking. It is not his appetite which requires tempting. It is
• 3:00:30
  his digestion, which requires sparing, and good sick cookery will save the digestion
• 3:00:35
  half its work. There may be four different causes, any one of which
• 3:00:41
  will produce the same result, that is, the patient slowly starving to death
• 3:00:48
  from want of nutrition. One defect in cooking, two defect in choice of
• 3:00:54
  diet, three defect in choice of hours for taking diet, four defect of
• 3:01:01
  appetite inpatient. Yet all these are generally comprehended in the one sweeping assertion that
• 3:01:09
  the patient has no appetite. Surely many lives might be saved by drawing a
• 3:01:16
  closer distinction for the remedies are as diverse as the causes. The remedy for
• 3:01:22
  the first is to cook better, for the second, to choose other articles
• 3:01:26
  of diet, for the third, to watch for the hours when the patient
• 3:01:30
  is in want of food, for the fourth to show him what he likes,
• 3:01:35
  and sometimes unexpectedly. But no one of these remedies will do for any
• 3:01:41
  of the other defects not corresponding with it, I cannot too often repeat that
• 3:01:46
  patients are generally either too languid to observe these things or too shy to speak
• 3:01:52
  about them. Nor is it well that they should be made to observe them.
• 3:01:56
  It fixes their attention upon themselves. Again, I say, what is
• 3:02:01
  the nurse or friend therefore, except to take notice of these things instead of
• 3:02:07
  the patient doing so? Again, the question is sometimes put, is their
• 3:02:13
  diarrhea? And the answer will be the same, whether it is just merging
• 3:02:18
  into cholera, whether it is a trifling degree brought on by some trifling indiscretion,
• 3:02:22
  which will cease the moment the cause is removed, or whether there is
• 3:02:26
  no diarrhea at all but simply relaxed bowels. It is useless to multiply instances
• 3:02:33
  of this kind as long as observation is so little cultivated as it is now.
• 3:02:39
  I do believe that it is better for the physician not to see the
• 3:02:41
  friends of the patient at all. They will often a mislead him than not,
• 3:02:46
  and as often by making the patient out worse as better than he really
• 3:02:50
  is. In the case of infants, everything must depend on the accurate observation
• 3:02:56
  of the nurse or mother who has to report, and how seldom is this
• 3:03:01
  condition of accuracy fulfilled. A celebrated man, though celebrated only for foolish things,
• 3:03:09
  has told us that one of his main objects in the education of his
• 3:03:11
  son was to give him a ready habit of accurate observation, a certainty of
• 3:03:16
  perception, and that for this purpose one of his means was a month's course.
• 3:03:20
  As follows, he took the boy rapidly past a toy shop. The
• 3:03:26
  father and son then described to each other as many of the objects as they
• 3:03:28
  could which they had seen in passing the windows, noting them down with pencil
• 3:03:33
  and paper, and returning afterwards to verify their own accuracy. The boy always
• 3:03:39
  succeeded best e g. If the father described thirty objects, the boy did
• 3:03:45
  forty, and scarcely ever made a mistake. I have often thought, how
• 3:03:50
  wise a piece of education this would be for much higher objects. And in
• 3:03:56
  our calling of nurses, the thing itself is essential. For it may safely
• 3:04:01
  be said not that the habit of ready and correct observation will by itself make
• 3:04:05
  us useful nurses, but that without it we shall be useless. With all
• 3:04:11
  our devotion. I have known a nurse in charge of a set of wards,
• 3:04:16
  who not only carried in her head all the little varieties in the diets
• 3:04:20
  which each patient was allowed to fix for himself, but also exactly what each
• 3:04:24
  patient had taken during each day. I have known another nurse in charge of
• 3:04:30
  one single patient who took away his meals day after day, all but untouched,
• 3:04:35
  and never knew it. If you find it helps you to note down
• 3:04:39
  such things on a piece of paper in pencil, by all means do so,
• 3:04:45
  I think it more often lames than strengthens the memory and observation. But
• 3:04:50
  if you cannot get the habit of observation, one way or another, you
• 3:04:52
  had better give up the being a nurse, for it is not your calling.
• 3:04:56
  However kind and anxious you may be, surely you can learn at least
• 3:05:01
  to judge with the eye how much an ounce of solid food is how much
• 3:05:07
  an ounce of liquid. You will find this helps your observation and memory very
• 3:05:11
  much. You will then say to yourself, A took about an ounce of
• 3:05:15
  his meat to day, B took three times in twenty four hours about a
• 3:05:18
  quarter of a pint of beef tea, instead of saying B has taken nothing
• 3:05:24
  all day, or I gave A his dinner as usual. I have known
• 3:05:28
  several of our real old fashioned hospital sisters who could, as accurately as a
• 3:05:35
  measuring glass, measure out all their patients wine and medicine by the eye,
• 3:05:39
  and never be wrong. I do not recommend this. One must be very
• 3:05:45
  sure of one's self to do it. I only mention it, because if
• 3:05:48
  a nurse can, by practice measure medicine by the eye, surely she is
• 3:05:54
  no nurse who cannot measure by the eye about how much food in ounces her
• 3:05:58
  patient has taken. In hospitals, those who cut up the diets give with
• 3:06:03
  quite sufficient accuracy to each patient his twelve ounces or his six ounces of meat,
• 3:06:09
  without weighing. Yet a nurse will often have patients loathing all food and
• 3:06:15
  incapable of any will to get well, who just tumble over the contents of
• 3:06:18
  the plate or dip the spoon in the cup to deceive the nurse, And
• 3:06:22
  she will take it away without ever seeing that there is just the same quantity
• 3:06:26
  of food as when she brought it. And she will tell the doctor too
• 3:06:31
  that the patient has eaten all his diets as usual, when all she ought
• 3:06:35
  to have meant is that she has taken away his diets as usual. Now,
• 3:06:39
  what kind of nurse is this? I would call attention to something else
• 3:06:46
  in which nurses frequently fail in observation. There is a well marked distinction between
• 3:06:52
  the excitable and what I will call the accumulative temperament in patience. One will
• 3:06:58
  blaze up at once under any shock or anxiety, and sleep very comfortably after
• 3:07:03
  it. Another will seem quite calm and even torpid under the same shock,
• 3:07:09
  And if people say he hardly felt it at all, yet you will find
• 3:07:13
  him some time after slowly sinking. The same remark applies to the action of
• 3:07:20
  narcotics of appariance, which in the one take effect directly in the other,
• 3:07:26
  not perhaps for twenty four hours, a journey, a visit, an unwonted
• 3:07:31
  exertion, will affect the one immediately, but he recovers after it. The
• 3:07:37
  other bears it very well at the time, apparently, and dies or is
• 3:07:41
  prostrated for life by it. People often say how difficult the excitable temperament is
• 3:07:46
  to manage. I say, how difficult is the accumulative temperament. With the
• 3:07:52
  first, you have an outbreak which you could anticipate, and it is all
• 3:07:58
  over. With the second, you never know where you are, You never
• 3:08:01
  know when the consequences are over, and it requires your closest observation to know
• 3:08:07
  what are the consequences of what? For the consequent by no means follows immediately
• 3:08:13
  upon the antecedent, and course observation is utterly at fault. Almost all superstitions
• 3:08:20
  are owing to bad observation, to the post hoc ergo propter hoc, and
• 3:08:24
  bad observers are almost all superstitious. Farmers used to attribute disease among cattle to
• 3:08:31
  witchcraft. Weddings have been attributed to seeing one magpie, deaths to seeing three,
• 3:08:37
  and I have heard the most highly educated nowadays draw consequences for the sick
• 3:08:43
  closely resembling these. Another remark, although there is unquestionably a physiognomy of disease
• 3:08:52
  as well as of health. Of all parts of the body, the face
• 3:08:56
  is perhaps the one which tells the least to the common observer or the casual
• 3:09:01
  visitor, because of all parts of the body, it is the one most
• 3:09:05
  exposed to other influences besides health, and people never or scarcely ever observe enough
• 3:09:15
  to know how to distinguish between the effect of exposure of robust health, of
• 3:09:20
  a tender skin, of a tendency to congestion, of suffusion, flushing,
• 3:09:24
  or many other things. Again, the face is often the last to show
• 3:09:31
  emaciation. I should say that the hand was a much surer test than the
• 3:09:35
  face, both as to flesh, color, circulation, et cetera, et
• 3:09:41
  cetera. It is true that there are some diseases which are only betrayed at
• 3:09:46
  all by something in the face, for example, the eye or the tongue,
• 3:09:50
  as greater irritability of brain by the appearance of the pupil of the eye.
• 3:09:54
  But we are talking of casual, not minute observation, and few minute
• 3:10:00
  observers will hesitate to say that far more untruth than truth is conveyed by the
• 3:10:05
  oft repeated words. He looks well or ill, or better or worse.
• 3:10:13
  Wonderful is the way in which people will go upon the slightest observation, or
• 3:10:16
  often upon no observation at all, or upon some sore which the world's experience,
• 3:10:22
  if it had any, would have pronounced utterly false. Long ago,
• 3:10:28
  I have known patience dying of sheer pain, exhaustion, and want of sleep
• 3:10:33
  from one of the most lingering and painful diseases known, preserve till within a
• 3:10:39
  few days of death, not only the healthy color of the cheek, but
• 3:10:43
  the muttled appearance of a robust child. And scores of times have I heard
• 3:10:48
  these unfortunate creatures assailed with I am glad to see you looking so well.
• 3:10:54
  I see no reason why you should not live till ninety years of age.
• 3:10:56
  Why don't you take a little more exercise and amusement. With all the other
• 3:11:01
  commonplaces with which we are so familiar. There is unquestionably a physiognomy of disease.
• 3:11:09
  Let the nurse learn it. The experienced nurse can always tell that a
• 3:11:15
  person has taken a narcotic the night before by the patchiness of the color about
• 3:11:18
  the face. When the reaction of depression has set in that very color,
• 3:11:24
  which the inexperienced will point to as a proof of health. There is again
• 3:11:30
  a faintness which does not betray itself by the color at all, or in
• 3:11:33
  which the patient becomes brown instead of white. There is a faintness of another
• 3:11:39
  kind, which, it is true, can always be seen by the paleness,
• 3:11:43
  but the nurse seldom distinguishes. She will talk to the patient who is
• 3:11:48
  too faint to move without the least scruple unless he is pale, and unless,
• 3:11:54
  luckily for him, the muscles of the throat are affected and he loses
• 3:11:58
  his voice. These two faintnesses are perfectly distinguishable by the mere countenance of the
• 3:12:03
  patient. Again, the nurse must distinguish between the idiosyncrasies of patients. One
• 3:12:11
  likes to suffer out all his suffering alone, to be as little looked after
• 3:12:16
  as possible. Another likes to be perpetually made much of and pitied, and
• 3:12:20
  to have someone always by him. Both these peculiarities might be observed and indulged
• 3:12:28
  much more than they are. For quite as often does it happen that a
• 3:12:31
  busy attendance is forced upon the first patient who wishes for nothing but to be
• 3:12:37
  let alone, As that the second is left to think himself neglected again.
• 3:12:43
  I think that few things press so heavily on one's suffering from long and incurable
• 3:12:48
  illness as the necessity of recording in words from time to time for the information
• 3:12:54
  of the nurse, who will not otherwise see that he cannot do this or
• 3:12:58
  that which she could do a month or a year ago. What is a
• 3:13:03
  nurse there for if she cannot observe these things for herself? Yet I have
• 3:13:09
  known, and known too among those, and chiefly among those whom money and
• 3:13:13
  position put in possession of everything which money and position could give. I have
• 3:13:18
  known, I say, more accidents fatal slowly or rapidly, arising from this
• 3:13:24
  want of observation among nurses than from almost anything else. Because a patient could
• 3:13:31
  get out of a warm bath alone a month ago, because a patient could
• 3:13:35
  walk as far as his bell a week ago, the nurse concludes that he
• 3:13:39
  can do so now, she has never observed the change, and the patient
• 3:13:43
  is lost from being left in a helpless state of exhaustion till someone accidentally comes
• 3:13:48
  in. And this not from any unexpected apoplectic, paralytic, or fainting fit,
• 3:13:56
  though even these could be expected. Far more, at least to them
• 3:14:00
  they are now if we did, but observe no from the expected or to
• 3:14:05
  be expected, inevitable, visible, calculable, uninterrupted increase of weakness, which
• 3:14:13
  none need fail to observe again. A patient not usually confined to bed is
• 3:14:20
  compelled by an attack of diarrhea, vomiting, or other accident to keep his
• 3:14:26
  bed for a few days. He gets up for the first time, and
• 3:14:30
  the nurse lets him go into another room without coming in a few minutes afterwards
• 3:14:35
  to look after him. It never occurs to her that he is quite certain
• 3:14:39
  to be faint or cold, or to want something. She says as her
• 3:14:45
  excuse, Oh, he does not like to be fidgeted after, Yes,
• 3:14:50
  he said so some weeks ago, But he never said he did not like
• 3:14:54
  to be fidgeted after when he is in the state he is in now,
• 3:14:58
  And if he did, you ought to make some excuse to go into him.
• 3:15:03
  More patients have been lost in this way than is at all generally known,
• 3:15:07
  that is, from relapses brought on by being left for an hour or
• 3:15:11
  two faint or cold or hungry after getting up for the first time. Yet
• 3:15:18
  it appears that scarcely any improvement in the faculty of observing is being made.
• 3:15:26
  Vast has been the increase of knowledge in pathology, that science which teaches us
• 3:15:30
  the final change produced by disease on the human frame. Scarce any in the
• 3:15:35
  art of observing the signs of the change while in progress. Or rather,
• 3:15:41
  is it not to be feared that observation as an essential part of medicine has
• 3:15:45
  been declining. Which of us has not heard fifty times from one or another,
• 3:15:52
  a nurse or a friend of the sick. I am a medical friend
• 3:15:54
  too, the following remark, So a is worse or be is dead?
• 3:16:01
  I saw him the day before, I thought him so much better. There
• 3:16:03
  certainly was no change from which one could have expected so sudden a change I
• 3:16:09
  have never heard any one say, though one would think it the more natural
• 3:16:13
  thing. There must have been some appearance which I should have seen if I
• 3:16:18
  had but looked. Let me try and remember what there was that I may
• 3:16:22
  observe another time. No, this is not what people say. They boldly
• 3:16:28
  assert that there was nothing to observe, not that their observation was at fault.
• 3:16:35
  Let people who have to observe sickness and death look back and try to
• 3:16:39
  register in their observation the appearances which have preceded relapse, attack, or death,
• 3:16:46
  and not assert that there were none or that there were not the right
• 3:16:50
  ones. A want of the habit of observing conditions, and an inveterate habit
• 3:16:56
  of taking averages are each of them often equally misleading. Men whose profession,
• 3:17:03
  like that of medical men, leads them to observe only or chiefly palpable and
• 3:17:09
  permanent organic changes are just as often wrong in their opinion of the result as
• 3:17:15
  those who do not observe at all. For instance, there is a broken
• 3:17:20
  leg. The surgeon has only to look at it once to know it will
• 3:17:24
  not be different if he sees it in the morning to what it would have
• 3:17:26
  been had he seen it in the evening, And in whatever conditions the patient
• 3:17:31
  is or as likely to be, there will still be the broken leg until
• 3:17:35
  it is set. The same with many organic diseases. An experienced physician has
• 3:17:43
  but to feel the pulse once, and he knows that there is aneurysm which
• 3:17:46
  will kill some time or other. But with the great majority of cases there
• 3:17:52
  is nothing of the kind, and the power of forming any correct opinion as
• 3:17:58
  to the result must entirely depend upon an inquiry into all the conditions in which
• 3:18:03
  the patient lives in a complicated state of society in large towns. Death,
• 3:18:09
  as every one of great experience knows, is far less often produced by any
• 3:18:15
  one organic disease than by some illness after many other diseases, producing just the
• 3:18:20
  sum of exhaustion necessary for death. There is nothing so absurd, nothing so
• 3:18:26
  misleading as the verdict. One so often hears so and so has no organic
• 3:18:33
  disease. There is no reason why he should not live to extreme old age.
• 3:18:37
  Sometimes the clause is added, sometimes not, provided he has quiet,
• 3:18:43
  good food, good air, et cetera, et cetera, et cetera.
• 3:18:48
  The verdict is repeated by ignorant people without the latter clause, or there is
• 3:18:52
  no possibility of the conditions of the latter clause being obtained, and this the
• 3:18:58
  only essential parts of the whole, is made of no effect. I have
• 3:19:03
  heard a physician, deservedly eminent assure the friends of a patient of his recovery.
• 3:19:09
  Why because he had now prescribed a course, every detail of which the
• 3:19:15
  patient had followed for years, and because he had forbidden a course which the
• 3:19:20
  patient could not by any possibility alter. Undoubtedly a person of no scientific knowledge
• 3:19:26
  whatever, but of observation and experience in these kinds of conditions, will be
• 3:19:31
  able to arrive at a much truer guess as to the probable duration of life
• 3:19:35
  of members of a family or inmates of a house than the most scientific physician
• 3:19:41
  to whom the same persons are brought to have their pulse felt, no inquiry
• 3:19:46
  being made into their conditions in life insurance and such like societies. Why they,
• 3:19:52
  instead of having the persons examined by a medical man, to have the
• 3:19:56
  houses, conditions, ways of life, life of these persons examined, at
• 3:20:01
  how much truer results would they arrive? W Smith appears a fine hailman,
• 3:20:09
  but it might be known that the next cholera epidemic he runs a bad chance.
• 3:20:13
  Mister and missus j are a strong, healthy couple, but it might
• 3:20:16
  be known that they live in such a house, in such a part of
• 3:20:20
  London, so near the river, that they will kill four fifths of their
• 3:20:24
  children. Which of the children will be the ones to survive might also be
• 3:20:28
  known. Averages again seduce us away from minute observation. Average mortalities merely tell
• 3:20:37
  that so many percent die in this town, and so many in that per
• 3:20:43
  annum. But whether A or B will be among these the average rate,
• 3:20:48
  of course, does not tell. We know, say that from twenty two
• 3:20:54
  to twenty four per thousand will die in London next year. But minute in
• 3:21:00
  marries into conditions enable us to know that in such a district, nay,
• 3:21:03
  in such a street, or even on one side of that street, in
• 3:21:07
  such a particular house, or even on one floor of that particular house,
• 3:21:13
  will be the excess of mortality. That is, the person will die who
• 3:21:16
  ought not to have died before old age. Now would it not very materially
• 3:21:24
  alter the opinion of whoever was endeavoring to form one if he knew that from
• 3:21:28
  that floor of that house, of that street the man came. Much more
• 3:21:35
  precise might be our observations even than this, and much more correct our conclusions.
• 3:21:43
  It is well known that the same names may be seen constantly recurring on
• 3:21:48
  workhouse books for generations. That is, the persons were born and brought up,
• 3:21:52
  and will be born and brought up generation after generation. In the conditions
• 3:21:58
  which make paupers death and disease are like the workhouse. They take from the
• 3:22:03
  same family, the same house, or in other words, the same conditions,
• 3:22:09
  Why will we not observe what they are? The close observer may safely
• 3:22:16
  predict that such a family, whether its members marry or not, will become
• 3:22:20
  extinct, that such another will degenerate morally and physically. But who learns the
• 3:22:26
  lesson? On the contrary, it may be well known that the children die
• 3:22:31
  in such a house at the rate of eight out of ten. One would
• 3:22:35
  think that nothing more need be said, for how could providence speak more distinctly?
• 3:22:41
  Yet nobody listens. The family goes on living there till it dies out,
• 3:22:46
  and then some other family takes it. Neither would they listen if one
• 3:22:50
  rose from the dead. In dwelling upon the vital importance of sound observation,
• 3:22:56
  it must never be lost sight of what observation is. It is not for
• 3:23:01
  the sake of piling up miscellaneous information or curious facts, but for the sake
• 3:23:07
  of saving life and increasing health and comfort. The caution may seem useless,
• 3:23:15
  but it is quite surprising how many men some women do it too, practically,
• 3:23:20
  behave as if the scientific end were the only one in view, or
• 3:23:24
  as if the sick body were but a reservoir for stowing medicines into and the
• 3:23:28
  surgical disease, only a curious case the sufferer has made for the attendant's special
• 3:23:33
  information. This is really no exaggeration. You think if you suspected your patient
• 3:23:41
  was being poisoned, say by a copper kettle, you would instantly, as
• 3:23:46
  you ought, cut off all possible connection between him and the suspected source of
• 3:23:50
  the injury, without regard to the fact that a curious mine of observation is
• 3:23:56
  therefore lost. But it is not everybody who does so. And it has
• 3:24:01
  actually been made a question of medical ethics. What should the medical man do
• 3:24:05
  if he suspected poisoning? The answer seems a very simple one. Insist upon
• 3:24:11
  a confidential nurse being placed with a patient, or give up the case.
• 3:24:16
  And remember, every nurse should be one who is to be depended upon.
• 3:24:22
  In other words, capable of being a confidential nurse. She does not know
• 3:24:28
  how soon she may find herself placed in such a situation. She must be
• 3:24:33
  no gossip, no vain talker. She should never answer questions about her sick
• 3:24:37
  except for those who have a right to ask them. She must, i
• 3:24:41
  need not say, be strictly sober and honest. But more than this,
• 3:24:46
  she must be a religious and devoted woman. She must have a respect for
• 3:24:50
  her own calling, because God's precious gift of life is often literally placed in
• 3:24:56
  her hands. She must be a sound and close and quick observer. And
• 3:25:01
  she must be a woman of delicate and decent feeling. To return to the
• 3:25:07
  question of what observation is, for it would really seem as if some had
• 3:25:11
  considered it as its own end, as if detection, not cure, was
• 3:25:16
  their business. Nay more, in a recent celebrated trial, three medical men,
• 3:25:22
  according to their own account, suspected poison prescribed for dysentery and left the
• 3:25:28
  patient to the poisoner. This is an extreme case, but in a small
• 3:25:33
  way, the same manner of acting falls under the cognisance of us all.
• 3:25:39
  How often the attendants of a case have stated that they knew perfectly well that
• 3:25:43
  the patient could not get well in such an air, in such a room,
• 3:25:48
  or under such circumstances, yet have gone on dosing him with medicine,
• 3:25:54
  and making no effort to remove the poison from him, or him from the
• 3:25:58
  poison which they knew was killing him. Nay more, have sometimes not so
• 3:26:03
  much as mentioned their conviction in the right quarter, that is, to the
• 3:26:07
  only person who could act in the matter. End of Section thirteen. Section
• 3:26:15
  fourteen conclusion. The whole of the preceding remarks apply even more to children and
• 3:26:24
  to pure operal women than to patients in general. They also apply to the
• 3:26:28
  nursing of surgical quite as much as to that of medical cases. Indeed,
• 3:26:33
  if it be possible, cases of external injury require such care even more than
• 3:26:39
  sick in surgical wards. One duty of every nurse certainly is prevention fever or
• 3:26:48
  hospital gangrene, or piemia, or purulent discharge of some kind males supervene.
• 3:26:56
  Has she a case of compound fracture, of amputation, or of chrysipelas,
• 3:27:01
  it may depend very much on how she looks upon the things enumerated in these
• 3:27:05
  notes, whether one or other of these hospital diseases attacks her patient or not.
• 3:27:11
  If she allows her ward to become filled with a peculiar close fetid smell
• 3:27:16
  so apt to be produced among surgical cases, especially where there is great suppuration
• 3:27:20
  and discharge, she may see a vigorous patient in the prime of life gradually
• 3:27:26
  sink and die, where according to all human probability, he ought to have
• 3:27:31
  recovered. The surgical nurse must, ever be on the watch, ever on
• 3:27:37
  her guard against want of cleanliness, foul air, want of light, and
• 3:27:41
  of warmth. Nevertheless, let no one think that, because sanitary nursing is
• 3:27:48
  the subject of these notes, therefore what may be called the handicraft of nursing
• 3:27:54
  is to be undervalued. A patient may be left to bleed to death in
• 3:27:58
  a sanitary palace. Another who cannot move himself may die of bed sores because
• 3:28:05
  the nurse does not know how to change and clean him, while he has
• 3:28:09
  every requisite of air, light and quiet. But nursing as a handicraft has
• 3:28:16
  not been treated of here for three reasons. One that these notes do not
• 3:28:20
  pretend to be a manual for nursing any more than for cooking for the sick.
• 3:28:26
  Two that the writer, who has herself seen more of what may be
• 3:28:30
  called surgical nursing, that is practical manual nursing, than perhaps anyone in Europe,
• 3:28:35
  honestly believes that it is impossible to learn it from any book, and
• 3:28:41
  that it can only be thoroughly learnt in the wards of a hospital. And
• 3:28:45
  she also honestly believes that the perfection of surgical nursing may be seen practiced by
• 3:28:50
  the old fashioned sister of a London hospital, as it can be seen nowhere
• 3:28:54
  else in Europe. Three. While thousands die of et cetera, who have
• 3:29:01
  this surgical nursing to perfection, the converse is comparatively rare. To revert to
• 3:29:07
  children. They are much more susceptible than grown people to all noxious influences.
• 3:29:15
  They are affected by the same things, but much more quickly and seriously.
• 3:29:20
  That is, by want of fresh air, of proper warmth, want of
• 3:29:24
  cleanliness in house, clothes, bedding, or body, by startling noises,
• 3:29:30
  improper food, or want of punctuality, by dullness, and by want of
• 3:29:35
  light, by too much or too little covering in bed or when up,
• 3:29:39
  by want of the spirit of management, generally in those in charge of them.
• 3:29:45
  One can therefore only press the importance as being yet greater in the case
• 3:29:50
  of children, greatest in the case of sick children, of attending to these
• 3:29:54
  things. That which, however, above all, is own to injure children
• 3:30:01
  seriously is foul air, and most seriously at night, keeping the rooms where
• 3:30:07
  they sleep tight shut up is destruction to them. And if the child's breathing
• 3:30:13
  be disordered by disease, a few hours only of such foul air may endanger
• 3:30:18
  its life, even where no inconvenience is felt by grown up persons in the
• 3:30:22
  same room. The following passages, taken out of an excellent lecture on sudden
• 3:30:30
  death in infancy and childhood just published, show the vital importance of careful nursing
• 3:30:35
  of children. In the great majority of instances, when death suddenly befalls the
• 3:30:43
  infant or young child, it is an accident. It is not a necessary
• 3:30:48
  inevitable result of any disease from which it is suffering. It may be here
• 3:30:54
  added that it would be very desirable to know how often death is with adults
• 3:30:58
  not unnecess inevitable result of any disease. Amid the words sudden, for sudden
• 3:31:05
  death is comparatively rare in middle age, and the sentence is almost equally true
• 3:31:09
  for all ages. The following causes of accidental death in sick children are enumerated.
• 3:31:18
  Sudden noises which startle, a rapid change of temperature which chills the surface,
• 3:31:24
  though only for a moment. A rude awakening from sleep, or even
• 3:31:28
  an over hasty or an over full meal, any sudden impression on the nervous
• 3:31:33
  system, any hasty alteration of posture, in short, any cause whatever by
• 3:31:39
  which the respiratory process may be disturbed. It may again be added that with
• 3:31:46
  very weak adult patients these causes are also not often suddenly fatal, it is
• 3:31:52
  true, but very much oftener than is at all generally known, irreparable in
• 3:31:56
  their consequences children and for adults, both for sick and for well, although
• 3:32:03
  more certainly in the case of sick children than in any others, I would
• 3:32:07
  here again repeat the most frequent and most fatal cause of all is sleeping,
• 3:32:13
  even for a few hours, much more for weeks and months in foul air,
• 3:32:18
  a condition which, more than any other condition disturbs the respiratory process and
• 3:32:24
  tends to produce accidental death in disease. I need hardly hear repeat the warning
• 3:32:33
  against any confusion of ideas between cold and fresh air. You may chill a
• 3:32:39
  patient fatally without giving him fresh air at all, and you can quite well,
• 3:32:43
  nay much better, give him fresh air without chilling him. This is
• 3:32:48
  the test of a good nurse in cases of long recurring faintnesses from disease,
• 3:32:56
  for instance, especially disease which affects the old organs of breathing fresh air to
• 3:33:01
  the lungs. Warmth to the surface and often as soon as the patient can
• 3:33:07
  swallow hot drink. These are the right remedies, and the only ones yet
• 3:33:13
  oftener than not. You see the nurse or mother just reversing this, shutting
• 3:33:20
  up every cranny through which fresh air can enter, and leaving the body cold,
• 3:33:24
  or perhaps throwing a greater weight of clothes upon it when already it is
• 3:33:28
  generating too little heat. Breathing carefully anxiously, as though respiration was a function
• 3:33:35
  which required all the attention for its performance, is cited as a not unusual
• 3:33:41
  state in children, and as one calling for care in all the things enumerated
• 3:33:46
  above. That breathing becomes an almost voluntary act even in grown up patients who
• 3:33:52
  are very weak must often have been remarked disease having interfered with the perfect accomplishment
• 3:34:00
  and of the respiratory function some sudden demand for its complete exercise issues in a
• 3:34:05
  sudden standstill of the whole machinery is given as one process life goes out for
• 3:34:11
  want of nervous power to keep the vital functions in activity is given as another
• 3:34:16
  by which accidental death is most often brought to pass in infancy, also in
• 3:34:24
  middle age. Both these processes may be seen ending in death, although generally
• 3:34:30
  not suddenly, and I have seen even in Middle Age the sudden standstill here
• 3:34:35
  mentioned, and from the same causes to sum up the answer to two of
• 3:34:43
  the commonest objections urged, one by women themselves, the other by men against
• 3:34:48
  the desirableness of sanitary knowledge for women, plus a caution comprises the whole argument
• 3:34:56
  for the art of nursing one. It is often said by men that it
• 3:35:03
  is unwise to teach women anything about these laws of health, because they will
• 3:35:07
  take to physicking. That there is a great deal too much of amateur physicking
• 3:35:11
  as it is, which is indeed true. One eminent physician told me that
• 3:35:16
  he had known more calamel given both at a pinch and for a continuance by
• 3:35:20
  mothers, governesses, and nurses to children than he had ever heard of a
• 3:35:26
  physician prescribing in all his experience. Another says that women's only idea in medicine
• 3:35:33
  is calamel and appariance. This is undeniably too often the case. There is
• 3:35:39
  nothing ever seen in any professional practice like the reckless physicking by amateur females.
• 3:35:46
  But this is just what the really experienced and observing nurse does not do she
• 3:35:52
  neither physics herself nor others. And to cultivate in things pertaining to health,
• 3:35:56
  observation and experience in women who are mothers, governesses, or nurses is just
• 3:36:03
  the way to do away with amateur physicking. And if the doctors did but
• 3:36:07
  know it, to make the nurses obedient to them helps to them instead of
• 3:36:11
  hinderances. Such education in women would indeed diminish the doctor's work, but no
• 3:36:18
  one really believes that doctors wish that there should be more illnesses in order to
• 3:36:22
  have more work. Two. It is often said by women that they cannot
• 3:36:30
  know anything of the laws of health or what to do to preserve their children's
• 3:36:35
  health, because they can know nothing of pathology or cannot dissect a confusion of
• 3:36:41
  ideas which it is hard to attempt to disentangle. Pathology teaches the harm that
• 3:36:46
  disease has done, but it teaches nothing more. We know nothing of the
• 3:36:52
  principle of health, the positive of which pathology is the negative, except from
• 3:36:58
  observation and expel exvuriance, And nothing but observation and experience will teach us the
• 3:37:05
  ways to maintain or to bring back the state of health. It is often
• 3:37:11
  thought that medicine is the curative process. It is no such thing. Medicine
• 3:37:16
  is the surgery of functions, as surgery proper is that of limbs and organs.
• 3:37:22
  Neither can do anything but remove obstructions. Neither can cure. Nature alone
• 3:37:28
  cures. Surgery removes the bullet out of the limb, which is an obstruction
• 3:37:35
  to cure, but nature heals the wound. So it is with medicine the
• 3:37:41
  function of an organ becomes obstructed. Medicine, so far as we know,
• 3:37:46
  assists nature to remove the obstruction, but does nothing more. And what nursing
• 3:37:52
  has to do in either case is to put the patient in the best condition
• 3:37:56
  for nature to act upon him. Generally, just the contrary is done.
• 3:38:01
  You think fresh air and quiet and cleanliness extravagant, perhaps dangerous, luxuries which
• 3:38:07
  should be given to the patient only when quite convenient, And medicine the sinequa,
• 3:38:13
  not the panacea. If I have succeeded in any measure in dispelling this
• 3:38:18
  illusion, and in showing what true nursing is and what it is not,
• 3:38:24
  my object will have been answered. Now for the caution three, It seems
• 3:38:33
  a commonly received idea among men and even among women themselves, that it requires
• 3:38:39
  nothing but a disappointment in love, the want of an object, a general
• 3:38:43
  disgust, or incapacity for other things to turn a woman into a good nurse.
• 3:38:48
  This reminds one of the parish where a stupid old man was set to
• 3:38:52
  be schoolmaster because he was past keeping the pigs. Apply the above receipt for
• 3:38:58
  making a good nurse to making a good servant, and the receipt will be
• 3:39:03
  found to fail. Yet popular novelists of recent days have invented ladies disappointed in
• 3:39:09
  love, or fresh out of the drawing room, turning into the war hospitals
• 3:39:13
  to find their wounded lovers, and when found forthwith abandoning their sick ward for
• 3:39:18
  their lover. As might be expected. Yet in the estimation of the authors,
• 3:39:24
  these ladies were none the worse for that, But on the contrary,
• 3:39:28
  were heroines of nursing. What cruel mistakes are sometimes made by benevolent men and
• 3:39:35
  women in matters of business about which they can know nothing and think they know
• 3:39:39
  a great deal the everyday management of a large ward, let alone of a
• 3:39:45
  hospital, The knowing what are the laws of life and death for men?
• 3:39:50
  And what the laws of health, for wards and wards are healthy or unhealthy
• 3:39:54
  mainly according to the knowledge or ignorance of the nurse. Are not these matters
• 3:40:00
  of sufficient importance and difficulty to require learning by experience and careful inquiry, just
• 3:40:05
  as much as any other art. They do not come by inspiration to the
• 3:40:11
  lady disappointed in love, nor to the poor workhouse drudge hard up for a
• 3:40:16
  livelihood. And terrible is the injury which has followed to the sick from such
• 3:40:22
  wild notions in this respect? And why is it so? In Roman Catholic
• 3:40:28
  countries both writers and workers are in theory, at least far before hours.
• 3:40:35
  They would never think of such a beginning for a good working superior or sister
• 3:40:39
  of charity, And many a superior has refused to admit a postulant who appear
• 3:40:46
  to have no better vocation or reasons for offering herself than these. It is
• 3:40:52
  true we make no vows, But is a vow necessary to convince us that
• 3:40:58
  the true spirit for learning any other art, most especially an art of charity
• 3:41:01
  a right, is not a disgust to everything or something else. Do we
• 3:41:07
  really place the love of our kind and of nursing as one branch of it
• 3:41:13
  so low as this, What would the Mayor Angelique of Port Royal, What
• 3:41:18
  would our own missus Frye have said to this note, I would earnestly ask
• 3:41:28
  my sisters to keep clear of both the jargons now current everywhere, for they
• 3:41:33
  are equally jargons. Of the jargon, namely about the rights of women,
• 3:41:39
  which urges women to do all that men do, including the medical and other
• 3:41:43
  professions, merely because men do it, and without regard to whether this is
• 3:41:46
  the best that women can do. And of the jargon which urges women to
• 3:41:52
  do nothing that men do, merely because they are women and should be recalled
• 3:41:56
  to a sense of their duty as women, and because this is women's way,
• 3:42:00
  and that is men's and these are things which women should not do,
• 3:42:05
  which is all assertion, and nothing more. Surely woman should bring the best
• 3:42:09
  she has, whatever that is, to the work of God's world, without
• 3:42:15
  attending to either of these cries, for what are they both of them,
• 3:42:20
  the one just as much as the other. But listening to the what will
• 3:42:24
  people say to opinion, to the voices from without? And as a wise
• 3:42:31
  man has said, no one has ever done anything great or useful by listening
• 3:42:37
  to the voices from without. You do not want the effect of your good
• 3:42:41
  things to be how wonderful for a woman, Nor would you be deterred from
• 3:42:46
  good things by hearing it said. Yes, but she ought not to have
• 3:42:50
  done this, because it is not suitable for a woman. But you want
• 3:42:54
  to do the thing that is good, whether it is suitable for a woman
• 3:42:58
  or not. It does not make a thing good that it is remarkable that
• 3:43:03
  a woman should have been able to do it. Neither does it make a
• 3:43:07
  thing bad which would have been good had a man done it, that it
• 3:43:11
  has been done by a woman. Oh, leave these jargons and go your
• 3:43:16
  way straight to God's work in simplicity and singleness of heart. End of Notes
• 3:43:24
  on nursing What it is and what it is not by Florence Nightingale