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 THE LIBRARY 
 
 OF 
 
 THE UNIVERSITY 
 
 OF CALIFORNIA 
 
 LOS ANGELES 
 
 GIFT OF 
 DR. AND MRS. ELMER BELT 
 
 DONATION BY 
 
 DR. AND MRS. ELMER BELT
 
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 r<yviXXy 
 
 O
 
 NOTES ON NURSING: 
 
 vVHAT IT IS, AND WHAT IT IS NOT. 
 
 BY 
 
 FLORENCE NIGHTINGALE, 
 
 WITH SOME ACCOUNT OF HER LIFE, 
 
 BOSTON: 
 WILLIAM CAllTEIl, 5 WATER STREET 
 
 1860.
 
 AC 
 B 
 
 PREFACE. 
 
 The following notes are by no means intended as a rule 
 of thought by which nurses can teach themselves to nurse, 
 still less as a manual to teach nurses to nurse. They are 
 meant simply to give hints for thought to women who 
 have personal charge of the health of others. Every wo- 
 man, or at least almost every woman, in England has, at 
 one time or another of her life, charge of the personal 
 health of somebody, whether child, or invalid, — in other 
 words, every woman is a nurse. Ea- ery day sanitary knowl- 
 edge, or the knowledge of nursing, or in other words, of 
 how to put the constitution in such a state as that it will 
 have no disease, or that it can recover from disease, takes 
 a higher place. It is recognized as the knowledge wliich 
 every one ought to have — distinct from medical knowl- 
 edge, which only a profession can have. 
 
 If, then, every woman must at some time or other of her 
 life, become a nurse, i. e., have charge of somebody's health, 
 how immense and how valuable would be the produce of 
 her united experience if every woman would think how to 
 nurse ! 
 
 I do not pretend to teach her how, I ask her to teach 
 
 herself, and for this purpose I venture to give her some 
 
 hints. 
 
 (ui)
 
 TABLE OF CONTENTS. 
 
 Florence Nightingale 1 
 
 Index ... 6 
 
 Ventilation and WARinNG 11 
 
 Health of Houses 19 
 
 Petty Management 27 
 
 Noise 34 
 
 Variety 44 
 
 Taking Food 48 
 
 What Food ? 53 
 
 Bed and Bedding 60 
 
 Light 64 
 
 Cleanliness of Rooms and Walls ... 66 
 
 Personal Cleanliness 70 
 
 Chattering Hopes and Advices ... 72 
 
 Observation op the Sick 79 
 
 Conclusion 95 
 
 Appendix . . 103 
 
 (iv)
 
 FLORENCE NIGHTINGALE. 
 
 In the year 1820, in Florence, that lovely city, 
 " where earth and sky 
 Are picture both and poetry," 
 was bom the younger of the two daughters of William Shore Night- 
 ingale, Esq. ; and, in memory of her birthplace, its beautiful name was 
 given to her who will be known to all time as Florence Nightingale. 
 
 Her father, William Shore Nightingale, son of William Shore, Esq., 
 of Tapton, is a descendant of the ancient Derbyshire family of Shore 
 — of which Lord Teignmouth is the representative of another branch. 
 He assumed the name of Nightingale by the Prince Regent's sign man- 
 ual in 1815, in accordance with the will of his maternal uncle, Peter 
 Nightingale, whose niece and sole heiress his father had married. In 
 early life, in 1818, he married Frances, daughter of William Smith, 
 Esq., formerly M. P. for Norwich, a zealous laborer in the cause of 
 slave emancipation, and a benevolent, eaimest man. By inheritance, 
 Mr. Nightingale possessed large wealth, and the ample estates of Em- 
 bley Park, Hampshire, and the Lea Hurst, Derbyshire. 
 
 The e; rly youth of Florence Nightingale was passed under circum- 
 stances well calculated to foster an elegant mind and a tender heart. 
 The child of affluent and intellectual parents, surrounded by all that is 
 beautiful in nature and rich in art, and beloved by all who came in 
 contact with her, her heart and mind developed their rare qualities 
 together. 
 
 Under the guidance of her father, she attained considerable proficien- 
 cy in the classics, and in mathematics — studies which are rarely pur- 
 sued by ladies in these latter days. Nor were the more feminine ac- 
 complishments neglected by the ardent student. She became an excel- 
 lent musician, and conversant with most of the modern languages, 
 speaking French, Italian, and German with fluency and purity. 
 
 During the course of her studies she travelled extensively, visiting 
 most of the cities of Europe, and penetrating even to the remotest cat- 
 aract of the Nile. While in Egypt, it is said, she tended the sick 
 Arabs with whom she came in contact, and frequently, by judicious 
 counsel and advice, rendered them important services. 
 
 The favorite home of Miss Nightingale's childhood — Lea Hurst, 
 Derbyshire — is a most picturesque and romantic spot. The quiet 
 and secluded hamlet of Lea abounds in lovely scenery, and in interest- 
 ing historical and literary associations. Lea Hurst is beautifully situ- 
 ated on rising ground, " in one of the most charming and extensive of 
 the Derbyshire valleys, and surrounded with hills and mountains, rocks 
 and woods, of majestic and gigantic proportions, and watered by the 
 ■winding Derwent and its tributary streams. " 
 
 From her earliest childhood, Florence Nightingale displayed a con- 
 stant and active sympathy with the suffering, the desolate, and the dis- 
 tressed among the poor around Lea Hurst and Embley. As a friend, 
 a benefactress and a consoler, she was daily welcomed in many a cot- 
 tage ; and to the alleviation of pains and sorrows she devoted her per- 
 sonal energies and her large fortune. She was for many years, as a 
 voluntary teacher, the principal support of the schools for the poor ia 
 the neighboring villages ; for she never wearied of well-doing. 
 
 1
 
 FLORENCE NIGHTINGALE. 
 
 Having attained the age when yoimg ladies of birth and fortune 
 generally " come out" and partake of the brilliant gayeties of society, 
 riorence Nightingale visited London, But it was for the purpose of 
 frequentmg and studying the hospitals, schools and reformatory insti- 
 tutions of the metropolis, a self-imposed duty, which she performed 
 with untiring energy and diligence. Yet she did not neglect to fulfil 
 the more immediate duties of her station with grace and propriety, 
 even to a presentation at Court ; which proved that she was not one of 
 those who devote themselves to the cause of charity in order to avoid 
 the onerous claims of social life. 
 
 From London, Florence Nightingale went to Edinburgh, and to the 
 Continent, intent on perfecting herself for a high and holy mission, 
 and gathering up stores of knowledge for present as well as for future 
 use. In the memorable year 1851, when all Europe held festive holi- 
 day in honor of the Great Exhibition, when ''the highlands of Scot- 
 land, the lakes of Switzerland, and all the bright spots of the Conti- 
 nent were filled with parties of pleasure," Miss Nightingale — so well 
 fitted by birth and education to shine a star in her own proper sphere 
 — took up her abode in a hospital at Kaiserwerth on the Rhine, where 
 Protestant Sisters of Mercy are trained as nurses for the sick ; and for 
 three long months, within the walls of this institution, she remained 
 in daily and nightly attendance, unwearyingly expending her health 
 and strength in the cause of benevolence. Here she made herself 
 thoroughly acquainted with all the rules and regulations required in 
 the management of a hospital. The Pasteur Flieaner, director of the 
 establishment, affirmed that during the progress of the institution, no 
 one had ever passed so distinguished an examination or shown herself 
 so thoroughly mistress of all she had to learn, as the young, wealthy, 
 and graceful Englishwoman. With the institution she was so favora- 
 bly impressed that she afterwards returned to it, and subsequently pub- 
 lished a little book containing an account of its origin and manage- 
 ment. 
 
 From Germany, Miss Nightingale returned to the happiness of home, 
 the love of her parents and sister, and to the fresh, free air of Derby- 
 shire and Hampshire, in order to recruit her health. 13ut her sympa- 
 thy and energy were speedily enlisted on behalf of the Hospital for 
 Sick Governesses, established in Harley Street, London, which was 
 languishing for want of proper management and judicious support. 
 She was appealed to for aid. ^lost young and wealthy ladies in such 
 a case would have given a handsome donation to assist the institution. 
 With the heroism of pure benevolence Florence Nightingale gave — 
 herself. 
 
 She took the active and entire superintendence of the Sanatorium, 
 devoting herself with indefatigable energy to place it on a firm basis. 
 Derbyshire and Hampshire were exchanged for the narrow, dreary es- 
 tablishment in Harley Street, to which she devoted all her time and 
 fortune. " While her friends missed her at assemblies, lectures, con- 
 certs, exhibitions and all the entertainments for taste and intellect 
 with which London, in its season, abounds," says one writer, "she, 
 whose powers could have best appreciated them, was sitting beside the 
 bed, and soothing the last complaints of some poor, dying, homeless, 
 querulous governess. The homelessness might, not improbably, result 
 from that very quc-rulousness ; but this is too frequently fomented, if 
 not created, by the hard, unreflecting folly which regards fellow-crea- 
 tures intrusted with forming the minds and dispositions of its children 
 
 ii
 
 FLORENCE NIGHTINGALE. 
 
 as ingenious, disagreeable machines, needing, like the steam-engine, 
 sustenance and covering, but, like it, quite beyond or beneath all sym- 
 pathy, passions, or affections. Miss Nightuigale tiiought otherwise, 
 and found pleasure in tending those poor, destitute governesses, in 
 their infirmities, their deaths, or their recoveries. She was seldom seen 
 outside the walls of the institution, and the few friends whom she ad- 
 mitted found her in the midst of nurses, letters, prescriptions, accounts, 
 and interruptions. Her health sank under the heavy pressure, but a 
 little Hampshire fresh air restored her, and the failing institution was 
 saved. 
 
 About this time, 1854, Florence Nightingale also took an active in- 
 terest in the Ragged Training Schools, and several similar institutions. 
 She felt, with Hannah More, that "the care of the poor is the profes- 
 sion of women," and all her talents were unceasingly employed in the 
 amelioration of their miseries. 
 
 13ut while Miss Nightingale was recruiting her health and spirits in 
 her beautiful home at Embley, a cry of dire distress and bitterest agony 
 came from the East, piercing England nearly to the heart. It arose 
 from our wounded brethren, huddled together, languishing in their 
 rough beds, destitute of comforts or even necessary accommodations, 
 crushed by the cold, unfeeling, iron heel of Routine, and by the heavy, 
 murderous hand of Mismanagement. An enthusiastic desire to re- 
 spond to it instantly sprang up in the breasts of all who heard it ; and 
 suggestions were offered from all quarters by warm and willing hearts. 
 Undisciplined zeal, however, could do little towards supplying the 
 wants of those dying heroes who were uttering the mournful cry for 
 help ; and it was feared lest the ardent feelings which had been roused 
 might flag or be misdirected for lack of some systematic arrangement. 
 Wealth was poured forth to aid, and food, clothing, medicines, and 
 other necessaries were shipped in abundance ; but something more was 
 needed. A proposition, originated by Lady Maria Forester, to form a 
 band of female nurses, to be despatched to the seat of war, w^as started, 
 and found favor with the government and the majority of the public. 
 
 The idea being propounded, the chief difficulty was to carry it out ; 
 and there was a fear " lest a noble impulse should fail for the Avant of 
 a head, a hand, and a heart to direct it." But, having engaged three 
 nurses. Lady Maria Forester waited on Miss Nightingale, and entreated 
 her to take the direction and entire control of the nursing establishment 
 for our sick and wounded soldiers and sailors on the distant shores of 
 the Levant. Lady J*Iaria's request, earnestly seconded by that of the 
 Right Hon. Sidney Herbert, then secretary-at-war, induced ^liss Night- 
 ingale to yield a generous consent to undertake the management of the 
 expedition. It is, indeed, affirmed by some, that, by a strange coinci- 
 dence, the noble woman had herself written to Mr. Herbert on the 
 very same day, volunteering her services where they were so direfully 
 needed. 
 
 Immediately on her intention becoming known, horror thrilled the 
 souls of those humane and wise Gradgrinds Avho, comprehending no 
 •' facts " but those which had undoubted precedents, had lau<?hed aloud 
 when Elizabeth Fry proposed to cleanse Newgate, and had coldly 
 sneer id when Hannah More hinted at Sunday schools. But, upheld 
 by her noble and compassionate heart, and resolved to follow humbly 
 and reverentially in the footsteps of Oxe who had suffered from evil 
 tongues, Florence Nightingale calmly held on her way up the steep 
 and rocky road, nor heeded the discordant cries which would have 
 called her back. 
 
 iii
 
 FLORENCE NIGHTINGALE. 
 
 Not a tnomcnt was lost in unnecessary delay, or in preliminary 
 preparations. Miss Nightingale formed, from some hundreds who 
 offered, a band of«thirty- seven nurses — many of them, like herself, 
 volunteers from the higher ranks of life, gentle ladies, accustomed to 
 ease and luxury, but not unused to tend the suffering or the dying, 
 nor to lead lives of charity and self-denial. Twelve nuns from the 
 Convent at Norwood, under charge of their superioress, an Irish lady, 
 proffered their services, and were gladly included in the noble corps ; 
 for the holy leader of the band was no narrow-minded bigot, and did 
 not doubt but that a basin of gruel, a glass of wine, or a cup of med- 
 icine, might perhaps be administered as tenderly by a hand which 
 claspejcl a missal as by one which touched a Testament. When every 
 thing was ready, Florence Nightingale bade farewell to her fond par- 
 ents and her affectionate sister, renounced her friendships and her 
 intellectual pleasures, and quitted the comforts of her home, the quiet 
 liberty of dear old England, for a perilous journey to a land teeming 
 with danger and disease. 
 
 She and her sister-laborers, prompted by the most sincere, charit^le, 
 and religious feelings which can inspire the human heart, \id fin- 
 daunted by the length of the voyage, the strange and distant cou -itry 
 before them, the awful scenes they would encounter, or the privations 
 they Avould have to endure, started for their destination on Tuesday, 
 the 24th of October, 1854. Surely, if there was heroism in dashing 
 up the heights of Alma, seeking glory at the cannon's mouth in defi- 
 ance of death and of all mortal opposition, amid the shouts of the vic- 
 tors and the cries of the vanquished, there was heroism unparalleled 
 in calmly volunteering to minister to the fever-stricken and the dying 
 in a place reeking with deadly disease and polluted air, where '* wounds 
 almost refused to heal, and M'here the heavy smell of pestilence could 
 be perceived outside the very walls," and surrounded by sights and 
 sounds calculated to appall the stoutest hearts. 
 
 They were accompanied by Mr. and !Mrs. Bracebridge, a clergyman, 
 and a courier. On their arrival at Boulogne, the self-devoted band 
 was hailed with demonstrations of sympathy and respect by a crowd 
 which assembled to welcome them on their way, and bid them " God 
 speed." In passing through France, they were received with the utmost 
 enthusiasm ; hotel-keepers refusing payment for their accommodation, 
 servants declining the customary fees, all emulating to evince achnira- 
 tion and sympathy. One of the Paris journals, on Miss Nightmgale's 
 passing through the French metropolis, observed of her that "her toi- 
 lette was charming, and she was almost as graceful as a Parisienne." 
 On the 27th, they sailed from Marseilles, in the Vectis steamer, for 
 Constantinople. 
 
 On the oth of November, Miss Nightingale, accompanied by Mr. 
 and Mrs, Bracebridge, and her nurses, arrived at Constantinople ; and 
 the whole party was speedily established at their new quarters in the 
 Barrack Hospital at Scutari. This was a handsome building, capable 
 of holding an immense number of soldiers ; the court-yard alone being 
 sufficiently large to afford space for exercising twelve thousand men, 
 and the corridors, running the whole length of the barrack, being esti- 
 mated to comprise four miles in extent. On three sides of the building 
 were galleries, in which were ranged in double rows the beds of the 
 patients. Five rooms, which had been set apart for wounded general 
 officers, were happily vacant ; and these were assigned to Miss Night- 
 ingale and her friends.
 
 FLORENCE NIGHTINGALE. 
 
 The appearance of the delicate, tender, thoughtful nurses was hailed 
 with delight and raptures of gratitude by the objects of their sympathy 
 and devotion. One poor fellow burst into tears, and exclaimed, "I 
 can't help crying when I see them. Only think of Englishwomen 
 coming out here to nurse us ; it is so homely and comfortable ! " The 
 heavy cares and duties which awaited them were terribly increased, 
 within a few hours of their coming, by the arrival of six hundred 
 wounded, sent down after the battle of Inkerman. The over- worked 
 surgeons, "one and all," acknowledged that their services, at such a 
 juncture, were invaluable; even the most <* hard-headed old Scotch 
 "- , geons," whom some of the croakers had feared would be constantly 
 resenting raps from the scented fan of Miss Nightingale, admitted that 
 the tender nurses ♦' were not in the way except to do good." 
 
 "Miss Nightingale," says one letter, in November, "appears emi- 
 nently qualified for the noble work she has undertaken. Her labors 
 will spare the clergy many a sad sight of men sinking for want of 
 proper nursing, and because food cannot be administered often enough. 
 This is impossible, with only the hospital orderlies ; but with the 
 nurses, all who need will be supplied." But food, clothing, medicines, 
 and extra medical aid were wanting ; and the men were constantly 
 sinking through exhaustion, when, if it had been at hand, a timely 
 stir ulant administered might have saved them. 
 
 Linen, flannels, stockings, and other necessary articles of clothing, 
 were not to be obtained ; the vast freights which had hcen sent from 
 England were either rotting under the snow at Balaklava, or hidden in 
 the mud outside the custom-house at Constantmople. The strength 
 with which Miss Nightingale supported the difficulties and duties of 
 her position surpassed even the expectations of those who were best 
 acquainted with her character and the resources of her nature. Every 
 day brought some new complication of misery to be unravelled. " Each 
 day," observes a qualified witness, " had its own peculiar trial to one 
 who had taken such a load of responsibility in an untried field, and 
 with a staff of her own sex all new to it. She has frequently been 
 known to stand twenty hours, on the arrival of fresh detachments of 
 sick, apportioning quarters, distributing stores, directing the labors of 
 her corps, assisting at the most painful operations where her presence 
 might soothe or support, and spending hours over men dying of chol- 
 era or fever. Indeed, the more awful to every sense any particular 
 case might be, the more certainly might be seen her slight form bending 
 over him, administering to his ease by every means in her power, and 
 seldom quitting his side until death released him." 
 
 Yet the difficulties of Florence Nightingale's position were increased 
 tenfold by the continual struggles which she was obliged to undergo 
 with System and the prejudices of individuals. By petty, daily con- 
 tests, she was compelled to extort from the authorities a scanty allow- 
 ance of the necessary materials required by her and her band of nurses. 
 Etiquette and "service" regulations impeded her movements at every 
 step; "indolence, indifference, and hicapacity " combined to clog her 
 exertions; for "no one would take 'responsibility' upon himself, 
 even to save the lives of hundreds." Happily, the presence and able co- 
 operation of Mr. Macdonald, the distributor of " The Times Fund," 
 enabled her at length to lay in stores, to institute proper culinary and 
 washing departments, and to introduce some order and comfort. Had 
 it not been for their mutual exertions, a large proportion of the poor 
 prostrate sufferers must have been condemned to wear the tattered, 
 
 V
 
 FLORENCE NIGHTINGALE. 
 
 filtiiV rags, in -which they Avere brought down from the Crimea. A 
 washing contract had, it is true, existed ; but it -was totally inoperative, 
 and the beds and habiliments of the men had been in a condition loath- 
 some and fold beyond description. A house, well supplied with water, 
 close to the Barrack Hospital, was engaged at the charge of the fund, 
 and here the clothing supplied by Miss Nightingale was washed and 
 dried. In ten days after her arrival an impromptu kitchen was fitted 
 up, from Avhich eight hundred men were daily supplied with well- 
 cooked food and other necessary culinary comforts in abundance — 
 beef-tea, chicken-broth, rice-pudding, jelly, chickens, and numerous 
 delicacies. Heretofore the cookery, performed by soldiers, without 
 any superintendence, and of course without any system, had been most 
 detestable, when the sickly, fastidious appetite of a fevered or consump- 
 tive patient is considered. Meat and vegetables had been boiled in 
 one large copper, the separate portions enclosed in nets, and served up 
 either done to rags or half raw ; and the delivery had been as devoid 
 of system as the cookery. Sometimes it would be six or seven o'clock 
 in the evening before, in individual cases, things ordered could be sup- 
 plied, and then the means of cooking would be at an end. In subor- 
 dinate as well as in leading points of arrangement, the same feminine, 
 directing hand was now to be traced. 
 
 With rare thoughtfulness, the nurses were employed in making up 
 needful articles of bedding or surgical requisites, stump pillows for 
 amputation cases, and other things of a like nature. 
 
 One "rule of the ser\ice" was in existence which alone exemplifies 
 the system bearing so heavily upon the helpless mvalids, and which it 
 required all the tact and firmness of Miss Nightingale to stand against ; 
 it demanded that all articles needed even for present use should be 
 procured from home through the commissariat ; and there was likewise 
 a regulation appointing that a "board" must judge stores already 
 landed, before they could be given out. On one occasion, the "board" 
 not having completed its arrangements, and the men languishing for 
 the stores sent from England, Miss Nightingale insisted that they 
 should be at once dispensed. Red Tape, shocked at the audacity of 
 such a singular proposition, interposed ; woe betide the man amenable 
 to martial law who should dare to touch even the cordage of one box ! 
 The noble-spirited woman, conscious that determination must effect 
 what entreaty had failed to do, had the store-house broken open, on 
 her own responsibility, and its contents distributed through their 
 proper channels. But, on all other occasions, she paid the most scru- 
 pulous deference to the existing laws. Her name and angelic minis- 
 terings Avere the theme of frequent grateful praise among the men in 
 the trenches ; and it was remarked that she made the Barrack Hospital 
 so comfortable, that the convalescents began to display a decided re- 
 luctance to leave it. 
 
 Not only in the scene of her arduous labors, but at home, was the 
 self- dedicated Samaritan assailed by jealousies and suspicions. The 
 circumstance of her having accepted the services of some Sisters of 
 Charity from the nunnery at Norwood, and from St. Stephen's Hospi- 
 tal, Dublin, drew down upon her, in December, so invidious an attack 
 from a clergyman of the Established Church, that the Hon ]SIrs. Sidney 
 Herbert was' obliged to step forward and defend her absent friend, and 
 show " how cruel and unjust" were the aspersions thrown upon her. 
 
 "It is melancholy to think," she wrote to the wife of the Rev. gen- 
 tleman, " that in England no one can undertake any thing without the 
 
 vi
 
 FLORENCE NIGHTINGALE. 
 
 most tincharitable and sectarian attacks ; and, had you not told me, I 
 should scarcely have believed that a clergyman of the Established 
 Church would have been the mouthpiece of slander. Miss Nightingale 
 is a member of the Established Church of England, and what is called 
 rather Low Church." 
 
 The Hon. and Rev. Sydney Godolphin Osborne adds his testimony 
 to the pure religion of the object of these animadversions : " I found 
 her myself to be, in her every word and action, a Christian ; I thought 
 this quite enough. It would have been, in my opinion, the most cruel 
 impertinence to scrutinize her words and acts to discover to which of 
 the many bodies of true Christians she belonged. I have conversed 
 •with her several times on the deaths of those whom I had \'isited min- 
 isterially in the hospitals, with whom she had been when they died. I 
 never heard one word from her lips that would not have been just what 
 I should have expected from the lips of those whom I have known to 
 be the most experienced and devout of our common faith. Her work 
 ought to answer for her faith ; at least, none should dare to call that 
 faith in question, in opposition to such w^ork, on grounds so weak and 
 trivial as those I have seen urged. ... If there is blame in look- 
 ing for a Roman Catholic priest to attend a dying Romanist, let me 
 share it with her — I did it again and again." 
 
 Early in January, 1855, the executive strength at Miss Nightingale's 
 disposal was increased by the arrival of Miss Stanley, with fifty more 
 nurses, who were terribly needed, for there were then on the Bospho- 
 rus and Dardanelles no less than eight hospitals, containing an aggre- 
 gate of nearly five thousand sick and wounded, while there were eleven 
 hundred more on their way from the Crimea. In the Barrack Hospi- 
 tal alone there were about three thousand patients, all of them severe 
 cases. 
 
 But as Florence Nightingale was struggling against the disgraceful 
 jealousy of hospital officials, her heart was cheered and encouraged by 
 a glorious letter, filled with true English warmth and sjTnpathy, writ- 
 ten by Queen Victoria — "not a letter stifi" with gold thread and glit- 
 tering with gems," but womanly and queen-like, '* with nothing of the 
 ermine about it but its softness and purity." 
 
 " Would you tell Mrs. Herbert," wrote the Queen of England to 
 ^Ir. Sidney Herbert, " that I beg she would let me see frequently the 
 accounts she receives from Miss Nightingale or Mrs. Bracebridge ; as 
 I hear no details of the wounded, though I see so many from officers, 
 &c., about the battle-field, and naturally the former must interest me 
 more than any one. Let Mrs. Herbert also know that I wish ^liss 
 Nightingale and the ladies would tell these poor, noble, wounded and 
 sick men that no one takes a warmer interest, or feels more for their 
 sufferings, or admires their courage and heroism more than their Queen. 
 Day and night she thinks of her beloved troops. So does the Prince. 
 Beg Mrs. Herbert to communicate these my words to those ladies, as 
 I know that our sympathy is much valued by these noble fellows." 
 
 It is easy to imagine that this letter, so gracious, kind, and tender, 
 must have strengthened the heart of the noble Florence Nightingale in 
 her arduous work. Touching and simple, those words of sympathy, 
 " spoken right nobly as a queen, right affectionately as a mother, right 
 eloquently as a woman," are worth a thousand times the brave speech- 
 es or heroism of any of the queens of " the jewel set in a golden sea." 
 But Her Majesty has proved by many good deeds that she can feci for 
 suffering and want, and has always evinced more especially a strong 
 
 vii
 
 FLORENCE NIGHTINGALE. 
 
 interest in her wounded or disabled soldiers, visiting and cheering 
 them on many occasions. 
 
 By February, the great increase of fever was the chief point of re- 
 mark ; it raged destructively, and in less than a month it swept away 
 no fewer than seven surgeons, leaving eight more, and three of the 
 nurses, dangerously ill. Indeed, at that time there was but one medi- 
 cal attendant well enough to wait on the sick in the Barrack Hospital ; 
 and his services were required in no less than twenty-one wards. Drs. 
 Newton and Struthers were tended in their last moments, and had their 
 dying eyes closed, by Miss Nightingale. For "wherever there is dis- 
 ease in its most dangerous form," Avrote Mr. Macdonald, in February, 
 "and the hand of the despoiler distressingly nigh, there is that incom- 
 parable woman sure to be seen ; her benignant presence is an influence 
 for good comfort, even amid the struggles of expiring nature. She is 
 « a ministering angel,' without any exaggeration, in these hospitals ; 
 and, as her slender form glides quietly along each corridor, every poor 
 fellow's face softens with gratitude at the sight of her. "S\Tien all the 
 medical officers have retired for the night, and silence and darkness 
 have settled down upon those miles of prostrate sick, she may be ob- 
 served alone, with a little lamp in her hand, making her solitary 
 rounds. The popular instinct was not mistaken which, when she set 
 out from England on her mission of mercy, hailed her as a heroine ; I 
 trust that she may not earn her title to a higher, though sadder, appel- 
 lation. No one who has observed her fragile figiu-e and delicate health 
 can avoid misgivmgs lest she should fail. With the heart of a true 
 woman, and the manners of a lady, accomplished and refined beyond 
 most of her sex, she combines a surprising calmness of judgment with 
 promptitude and decision of character." 
 
 Of the sublime courage which must have supported her during these 
 solitary nocturnal rounds we may judge by the slight sketch given in 
 another place. Speaking of the frightful and sickening sounds and 
 sights in the wards and corridors, he says : " Duruag the day little of 
 this is heard ; but when all is silent, and sleep has settled down upon 
 the occupants of each ward and corridor, then rise at intervals upon 
 the ear sounds which go straight to the heart of the listener." 
 
 Merely to see her pass along was an inexpressible comfort to the 
 men. "She would speak to one," said a poor fellow, writing home, 
 " and nod and smile to a many more ; but she couldn't do it to all, 
 you know. "We lay there by hundreds ; but we could kiss her shadow 
 as it fell, and lay our heads on the pillow again, content." In her 
 rounds, to one she would administer words of consolation and hope, to 
 another teach resignation, now cheering with a smile or sjTupathizing 
 with a sigh — ministering to the necessities both of mind and body of 
 the sufferers, who, following her light, soft footsteps with their tear- 
 brimmed eyes, bent to "kiss her shadow as it fell." Such was her 
 uifluence, that when men, frenzied by their wounds and disease, had 
 worked themselves into a passionate refusal to submit to necessary op- 
 erations, a few calm sentences of hers seemed at once to allay the 
 storm ; and the men would submit willingly to the painful ordeal they 
 had to undergo. 
 
 Of Florence Nightingale's personal appearance the author of " Scu- 
 tari and its Hospitals " gives a most interesting description. "Miss 
 Nightingale," he says, " is jvist what you would expect in any other 
 well-bred woman, who may have seen, perhaps, rather more than 
 thirty years of life ; her manner and countenance are prepossessing, 
 
 viii
 
 FLORENCE NIGHTINGALE. 
 
 and this without the possession of positive beauty ; it is a face not 
 easily forgotten, — pleasing in its smile, with an eye betokening great 
 self-possession, and giving, when she wishes, a quiet look of tirm deter- 
 mination to every feature. Her general demeanor is quiet, and rather 
 reserved ; still, I am much mistaken if she is not gifted with a very 
 lively sense of the ridiculous. In conversation, she speaks on matters 
 of business with a grave earnestness I should not expect from her 
 appearance. She has evidently a mind disciplined to restrain, under 
 the principles of the action of the moment, every feeling which would 
 interfere with it. She has trained herself to command, and learned 
 the value of conciliation towards others, and constraint over herself. 
 She seems to xmderstand business thoroughly. Her nerve is won- 
 derful. I have been with her at very severe operations ; she was more 
 than equal to the trial." 
 
 In April ^Miss Nightingale lost a very dear personal friend, one of 
 the nurses, a young and amiable lady named Miss Sniythc. This lady 
 had commenced her occupation as nurse at Scutari, but, being re- 
 quested to join ]Miss Bracebridge at Kululee, — which was on the 
 Asiatic side of the Bosphorus, five miles from Scutari, — she left for 
 that place, much regretted by Miss Nightingale, who said she hoped 
 that they would have labored together in the same hospital. Shortly 
 after her arrival she was attacked by fever, and died deeply mourned. 
 
 Miss Nightingale's firm, systematic, and energetic thoughtfulness at 
 length gained its w^ay, and she had the satisfaction of seeing that the 
 most important part of her work at Scutari w^as accomplished. She 
 accordingly repaired to Balaklava, with the view of inspecting its hos- 
 pitals, arriving there May 4, 1855. There she examined the general 
 state of aff'airs, had new huts erected, kitchens built, and vigorous 
 organization instituted ; but no sooner were all these matters arranged 
 than the long- continued arduous exertions which she had undergone 
 told on her system. Her delicate and fragile fiame was attacked by 
 Crimean fever ; and, completely prostrated, she was carried up to the 
 hut-hospital on the heights. 
 
 For a fortnight the fever continued its hold ; but at the end of that 
 time Florence Nightingale rose, weak, yet pronounced out of danger, 
 from her sick bed. She was earnestly entreated to return to England ; 
 but no persuasion could induce her to quit her post, or to proceed 
 further than Scutari. Too well she knew that her presence on that 
 sad spot was still urgently needed. She left Balaklava for Scutari, 
 June 6 ; Lord Ward placing his steam yacht at her disposal, that she 
 might have the advantage of change of air in sea excursions to recruit 
 her strength. So exhausted was she that she had to be carried down 
 to the vessel, tenderly and reverently in the arms of the men, amidst 
 their heartfelt prayers for her speedy recovery. 
 
 Miss Nightingale's efforts for the poor fellows in the hospitals did 
 not terminate with their death ; for on her return to Scutari she 
 originated a scheme for erecting a monument to the brave men who 
 had died during the winter. This memorial has been only recently 
 completed, and now towers in gloomy grandeur above the surrounding 
 graves of our British heroes. It is simple and massive ; a square base, 
 surmounted by four figures of angcLs with drooping wings, who sup- 
 port a tapering shaft, which rises towards the sky. In four difi'erent 
 languages on each side of the base is this inscription : — 
 
 "This Monument was erected by Queen Victokia and iier 
 
 People." 
 
 ix
 
 FLORENCE NIGHTINGALE. 
 
 By December, 1855, the greater number of the hospitals were 
 closed ; the Barrack Hospital was again used for its original purpose ; 
 and all seemed hopeful and invigorated. Her Majesty, to mark her 
 warm appreciation of the inestimable services of Miss Nightingale, 
 presented her with a beautiful ornament, adapted to be worn as a 
 decoration of the most elegant and costly description. It was formed 
 of a St. George's Cross, in ruby-red enamel, on a white field, repre- 
 senting England ; this was encircled by a black band, typifying the 
 office of charity, on which was inscribed the legend, "Blessed are the 
 merciful." Tlie letters V. R., surmounted by a crown in diamonds, 
 were impressed upon the centre of the St. George's Cross, from which 
 emanated rays of gold. Y/ide- spreading branches of palm, in bright- 
 green enamel, tipped with gold, composed a framework for the shield, 
 their stems being banded with a ribbon of blue enamel, inscribed with, 
 the word "■Crimea." At the top three brilliant stars of diamonds 
 illustrated the idea of the light of heaven shed upon labors of mercy, 
 peace, and charity. On the back of the jewel there was an inscription 
 written by Her Majesty, recording it to be a gift in memory of services 
 rendered to her brave army by ^Nliss Nightingale. The ornament Avas 
 about three inches in depth by two and a half in width. This gift was 
 accompanied by an autograph letter full of deep feeling, and graceful, 
 queenly kindness. 
 
 The sultan also presented !Miss Nightingale with a superb bracelet, 
 set in brilliants, as "a mark of his estimation of her devotion." 
 
 At the close of 1855 it was resolved that an acceptable testimonial 
 of public gratitude should be offered to the generous Florence Night- 
 ingale ; and a " Nightingale fund " was immediately raised. But, 
 as the noble-hearted woman distinctly declined any purely personal 
 reward for her efforts, a resolution was passed at a meeting held in 
 Willis's Rooms, in December, that the fund raised should be invested 
 to establish "an institute for training, sustenance, and protection of 
 nurses and hospital attendants," to embrace the paid and the unpaid, 
 for whom a home was to be provided, and a retreat for old age. 
 Numerous meetings were held, over some of which presided a prince 
 of the blood royal, who had been a witness of Miss Nightingale's 
 labors in the East, and which were attended by men of the highest 
 and noblest reputation. One important meeting was held at the Man- 
 sion House, December 26, at which the lord mayor presided, and at 
 which the names of many of the most influential merchants, traders, 
 and manufacturers were announced as ha-\dng consented to become 
 members of a committee. A copy of the proceedings of the meeting 
 at "Willis's Rooms was sent .out to Miss Nightingale ; to this she re- 
 turned, in January, 1856, a letter most characteristic of her firm, 
 practical, and yet gracious, kindly disposition. "Exposed as I am," 
 she says, "to be misinterpreted and misunderstood, in a field of action 
 in which the work is new, complicated, and distant from many who 
 sit in judgment on it, it is, indeed, an abiding sixpport to have such 
 sympathy and such appreciation brought home to me in the midst of 
 labors and difficulties all but overpowering. I must add, however, 
 that my present work is such as I would never desert for any other, 
 so long as I see room to believe that what 1 may do here is unfinished. 
 May I, then, beg you (Mrs. Herbert) to express to the committee that 
 I accept their proposal, provided I may do so on their understanding 
 of this great uncertainty, as to when it will be possible for me to carry 
 it out." This gift of gratitude was, in very truth, but giving its recip- 
 
 X
 
 FLORENCE NIGHTINGALE. 
 
 lent more -work to execute; jet, as her friend Mr. Sidney Herbert 
 observed, " Miss Nighting-ale looks to her reward from this country in 
 having a fresh field for her labors, and means of extending the good 
 that she has already begun, A compliment cannot be paid dearer to 
 her heart than in givmg her more -work to do." 
 
 In ^larch, 1856, !Miss Nightingale sustained a slight injury from 
 the upsetting of a vehicle, in which, with some of the nurses, she was 
 proceeding up to the fi-ont of Balaklava. Her back being hurt, she 
 was obliged to remain for a short time in the Castle Hospital, which 
 had been erected during the summer of 1855, in a lonely but healthy 
 spot at the mouth of Balaklava Harbor. During the spring, despite 
 her anxieties and responsibilities, she found time to attend to different 
 minor affairs ; through her exertions, *' a considerable quantity of school 
 materials, such as maps and slates, was supplied to the schools ; " she 
 advanced on her own respond- ibility a sufficient sum from *' T/ie limes' 
 Fund " to complete the erection of the Inkerman Cafe ; she aided the 
 active senior chaplain in establishing a library and schoolroom, and 
 warmly assisted him in organizing evening lectures for the men. She 
 took a kindly interest in the private affairs of the men, and forwarded 
 their savings to their families in England, at a time when there was no 
 provision for sending home small sums ; she wrote letters for the sick ; 
 she studied the comforts of those who were convalescent ; and from 
 the dying she took charge of bequests. She had a tent constructed, to 
 protect from the glaring heat of an eastern sun the invalids who were 
 permitted to enjoy the air, and endured the mortification of a refusal, 
 from the hospital authorities, to have the tent put up. 
 
 M. Alexis Soyer, in his " Culinary Campaign," relates the follo\A-ing 
 interestmg incident : — 
 
 " Before leaving the batterj^ I begged ISIiss Nightingale, as a favor, 
 to give me her hand, which she did. I then requested her to ascend 
 the stone rampart next the w^ooden gun carriage, and lastly to sit upon 
 the centre mortar, to which requests she very gracefully and kindly 
 acceded. I then boldly exclaimed, * Gentlemen, behoW this amiable 
 lady sitting fearlessly upon that terrible instrument of war. Behold 
 the heroic daughter of England, the soldier's fiiend ! ' All present 
 shouted, ' Bravo ! bravo ! Hurrah I hurrah ! Long live the daughter 
 of England ! ' " 
 
 At length Florence Nightingale's holy work of Christian charity 
 ■was accomplished,* and she prepared to return to England. The period 
 of this event was kept a profound secret, for she ever carefully shunned 
 publicity ; and, desirous of maintaining the strictest incognito, she 
 declined the offer of a passage in a British man-of-war, and embarked 
 on board a French vessel. Passing through France by night, and 
 travellhig her own country unrecognized, she quietly arrived at Lea 
 Hurst, Derbyshire, Friday, August 15, 1856.* 
 
 In October, Her Majesty invited her to visit the royal residence at 
 Balmoral ; and, at a ball given there, she was seated wdth the royal 
 family and the court circle at one end of the hall. On this occasion, 
 it was noticed that her hair, which the severe attack of illness she had 
 suffered in the Crimea necessitated cutting off, was " quite short," but 
 a charming little cap made a very graceful head-dress. 
 
 * It is deeply interesting to Icaru that tlio apartments in the poiithern tower 
 of the IJarrack Hospital, formerly occupied by Miss iN'ighting^ale, uow remain, 
 even as regards the furniture they contain, precisely as they were during- her 
 residence there ; a touching relic, which we owe either to our late ambassador, 
 I/Pr4 Stratford, or to his successor, Sir Henry Bulwer. 
 
 xi
 
 FLORENCE NIGHTINGALE. 
 
 A subscription being raised by the ^A-orkingmen of Sheffield to erect 
 a monninent in that town to the memory of their countrymen who liad 
 falk-n in tlie Crimea, a request was made, in October, to Miss Night- 
 ingale, througli her relative Miss Shore, of Meersbrook Hall, that she 
 Avould consent to lay the foundation stone. Miss Nightingale, in re- 
 fusing, sent a check for twenty pounds towards the object proposed, 
 but said, " It is with real pain that I feel compelled to decline the priv- 
 ilege, -which they offer me, of laying the first stone ; but I believe I 
 shall best honor the cause of those brave dead by abstaining from ap- 
 pearing to court that publicity which I consider to have been my great- 
 est impediment in the work I have engaged in for their sakes — imped- 
 ing it by arousing in some minds a care for worldly distinctions." 
 
 As an instance of her large-hearted benevolence, we may cite an in- 
 cident which occurred on her return. In France there exists a chari- 
 table institution, — the " OEuvre de Notre Dame D'Orient," — under 
 the direction of I'Abbe Legendre, almoner of the hospital of Bour- 
 bonne-les-bains, a town to which large numbers of military men resort 
 annually for the benefit of the waters. A relief fund being set on foot 
 to aid infirm soldiers on their discharge from the hospital. Miss Night- 
 ingale forwarded a donation of one hundred francs, through Lady Fox 
 Strangvt'ays, widow of the general who fell at Inkerman. Accompa- 
 n}-ing this donation was a graceful letter, addressed to the Abb6. in 
 which she said, " I feel the warmest sympathy with you in the touch- 
 ing object of your work, and I ahi happy to join in it to the limited 
 extent which my own engagements allow. I received, too, from the ex- 
 cellent religious ladies who were attached to the French army in the 
 East, so many tokens of their friendship, — they gave me their assist- 
 ance with such entire self-denial, and lightened my hard task in the 
 hospital with so much devotedness, that I shall always seek any op- 
 portunity of showing my gratitude to France and to her brave chil- 
 dren, whom I have been taught by these ladies to love and respect." 
 
 A graceful and interesting incident, in connection y\-iih the Nightin- 
 gale Fund, occurred very recently. It will scarcely be forgotten 
 that Mr. and ISIadame Goldschmidt contributed more than two thou- 
 sand pounds to the fimd, being the proceeds of a grand concert given 
 at Exeter Hall for the piirpose, when the generous donors not only 
 performed gratuitously themselves, but insisted on defraying every ex- 
 pense connected Avith the concert. This munificence, showing that 
 true genius is at all times kindred and sympathetic, excited such ad- 
 miration, that several of those who took a deep interest in the success 
 of the Nightingale xindertaking resolved to present Mr. and Madam-e 
 Goldschmidt, as a testimony of their regard, a copy in marble of Dur- 
 ham's bust of Her Majesty. This desire was carried into effect at the 
 Mansion House on the 17th of last June, when the Lord Mayor, Lord 
 Monteagle, Mr. and Madame Bunsen, Mr. and Mrs. George Grote, Mr. 
 and ^Irs. S. C. Hall, Dr. Mackay, Mrs. and Miss Stanley, Mr. Brace- 
 bridge, and several other friends and subscribers, were pres nt. The 
 Lord Mayor offered the bust in the name of the subscribers, and truly- 
 remarked, in a very happy speech, that " gifted as Madame Gold- 
 schmidt u as with the divinest faculty of song, it has been and is her 
 greatest lionor that she has ever been prepared to devote a proportion 
 of the proceeds of her genius to the large purposes of charity." 
 
 One of the brightest, noblest names in the list of brave, heroic 
 women, is — 
 
 FLORENCE NIGHTINGALE, 
 xii
 
 FLORENCE NIGHTINGALE. 
 
 Florexce Nightingale will be, tlii-ough all time to come, the 
 representative nurse par excellence. In her case it is a special calling, 
 in virtue of natural capacity, moral and intellectual at once. She did 
 not set out from any chosen starting point. She did not propose to 
 earn her own salvation by a life of good works. She was not incited 
 by visions of a religious life in a favored monastic community. She 
 did not aspire to take m hand a department of human misery, in order 
 to extinguish it, and then look about to see what particular misery it 
 should be. She does not appear to have had any plans relating to 
 herself at all. Nor was she overtaken by the plague in a village ; nor 
 did she overtake a fever in a village in the course of her travels, like 
 her representative sisters of an earlier time ; nor did she do the work 
 of the occasion, and reenter ordinary life as if nothuig had happened. 
 Her case is special and singular in every way. 
 
 Her childhood and youth Avere very much like those of little girls 
 who have wealthy parents, and carefully- chosen governesses, and good 
 masters, and much travel — in short, all facilities for intellectual culti- 
 vation by study and extended intercourse with society, at home and 
 abroad. 
 
 The peculiarity in the case of herself and her nearest relatives seems 
 to be their having been reared in an atmosphere of sincerity and free- 
 dom, — of reality, in fact, — which is more difficult to obtain than 
 might be thought. There was a certain force and sincerity of character 
 in the elder members on both sides of the house which could not but 
 affect the formation of the children's characters ; and in this case there 
 was a governess also whose lofty rectitude and immaculate trutlifuhiess 
 commanded the reverence of all Avho knew her. 
 
 In childhood a domestic incident disclosed to the honest-minded 
 little girl what her liking was, and she followed the lead of her natural 
 taste. She took care of all cuts and bruises, and nursed all illness 
 within her reach ; and there is always a good deal of these things 
 within the reach of country gentry who are Avealthy and benevolent. 
 For the usual term of young-lady life, Florence Nightingale did as 
 other young ladies. She saw Italy, and looked at its monuments ; 
 she once went to Egypt and Greece with the Bracebridges ; she visited 
 in society, and went to court. But her heart was not in the apparent 
 objects of her life — not in travel for amusement, nor in art. In liter- 
 ature, books Avhich disclosed life and its miseries, and character with 
 its sufferings, burnt themselves in upon her mind, and created much 
 of her future effort. She Avas never resorted to for sentiment. Senti- 
 mentalists ncA'cr had a chance Avith her. Besides that her character 
 was too strong, and its quality too real, for any sympathy Avith shal- 
 loAvness and egotism, she had tAvo characteristics* Avhich might avcU 
 daunt the sentimentalists — her reserve, and her capacity for ridicule. 
 Ill Avould they have fared Avho had come to her for responsiA'c sympa- 
 thies about sentiment, or even real woes in Avhich no practical help 
 was proposed ; and there is perhaps nothing uttered by her, from her 
 evidence before the Sanitary Commission for the Army to her recently- 
 published " Notes on Nursing," Avhich does not disclose powers of 
 irony Avhich self- regardant persons may Avell dread. 
 
 Such force and earnestness must find or make a career. She evi- 
 dentlv believes, as all persons of genius do, that she found it, while 
 1 (1)
 
 2 FLOREXCE NIGiniNGALE, 
 
 others say she made it. Philosophy will hereafter reconcile the Uvo 
 in her case and many others. As a matter of fact, whil ^ otlier young 
 ladies were busy, and perhaps better cmployecl than usual, in. enjoyiiv^ 
 the great exhibition, she was in the Kaiserwerth Institution, on tb.e 
 Rhine, going throiigh the training for nursing, and investigating the 
 methods of organization there and elsewhere. 
 
 The strongest sensation she perhaps evei- excited among her personal 
 acquaintance was when she ttndertook to set up the Sanitarium in 
 Harley Street, and left home to superintend the establishment. Her 
 first M'ork there was chiefly financial ; and the powers of administra- 
 tion she manifested were a complete justification of what she had done 
 in leaving her father's house to become what people called the matron 
 of a charity. At first common-minded people held up hands and eyes 
 as if she had done something almost scandalous. EetAveen that day 
 and this they must have discovered that she could exalt any function, 
 and that no function could lower her. She rectified the accounts, paid 
 the debts, and brought all round ; and she always had leisure to help 
 and comfort the sick ladies in the house. At one time, I remember, 
 there was not a case in the house which was not hopeless ; but there 
 was no sign of dismay in Florence Nightingale. She completed her 
 task, showing unconsciously by it how a woman as well as a man may 
 be born to administration and command. 
 
 By a sort of treachery only too common in the visitors of celebrated 
 people, Ave have all seen the letter of ilr. Sidney Herbert, in 1854, 
 entreating Miss Nightingale to go — accompanied by her friends the 
 Bracebridges, who are familiar Avith life in the East — to Turkey, to 
 minister among the sick and Avounded of our array. How soon she 
 was ready, and how she and her band of nurses went, and Avere just 
 in time to receive the Avounded from Inkermann, no Englishman for- 
 gets. No man of any nation concerned Avill ever forget her subsequent 
 serA'ices. She had against her not only a chaos of disorder in Avhich 
 to moA-e, and a hell of misery around her to relieve, but special diffi- 
 culties in the jealousy of the medical officers, the raAvness of the nurses 
 so hastily collected, and the incompatibilities of the volunteer ladies 
 who started on the enterprise Avith her or after her. On the state of 
 the hospitals it can, I hope, never be necessary to enlarge again. We 
 all knoAv hoAv, under her superintendence, places became clean and 
 airy, and persons cleanly, clothed, fed, and aff'orded some chance of 
 recovery from maladies or Avounds. "While history abides, the image 
 of Florence Nightingale, lamp in hand, going through miles of beds, 
 night by night, noting every patient as she Avent, and ministering 
 Avherever most Avanted, will always glow in men's hearts ; and the 
 sayings of the men about her Avill be traditions for future generations 
 to enjoy. 
 
 She Avas prostrated by the Crimean f?ver at Ealaklava, and carried 
 up to the hospital on the cliff's till she began to mend. Avhen she Avas 
 taken to sea. She Avould not come home, because her Avork at Scutari 
 Avas not finished. She remained there till the end of the Avar ; by 
 Avhieh time she and her military and medical coadjutors had shoAvn 
 Avhat hospitals may be, and how low the rate of mortality of an army 
 may be reduced, even in tiuie of Avar. 
 
 She has ncA'er recoA'ered from that feA'er ; find for '^ome years she has 
 been, confined by seA^ere and increasing illness. Not the less has she 
 worked, steadily and most efficiently. She caimot fulfil her aim — 
 of trainiiig nurses in an institution of her OAvn, and thus raising up a 
 body of successors. The grateful people of England supplied the
 
 FLORENCE NIGHTLVGALE. 3 
 
 means, "without her knoAvledge or desire, which was the same thing as 
 imposing a ncAv service upon lier. She wished to decline it when she 
 found how little likely her health was to improve. Her letter to the 
 trustees of the fund mUst be fresh in all memories, and the reply of 
 the trustees, who satisfied her that the money was accumulating, and 
 the plan and Ihe public able and willing to wait. If she could not do 
 this particular work, she has done many others. Her written evidence 
 before the Sanitary Commission for the Army is a great work in itself. 
 So are various reforms urged on the military authorities by her and 
 her coadjutors, and now adopted by the war office. Reforms in the 
 Indian army are about to follow. The lives thus saved no one M'ill 
 attempt to number ; and the amount of misery and vice precluded by 
 her scientific humanity is past all estimate. 
 
 Her •• Notes on Nursing," prepared and issued in illness and pain, 
 are the crowning evidence of what she is, and can do. Hitherto we 
 have, I trust, appreciated and honored her acts ; now we are enabled 
 to perceive and appreciate her mind. It was as certain before as it 
 can ever be that she must have acquired no little science, in various 
 departments, to produce the effects she wrought ; but we see it all now. 
 We see also, much more clearly than ever, her nioral characteristics. 
 I will not describe them when they can be so much better seen in her 
 " Notes on Nursing." Any one who reads those Notes without being 
 moved in the depths of his heart M'ill not understand the writer of them 
 by any amount of description ; and those who have been so moved do 
 not need and will not tolerate it. The intense and exquisite humanity* 
 to the sick, underlying the glorious common sense about affairs, and . 
 the stern insight into the weaknesses and the perversions of the 
 healthy, troubled as they are by the sight of suffering, and sympa- 
 thizing with themselves instead of the patient, lay open a good deal 
 of the secret of this wonderful woman's life and power. We begin to 
 see how a woman, any thing but robust at any time, may have been 
 able, as well as willing, to undertake whatever was most repulsive and 
 most agonizing in the care of wounded soldiers and crowds of cholera 
 patients. We see how her minute economy and attention to the small- 
 est details are reconcilable with the magnitude of her administration, 
 and the comprehensiveness of her plans for hospital establishments, 
 and for the reduction of the national rate of mortality. As the livos 
 of the sick hang on small things, she is as earnest about the quality 
 of a cup of arrowroot, and the opening and shutting of doors, as about 
 the institution of a service between the commissariat and the regi- 
 mental, which shall insure an army against being starved when within 
 reach of food. In the mind of a true nurse nothing is too great or 
 too small to be attended to Avith all diligence ; and therefore we have 
 seen Florence Nightingale doing and insisting upon the right about 
 shirts and toAvels, spoon-mcate, and the boiling of rice, and largely 
 aiding in reducing the mortality of the army from nineteen in the 
 thousand to eight, in times of peace. 
 
 In the spirit and tone of this book we see, too, how it is that, with 
 all her fame, we have known so little of the woman herself. Where 
 it is of use to tell any piece of her own experience, she tills it ; and 
 these scraps of autobiography will be eagerly sei;^cd upon by all kinds 
 of readers ; but, except for the purpose of direct utility, she never 
 speaks of herself, more or less, or even discloses any of her opinions, 
 views, or feelings. This reserve is a great distinction in these days of 
 self-exposure, and descanting on personal experiences. It is th(; l)est 
 possible rebuke to the egotism, or the sentimentality, which has led
 
 4 FLORENCE NIGHTINGALE. 
 
 several ladies to imagine thnt they could be nurses, without having 
 tried whether they could bear the discipline. Her pure, undisguised 
 common sense, and her keen perception of all deviations from common 
 sense, may have turned back more or fewer women from the nursing 
 vocation ; but this is probably an vuimixed good ; for those Avho could 
 be thus turned back were obviously unfit to proceed. She is the rep- 
 resentative of those only who are nurses ; that is, capable of the hardest 
 and highest duties and sacrifices which women can undertake from 
 love to their race. 
 
 In the end she will have won over far more than she can have (most 
 righteously and mercifully) discouraged. Generations of women for 
 centuries to come will be the better, the more helpful, and the more 
 devoted for Florence Nightingale having lived ; and no small number 
 of each generation will try their strength on that difficult path of 
 beneficence which she has opened, and on which her image will for- 
 ever stand to show the way. Ingleby Scott. 
 
 THE JEWEL PRESENTED TO MISS NIGHTINGALE, 
 BY QUEEN VltTORIA.
 
 INDEX 
 
 PAGE 
 
 Disease a reparative process, . . 7 
 Of the sufferin<^8 of disease ; disease 
 
 not always the cause, 7 
 
 What mirsiiig ou^dit to do, .... 8 
 Nursiug^ the siek little understood, 8 
 Nurpinf,-- ouf,'-ht to assist the repara- 
 tive proccns, 8 
 
 Kursiuf^ the well little understood, 9 
 Curious deductions from an exces- 
 sive death rate, 9 
 
 First rule of nursing to keep the air 
 
 within as pure as the air without, 11 
 Why are uninhabited rooms shut 
 
 up? 11 
 
 Without chill, 12 
 
 Open windows, 13 
 
 What kind of warmth desirable, . . 13 
 Bedrooms almost universally foul, 13 
 An air-test of essential consequence, 14 
 When warmth must be most care- 
 fully looked to, 14 
 
 Cold air not ventilation, nor fresh 
 
 air a method of chill, 15 
 
 Kight air. Air from outside. Open 
 
 your windows, shut your doors, IG 
 Smoke. Airing damp things in a 
 patient's room. Effluvia from 
 
 excreta, 17 
 
 Chamber utensils without lids, . . 18 
 Don't make your sick room into a 
 
 sewer, 18 
 
 Abolish slop-pails. Fumigations. 
 Health of houses — five points es- 
 sential. Health of carriages, . . 19 
 
 Pure air. Pure water, 20 
 
 Drainage. Sinks, 21 
 
 Cleanliuess. Light, -22 
 
 Three common errors in managing 
 
 the health of houses, 22 
 
 Head in charge must see to house 
 
 hygiene, not do it herself, .... 23 
 Does God think of these things so 
 
 seriously ? 23 
 
 How does he carry out his laws ? . 24 
 How does he teach his laws .''... 24 
 
 Servants' rooms, 24 
 
 Physical degeneration in families ; 
 its causes. Don't make your sick 
 room into a ventilating shaft for 
 the whole house. lufuction. Dis- 
 eases are not individuals arranged 
 in classes, like cats and dogs, but 
 conditions growing out of one 
 
 another, 25 
 
 Why must children have measles, 
 
 &c. ? Petty management, .... 27 
 Hlustrations of the want of it, . . . 28 
 Strangers coming into sick room, . 28 
 Sick room airing the whole house, , 28 
 Uninhabited room fouling the 
 whole house. Lingering smell of 
 
 p;iiut a want of care, 28 
 
 Delivery and non-delivery of letters 
 
 and messages, 29 
 
 Partial measures such as " being al- 
 
 1* 
 
 Pl. .'V 
 
 ways in the way " yourself, in- 
 crease instead of savin"- the pa- 
 tient's anxiety, because tney must 
 be only partial. Why let your 
 patient ever be surprised.' . ... 29 
 AVhat is the cause of half the aeci- 
 
 dents which happen ? 30 
 
 Petty management better under- 
 stood in institutions than in pri- 
 vate houses. What institutions 
 are the exception ? Nursing in 
 
 regimental hospitals, 31 
 
 What it is to be " in charge," ... 32 
 Why hired nurses give so much 
 trouble. Unnecessary noise. Nev- 
 er let a patient be waked out of 
 
 his first sleep, 34 
 
 Noise which excites expectation, . 35 
 Whispered conversation in the 
 
 room, or just outside the door, 35, 36 
 Noise of female dress. Patient's 
 repulsion to nurses who rustle, . 36 
 
 Burning of the crinolines, 37 
 
 Indecency of the crinolines, .... 37 
 Hurry peculiarly hurtful to sick, . 37 
 How to visit the sick, and not hurt 
 
 them. These things not fancy, . 38 
 Interruption damaging to sick and 
 
 to well, 38, 39 
 
 Keeping a patient standing. Pa- 
 tients dread surprise. Never speak 
 to a patient in the act of moving, 39 
 Effects of over-exertion on sick, . . 40 
 Careless observation of the results 
 
 of careless visits, 40 
 
 Difference between real and fancy 
 
 patients, 41 
 
 Conciseness necessary*vith sick, . 41 
 Irresolution most painful to them, 43 
 What a patient must not have to 42 
 
 see to. Reading aloud, 42 
 
 Read aloud slowly, distinctly, and 
 
 steadily to the sick, 43 
 
 Never read aloud by fits and starts 
 to the sick. The sick would rather 
 be told a thing than have it read 
 
 to them, 43 
 
 People overhead. Music, 44 
 
 Variety a means of recovery, ... 44 
 Color and form means of recovery ; 
 this is no fancy. Flowers, ... 45 
 
 Effect of body on mind, 40 
 
 Sick suffer to excess from mental as 
 well as bodily pahi. Help the 
 sick to vary their thoughts, ... 40 
 Desperate desire in the sick to " see 
 out of window." Supply to the 
 sick the defect of manual lalwr, . 47 
 Physical effect of color. Want of at- 
 tention to hours of taking food, . 4fti 
 Life often hangs upon minutes in 
 
 taking food, 49 
 
 Patients often starved to death in 
 chronic cases. Food never to bo 
 left by the patient's side. Pa- 
 (5)
 
 INDEX. 
 
 PAGE 
 
 ticnt had better not see more 
 loud tliaii his own, 50 
 
 You cauuot be too careful as to 
 quality in sick diet, 51 
 
 Nurse must have some rule of 
 thought about her patient's diet. 
 Nurse must have some ride of 
 time about the patient's (Uet, . . 52 
 
 Keep your patient's cup dry under- 
 neath. Common errors in diet. 
 Beef tea. Eggs. 3Ieat without 
 vegetables, 53 
 
 Arrowroot. Milk, butter, cream, &g. 
 Intelligt-nt cravings of particular 
 sick for particular articles of diet, 54 
 
 Sweet things. Jelly, 55 
 
 Beef tea. Observation, not chemis- 
 try, must decide sick diet, . . . . 5G 
 
 Home-made bread. Sound obser- 
 vation has scarcely yet been 
 brought to bear on sick diet, ... 57 
 
 Tea and coffee. Cocoa, 58, 59 
 
 Bulk. Feverishness a symptom of 
 bedding. Uncleanliness of ordi- 
 nary bedding. Nurses often do 
 not think the sick room any busi- 
 ness of theirs, but only the sick, 60 
 
 Air your dirty sheets, not only your 
 clean ones, • . . 61 
 
 Iron siJring bedsteads the best. 
 Comtort and cleanliness of two 
 beds. Bed not to be too wide, . . 62 
 
 Bed not to be too high, nor in a 
 dark place, nor a four-poster with 
 curtains. Scrofula often a result 
 of disposition of bed clothes. 
 Bed sores. Heavy and impervi- 
 ous bed clothes, 63 
 
 Light essential to both health and 
 recovery, 64 
 
 Aspect, view, ami sunlight, matters 
 of lirst importance to the sick, . . 65 
 
 Without sunlight, we degenerate 
 body and mind. Almost all pa- 
 tients lie with their faces to tlie 
 light. Cleanliness of carpets and 
 furniture, 66 
 
 Dust never removed now. How a 
 room is dunted, 67 
 
 Floors. Papered, plastered, oil- 
 painted walls. Atmosphere in 
 painted and papered rooms quite 
 distinguishable. Best kind of 
 wall for a sick room. How to 
 keep your wall clean at the ex- 
 pense of your clothes, 68 
 
 Dirty air from without. Best kind 
 of wall for a house. Dirty air 
 from within. Dirty air Irom the 
 carpet. Kemedies, 69 
 
 Poisoning by the skin, 70 
 
 Ventilation and skin-cleanlinesa 
 equally essential, 71 
 
 Steaming and rubbing the skin. 
 Advising the sick, 72 
 
 Chattering hopes the bane of the 
 sick, 73 
 
 Patient does not want to talk of 
 himself. Absurd statistical com- 
 parisons made in common, coa- 
 
 PAO> 
 
 versation by the most sensible 
 people for tlie benefit of the sick. 
 Absurd consolations put forth for 
 the benefit of the sick, 74 
 
 Wonderful presumption of the ad- 
 visers of tlie sick. Advisers the 
 same now as two hundred years 
 ago. Mockery of the advice given 
 to sick, 76 
 
 Means of giving pleasure to the 
 sick, 77 
 
 Two new classes of patients pe- 
 culiar to this generation. What 
 is tlie use of the question, Is he 
 better .' 79 
 
 Leading questions useless or mis- 
 leading, 81 
 
 Means of obtaining inaccurate in- 
 formation, 82 
 
 As to food patient takes or does 
 not take, 83 
 
 As to diari-hoea. More important to 
 spare the patient thouglit than 
 physical exertion. Means of cul- 
 tivating sound and ready obser- 
 vation, 83,84 
 
 Sound and ready observation essen- 
 tial in a nurse, 85 
 
 English women have great capacity 
 of, but little practice in, close ob- 
 servation, 86 
 
 Difference of excitable and accumu- 
 lative temperaments. Supersti- 
 tion the fVuit of bad observation. 
 Physiognomy of disease little 
 shown by the face, 87 
 
 Peculiarities of patients. Nurse 
 must observe for herself increase 
 of patient's weakness ; patient 
 will not tell her. Accidents aris- 
 ing from the nurse's want of ob- 
 servation, 89 
 
 Is tlie faculty of observing on the 
 decline i Observation of general 
 conditions. Approach of death ; 
 paleness by no means an invaria- 
 ble effect, as we find in novels,. . 90 
 
 " Average rate of mortality " tells 
 us only that so many per cent, 
 will die. Observation must tell 
 us ivhich in the hundred they will 
 be who will die, 93 
 
 What observation is for. What a 
 confidential nurse should be, . . 94 
 
 Observation is for practical pur- 
 poses. Sanitary nursing as es- 
 sential in surgical as in medical 
 cases, but not to supersede surgi- 
 cal nursing, 95 
 
 Children : their greater susceptibil- 
 ity to the same things, 90 
 
 Summary. Keckless amateur phys- 
 icking by women. Keal knowl- 
 edge of the laws of health alone 
 can check this. Danger of j^hys- 
 icldng by amateur females, ... 98 
 
 What pathology teaches. What ob- 
 servation alone teaches. What 
 medicine does. What nature alone 
 does, lOQ
 
 ^WES ON NURSING 
 
 WHAT IT IS AND ^VHAT IT IS NOT. 
 
 3>«=;c 
 
 Shall we begin by taking it as a general principle — • 
 that all disease, at some period or other of its course, is 
 more or less a reparative process, not necessarily accom- 
 panied with suifering: an effort of nature to remedy a 
 process of poisoning or of decay, which has taken place 
 weeks, months, sometimes years beforehand, unnoticed, 
 the termination of the disease bfeing then, while the an- 
 tecedent process was going on, determined ? 
 
 If we accept this as a general principle, we shall be im- 
 mediately met with anecdotes and instances to prove the 
 contrary. Just so if we were to take, as a principle — all 
 the climates of the earth are meant to be made habitable 
 for man, by the efforts of man — the objection Avould be 
 immediately raised, — Will the top of Blount Blanc ever 
 be made habitable ? Our answer would be. It will be 
 many thousands of years before we have reached the bot- 
 tom of Mount Blanc in making the earth healthy. Wait 
 till we have reached the bottom before we discuss the top. 
 
 In watching diseases, both in private houses and in 
 public hospitals, the thing which strikes the experienced 
 observer most forcibly is this, that the symptoms or the 
 sufferings generally considered to be inevitable and inci- 
 dent to the disease are very often not symptoms of the 
 disease at all, but of sometliing quite different — of the 
 want of fresh air, or of hglit, or of warmth, or of quiet, or 
 of cleanliness, or of punctuality and care in the adminis- 
 tration of diet, of each or of all of these. And this quite 
 as much in private as in hospital nursing. 
 
 The reparative process Avhich Xature has instituted and 
 
 K7)
 
 8 NOTES ON NURSING. 
 
 which we call disease, has been hindered by some want of 
 knowledge or attention, in one or in all of these things, 
 and pain, suffering, or interruption of the whole process 
 sets in. 
 
 If a patient is cold, if a patient is feverish, if a patient 
 is faint, if he is sick after taking food, if he has a bed-sore, 
 it is generally the fault not of the disease, but of the 
 nursing. 
 
 I use the word nursing for want of a better. It has 
 been limited to signify httle more than the administration 
 of medicines and the application of poultices. It ought to 
 signify the proper use of fresh aii-, light, warmth, cleanli- 
 ness, quiet, and the proper selection and administration 
 of diet — all at the least expense of vital power to the 
 patient. 
 
 It has been said and wi-itten scores of times, that every 
 woman makes a good nurse. I believe, on the contrary, 
 that the very elements of nursing are all but unknown. 
 
 By this I do not mean that the nurse is always to blame. 
 Bad sanitary, bad architectural, and bad administrative 
 aiTangements often make it impossible to nurse. But the 
 art of nursing ought to include such an-angements as alone 
 make what I understand by nursing, possible. 
 
 The art of nursing, as now practised, seems to be ex- 
 pressly constituted to unmake what God had made disease 
 to be, viz., a reparative process. 
 
 To recur to the first objection. If we are asked, Is such 
 or such a disease a reparative process ? Can such an ill- 
 ness be unaccompanied with suffering? Will any care 
 prevent such a patient from suffering this or that? — I 
 humbly say, I do not know. But when you have done 
 away with all that pain and suffering, which in patients 
 are the symptoms, not of their disease, but of the absence 
 of one or all of the above-mentioned essentials to the suc- 
 cess of ISTature's reparative processes, we shall then know 
 what are the symptoms of and the sufferings inseparable 
 from the disease. 
 
 Another and the commonest exclamation which will 
 be instantly made is — Would you do nothing, then, in 
 cholera, fever, &c. ? — so deep-rooted and universal is the 
 conviction that to give medicine is to be doing something, 
 or rather every thing ; to give air, warmth, cleanliness, &c., 
 is to do nothing. The reply is, that in these and many
 
 NOTES ON NURSING. '9 
 
 other similar diseases the exact vaUie of pai-ticular reme- 
 dies and modes of treatment is by no means ascertained, 
 while there is universal experience as to the extreme im- 
 portance of careful nursing in determining the issue of the 
 disease. 
 
 11. The very elements of what constitutes good nursing 
 are as httle understood for the well as for the sick. The 
 same laws of health or of nursing, for they are in reality 
 the same, obtain among the well as among the sick. The 
 bi'eaking of them produces only a less violent consequence 
 among the former than among the latter, — and this some- 
 times, not always. 
 
 It is constantly objected, — " But how can I obtain this 
 medical knowledge ? I am not a doctor. I must leave 
 this to doctor." 
 
 O, mothers of families ! You who say this, do you 
 know that one in every seven infants in this civilized land 
 of England perishes before it is one year old ? That, in 
 London, two in every five die before they are five years 
 old ? And, in the other great cities of England, nearly 
 one out of two ? * " The Ufe duration of tender babies " 
 
 * Upon, this fact the most wonderful deductions have been strung. 
 For a long time an announcement something like the following has 
 been going the round of the papers: "More than 25,000 children 
 die every year in London under 10 years of age ; therefore we want a 
 Children's Hospital." This spring there was a prospectus issued, and 
 divers other means taken to this effect: "There is a great want of 
 sanitary knoM'ledge in women ; therefore we want a Woman's Hospi- 
 tal." Now, both the above facts are too sadly true. But what is 
 the deduction r The causes of the enormous child-mortality are per- 
 fectly well known ; they are chiefly want of cleanliness, want of ven- 
 tilation, want of whitewashing ; m one word, defective household hy- 
 giene. The remedies are just as well known ; and among them is 
 certainly not the establishment of a Child's Hospital. This may be a 
 want ; just as there may be a want of hospital room foi adults. But 
 the Registrar- General would certainly never think of giving us as a 
 cause for the high rate of child-mortality in (say) Liverpool that there 
 was not sufficient hospital room for children ; nor would he urge upon 
 us, as a remedy, to found a hospital for them. 
 
 Again, women, and the best women, are wofully deficient m sanitary 
 knowledge ; although it is to women that we must look, first and last, 
 for its application, as far as household hygiene is concerned. But who 
 would ever thmk of citing the institution of a Woman's Hospital aa 
 the way to cure this want ? 
 
 We have it, indeed, upon very high authority that there is some ft^ar 
 lest hospitals, as they have been hitherto, may not have generally 
 increased, rather than diminished, the rate of mortality — especially of 
 child-mortalitv.
 
 10 NOTES ON NURSING. 
 
 (as some Saturn, turned analytical chemist, says) "is the 
 most delicate test ^ of sanitary conditions. Is all this pre- 
 mature suffering and death necessary ? Or did Nature 
 intend mothers to be always accompanied by doctors? 
 Dr is it better to learn the piano-forte than to learn the 
 laws which subserve the preservation of offspring ? 
 
 Macaulay somewhere says, that it is extraordinaiy that, 
 whereas the laws of the motions of the heavenly liodies, 
 far removed as they are from us, are perfectly well under- 
 stood, the laws of the human mind, which are under our 
 observation all day and every day, are no better under- 
 stood than they were two thousand years ago. 
 
 But how much more extraordinary is it that, whereas 
 what we might call the coxcombries of education — e. g^ 
 the elements of astronomy — are now taught to every 
 school-girl, neither mothers of fkmihes of any class, nor 
 school-mistresses of any class, nor nurses of children, nor 
 nurses of hospitals, are taught any thing about those laws 
 which God has assigned to the relations of our bodies with 
 the world in which He has put them. In other words, the 
 laws wliich make these bodies, into which He has put our 
 minds, healthy or unhealthy organs of those minds, are all 
 but unlearnt. Xot but that these laws — the laws of life 
 — are in a certain measure understood, but not even 
 mothei-s think it worth their while to study them — to 
 study how to give their children healthy existences. They 
 call it medical or physiological knowledge, fit only for 
 doctors. 
 
 Another objection. 
 
 We are constantly told, — " But the circumstances 
 which govern our children's healths are beyond our con- 
 trol. What can we do with winds ? There is the east 
 wind. Most people can tell before they get up in the 
 morning whether the wind is in the east." 
 
 To this, one can answer with more certainty than to the 
 former objections. Who is it who knows when the wind 
 is in the east? Not the Highland drover, certainly, ex- 
 posed to the east wind, but the young lady who is worn 
 out with the want of exposure to the fresh air, to sunlight, 
 &c. Put the latter under as good sanitary circumstances 
 as the former, and she too will not know when the wind 
 is in the east.
 
 VENTILATION AND "FARMING. 11 
 
 I. VEXTILATIOX AND WARMING. 
 
 The very first canon of nursing, the first and the last 
 thing upon which a nurse's attention must be fixed, the 
 first essential to a patient, without which all the rest you 
 can do fisr him is ao nothing, with which I had almost 
 said you may leave all the rest alone, is this : To keep 
 
 THE AIR HE BREATHES AS PURE AS THE EXTEEXAL AIR, 
 
 WITHOUT CHiLLixG HIM. Yct wliat is SO little attended 
 to ? Even where it is thought of at all. the most exti-aor- 
 dinary misconceptions reign about it. ±L'\'en in admitting 
 air into the patient's room or ward, few people ever think, 
 where that air comes from. It may come from a corridor 
 into which other wards are ventilated, from a hall, always 
 unaired, always full of the fumes of gas, dinner, of various 
 kinds of mustiness ; from, an underground kitchen, sink, 
 washhouse, water-closet, or even, as I myself have had 
 sorrowful experience, from open sewei-s loaded with filth; 
 and with this the patient's room or ward is aired, as it is 
 called — poisoned, it should rather be said. Always air 
 from the air without, and that, too, through those windows 
 through which the air comes freshest. From a closed 
 court, especially if the wind do not blow that way, air may 
 come as stagnant as any from a hall or corridor. 
 
 Again, a thing I have often seen both in private houses 
 and institutions. A room remains uninhabited; the fire- 
 place is carefully fastened up with a board ; the windows 
 are never opened ; probably the shutters are kept always 
 shut ; perhaps some kind of stores are kept in the room ; 
 no breath of fresh air can by possibility enter into that 
 room, nor any ray of sun. The air is stagnant, musty, and 
 corrupt as it can by possibility be made. It is quite ripe 
 to breed small-pox, scarlet-fever, diphtheria, or any thing- 
 else you please.* 
 
 Yet the nursery, ward, or sick room adjoining will posi 
 
 * The common idea as to uninhabited rooms is, that they may safely 
 be left Avith doors, -windows, shutters, and chimney-board, all closest 
 — hermetically sealed if possible — to keep out the dust, it is said 
 and that no harm will happen if the room is but opened a short hoiix 
 before the inmates are put in. I have often been asked the question 
 for uninhabited rooms, «' But when ought the windows to be opened ? " 
 The answer is, " When ought they to be shut ? "
 
 12 NOTES ON NURSING. 
 
 tively be aired (?) by having the door opened into that 
 room. Or children will be put into that room, without 
 previous preparation, to sleep. 
 
 A short time ago a man walked into a back-kitchen in 
 Queen square, and cut the throat of a poor consumptive 
 creature, sitting by the fire. The murderer did not deny 
 the act, but simply said, "It's all right." Of course he 
 was mad. 
 
 But in om' case, the extraordinary thing is that the vic- 
 tim says, "It's all right," and that we are not mad. Yet, 
 although we " nose " the murderers, in the musty, unaired, 
 unsunned room, the scarlet fever which is behind the door, 
 or the fever and hospital gangrene which are stalking 
 among the crowded beds of a hospital ward, we say, "It's 
 all right." 
 
 With a proper supply of windows, and a proper supply 
 of fuel in open fire-places, fi-esh air is comparatively easy 
 to secure when your patient or patients are in bed. Never 
 be afraid of open windows then. People don't catch cold 
 in bed. This is a popular fallacy. With proper bed- 
 clothes and hot bottles, if necessary, you can always keep 
 a patient warm in bed, and well ventilate him at the same 
 time. 
 
 But a careless nurse, be her rank and education what it 
 may, will stop up every cranny and keep a hot-house heat 
 when her patient is in bed, — and, if he is able to get up, 
 leave him comparatively unprotected. The time when 
 people take cold (and there are many ways of taking cold, 
 besides a cold in the nose,) is when they first get up after 
 the two-fold exhaustion of dressing and of having had the 
 skin relaxed by many hours, periiaps days, in bed, and 
 thereby rendered more incapable of reaction. Then the 
 same temperature which refreshes the patient in bed may 
 destroy the patient just risen. And common sense will 
 point out, that, while purity of air is essential, a tempera- 
 ture must be secured which shall not chill the patient. 
 Otherwise the best that can be expected will be a feverish 
 reaction. 
 
 To have the air within as pure as the air without, it is 
 not necessary, as often appears to be thought, to make it 
 as cold. 
 
 In the afternoon again, without care, the patient whose 
 vitaJ Dowej's have then risen often finds the room as close
 
 VENTILATION AND WARMING. 13 
 
 and oppressive as he found it cold in the morning. Yet 
 the niii-se will be terrified, if a window is opened.* 
 
 I know an intelligent humane house surgeon who makes 
 a practice of keeping the ward windows open. The phy- 
 sicians and surgeons invariably close them while going 
 their rounds ; and the house surgeon very properly as in- 
 variably opens them whenever the doctors have turned 
 their backs. 
 
 In a little book on nursing, published a short time ago, 
 we are told, that, " with proper care it is very seldom that 
 the windows cannot be opened for a few minutes twice in 
 the day to admit fresh air from without." I should think 
 not ; nor twice in the hour either. It only shows how lit- 
 tle the subject has been considered. 
 
 Of ail methods of keeping patients warm the very worst 
 certainly is to depend for heat on the breath and bodies of 
 the sick. I have known a medical officer keep his ward 
 windows hermetically closed. Thus exposing the sick to 
 all the dangers of an infected atmosphere, because he v/as 
 afraid that, by admitting fresh air, the .temperature of the 
 ward would be too much lowered. This is a destructive 
 fallacy. 
 
 To attempt to keep a ward warm at the expense of 
 making the sick repeatedly breathe their own hot, humid, 
 putrescing atmosj^here is a certain way to delay recoveiy 
 or to destroy life. 
 
 Do you ever go into the bed-rooms of any persons of 
 any class, whether they contain one, two, or twenty peo- 
 ple, whether they hold sick or well, at night, or before the 
 windows are opened in the morning, and ever find the air 
 any thing but unwholesomely close and foul? And why 
 should it he so? And of hoAV much importance is it that 
 it should not be so? During sleep, the human body, even 
 when in health, is far more injured by the influence of foul 
 air than when awake. Why can't you keej) the air all 
 
 * It is very dosirable that the windows in a sick room should be 
 such that the patient shall, if he can move about, be able to open and 
 shut them easily himself. In fact, the sick room is very seldom kept 
 aired if this is not the case — so very few people have any perception 
 of what is a healthy atmosphere for the sick. The sick man often 
 says, '« This room where I spend 22 hours out of the 24, is fresher 
 than the other where I only spend 2. Because here I can manage tlie 
 windows myself," And it is true. 
 2
 
 14 NOTES ON NURSING, 
 
 night, then, as pure as the air without in the rooma jon 
 sleep in? But for this, you must have sufficient outlet for 
 the impure air you make yourselves to go out ; sufficient 
 inlet for the pure air from without to come in. You must 
 have open chimneys, open windows, or ventilators ; no 
 close curtains round your beds ; no shutters or curtains to 
 your windows, none of the contnvanccs by v>'hich you un- 
 dermine your own health or destroy the chances of re- 
 covery of your sick.* 
 
 A careful nurse will keep a constant watch over her 
 sick, especially weak, protracted, and collapsed cases, to 
 guard against the effects of the loss of vital heat by the 
 patient himself. In certain diseased states much less heat 
 is produced than in health ; and there is a constant ten- 
 dency to the decline and ultimate extinction of the vital 
 powers by the call made upon them to sustain the heat of 
 the body. Cases where this occurs should be watched 
 with the greatest care from hour to hour, I had almost said 
 
 * Dr. An^^s Smith's air-test, if it could be made of simpler appli- 
 cation, -would be invaluable to use in every sleeping and sick room. 
 Just as without the use of a thermometer no nurse should ever put a 
 patient into a bath, so should no nurse, or mother, or superintendent, 
 be -without the air-test in any ward, nursery, or sleeping-room. If the 
 main function of a nurse is to maintain the air within the room as 
 fresh as the air without, without lowering the temperature, then she 
 should always be provided with a thermometer which indicates the 
 temperature, with an air-test which indicates the organic matter of the 
 air. But to be used, the latter must be made as simple a little instru- 
 ment as the former, and both should be self-registering. The senses 
 of nurses and mothers become so dulled to foul air, that they are per- 
 fectly unconscious of what an atmosphere they have let their children, 
 patients, or charges, sleep in. But if the tell-tale air-test were to ex- 
 hibit in the morning, both to nurses and patients, and to the superior 
 officer going round, what the atmosphere has been diiring the night, I 
 question if any greater security could be afforded against a recurrence 
 of the misdemeanor. 
 
 And O, the crowded national school ! where so many children's 
 epidemics have their origin, what a tale its air-test would tell ! We 
 should have parents saying, and saying rightly, " I will not send 
 my child to that school, the air-test stands at ' Horrid.' " And the 
 dormitories of our great boarding schools ! Scarlet fever Avould be no 
 more ascribed to contagion, but to its right cause, the air test standing 
 at '<Foul." 
 
 We should hear no longer of "Mysterious Dispensations," and of 
 "Plague and Pestilence," being " in God's hands," when, so far as we 
 know. He has put them into oxir own. The little air-test M'ould both 
 betray the cause of these " mysterious pestilences," and call upon us to 
 remedy it.
 
 VENTILATION AND WARMING. 15 
 
 from minute to minute. The feet and legs should be ex- 
 amined by the hand from time to time, and whenever a 
 tendency to chilling is discovered, hot bottles, hot bricks, 
 or warm flannels, Avith some w^arm drink, sliould be made 
 use of until the temperature is restored. The fire should 
 be, if necessary, replenished. Patients are frequently lost 
 hi the latter stages of disease from w^ant of attention to 
 such simple precautions. The nurse may be trusting to 
 the patient's diet, or to his medicine, or to the occa- 
 sional dose of stimulant wdiich she is directed to give him, 
 while the patient is all the while sinking from want of a 
 little external warmth. Such cases happen at all times, 
 CA'on during the height of summer. This fatal cliill is most 
 apt to occur tow'ards early morning at the period of the 
 lowest temperature of the twenty-four hours, and at the 
 time when the effect of the preceding day's diets is ex- 
 hausted. 
 
 Generally speaking, you may expect that weak patients 
 w^ill sufier cold much more in the morning than in the 
 evening. The vital powers are much lower. If they are 
 feverisli at night, with buniing hands and feet, they are 
 almost sure to be chilly and shivering in the morning. 
 But nurses are very fond of heating the foot-wanner at 
 night, and of neglecting it in the morning, when they are 
 busy. I should reverse the matter. 
 
 All these things require common sense and care. Yet, 
 perhaps, in no one single thing is so little common sense 
 shown, in all ranks, as in nursing.* 
 
 The extraordinary confusion between cold and ventila- 
 tion, even in the minds of Avell educated people, illustrates 
 
 AVith private sick, I think, but certainly with hospital sick, the 
 nurse should never be satisfied as to the freshness of their atmosphere, 
 unless she can feel the air gently moving over her face, Avhen still. 
 
 But it is often observed that the nurses Avho make the greatest 
 outcry against open -windows, are those who take the least pains to 
 prevent dangerous draughts. The door of the patients' room or waid 
 mu^it sometimes stand open to allow of persons passing in and out, or 
 heavy things being carried in and out. The carefiil nurse will keep 
 the door shut while she shuts the windows, and tlien, and not before, 
 set the door open, so that a patient may not be left sitting up in bed, 
 perhaps in a profuse perspiration, directly in the draught between the 
 open door and window. Neither, of course, should a patient, while 
 being washed or in any way exposed, remain in the draught of an open 
 window or door.
 
 16 NOTES ON NURSING. 
 
 this. To make a room cold is by no means necessarily to 
 ventilate it. Nor is it at all necessary, in order to venti- 
 late a room, to chill it. Yet, if a nurse finds a room close, 
 she will let out the fire, thereby making it closer, or she 
 will open the door into a cold room, without a fire, or an 
 open window in it, by M'ay of improving the ventilation. 
 The safest atmosphere of all for a patient is a good fire 
 and an open window, excepting in extremes of tempera- 
 ture. (Yet no nurse can ever be made to understand 
 this.) To ventilate a small room without draughts of 
 course requires more care than to ventilate a large one. 
 
 Another extraordinary fallacy is the dread of night air. 
 What air can we breathe at night but night air? The 
 choice is between pure night air from without and foul 
 night air from within. Most people prefer the latter. An 
 unaccountable choice. What will they say if it is proved 
 to be true that fully one-half of all the disease we suffer 
 from is occasioned by people sleeping with their windows 
 shut? An open window most nights in the year can 
 never hurt any one. This is not to say that light is not 
 necessary for recovery. In great cities, night air is often 
 the best and purest air to be had in the twenty-four hours. 
 I could better understand in towns shutting the windows 
 during the day than during the night, for the sake of the 
 sick. The absence of smoke, the quiet, all tend to making 
 night the best time for airing the patients. One of our 
 highest medical authorities on Consumption and Climate 
 has told me that the air in London is never so good as 
 after ten o'clock at night. 
 
 Always air your room, then, from the outside air, if pos- 
 sible. Windows are made to open ; doors are made to 
 shut — a truth which seems extremely difticult of appre- 
 hension. I have seen a careful nurse airing her patient's 
 room though the door, near to which were two gaslights, 
 (each of which consumes as much air as eleven men,) a 
 kitchen, a corridor, the composition of the atmosphere in 
 which consisted of g&s, paint, foul air, never changed, full 
 of effluvia, including a current of sewer air from an ill- 
 placed sink, ascending in a continual stream by a well- 
 staircase, and discharging themselves constantly into the 
 ])atient's room. The window of the said room, if opened, 
 was all that was desirable to air it. Every room must be
 
 VENTILATION AND WARMING. 17 
 
 aired from without — every passage from without. But 
 the fewer passages there are in a hospital the better. 
 
 If we are to preserve the air within as pure as the air 
 without, it is needless to say that the chimney must not 
 smoke. Almost all smoky chimneys can be cured — from 
 the bottom, not from the top. Often it is only necessary 
 to have an inlet for air to supply the tire, which is feeding 
 itself, for want of this, from its own chimney. On the 
 other hand, almost all chimneys can be made to smoke by 
 a careless nurse, who lets the fire get low and then over- 
 whelms it with coal ; not, as we verily believe, in order to 
 spare herself trouble, (for very rare is unkindness to the 
 sick,) but from not thinking what she is about. 
 
 In laying down the principle that the first object of the 
 nurse must be to keep the air breathed by her patient as 
 pure as the air without, it must not be forgotten that 
 every thing in the room which can give off effluvia, be- 
 sides the patient, evaporates itself into his air. And it 
 follows that there ought to be nothing in the room, ex- 
 cepting him, which can give off effluvia or moisture. Out 
 of all damp towels, &c., which become dry in the room, 
 the damp, of course, goes into the patient's air. Yet this 
 " of course " seems as little thought of, as if it were an ob- 
 solete fiction. How very seldom you see a nurse who 
 acknowledges by her practice that nothing at all ought to 
 be aired in the patient's room, that nothing at all ought to 
 be cooked at the patient's fire ! Indeed the arrangements 
 often make this rule impossible to observe. 
 
 If the nurse be a very careful one, she will, when the 
 patient leaves his bed, but not his room, open the sheets 
 wide, and throw the bed-clothes back, in order to air his 
 bed. And she will spread the wet towels and flannels 
 carefully out upon a horse, in order to dry them. Now 
 either these bed-clothes and towels are not dried and aired, 
 or they dry and air themselves into the patient's air. And 
 whether the damp and effluvia do him most harm in his 
 air or in his bed, I leave to you to determine, for I cannot. 
 
 Even in health people cannot repeatedly breathe air in 
 which they live with impunity, on account of its becoming 
 charged with unwholesome matter from the lungs and 
 skin. In disease where every thing given off from the 
 body is highly noxious and dangerous, not only must there 
 be plenty of ventilation to carry ofl:* the effluvia, but every 
 2*
 
 18 NOTES ON NURSING. 
 
 thing which the patient passes must be instantly removed 
 away, as being more noxious than even the emanations 
 from tlie sick. 
 
 Of the fatal effects of the effluvia from the excreta it 
 would seem unnecessary to speak, were they not so con- 
 stantly neglected. Concealing the utensils behind the 
 vallance to the bed seems all the precaution which is 
 thought necessary for safety in private nursing. Did you 
 but think for one moment of the atmosjihere under that 
 bed, the saturation of the under side of the mattress with 
 the warm evaporations, you would be startled and fright- 
 ened too ! 
 
 The use of any chamber utensil vnthoiit a lid* should 
 be utterly abolished, whether among sick or well. You can 
 easily convince yourself of the necessity of this absolute 
 rule, by taking one with a lid, and examining the under 
 side of that lid. It will be found always covered, when- 
 ever the utensil is not empty, by condensed offensive mois- 
 ture. Where does that go, when there is no lid ? 
 
 Earthenware, or if there is any wood, highly polished 
 and varnished wood, are the only materials fit for patients' 
 
 * But never, never should the possession of this indispensable lid 
 confirm you in the abominable practice of letting the chamber utensil 
 remain in a patient's room unemptied, except once in the 24 hours, i. e., 
 when the bed is made. Yes, impossible as it may appear, I have 
 known the best and most attentive nurses guilty of this ; ay, and 
 have known, too, a patient afflicted with severe diarrhoea for ten days, 
 and the nurse (a very good one) not know of it, because the chamber 
 utensil (one with a lid) was emptied only once in 24 hours, and that 
 by the housemaid who came in and made the patient's bed every 
 evening. As well might you have a sewer under the room, or think 
 that in a water-closet the plug need be pulled up but once a day. ALso 
 take care that your lid, as well as your utensil, be always thoroughly 
 rinsed. 
 
 K a nurse declines to do these kinds of things for her patient, " be- 
 cause it is not her business," I should say that nursing was not her 
 calling. I have seen surgical " sisters," women whose hands were 
 ■worth to them two or three guineas a- week, down upon their knees 
 scouring a room or hut, because they thought it otherwise not fit for 
 their patients to go into. I am far from wishing nurses to scour. It 
 is a waste of power. But I do say that these women had the true 
 nurse-calling — the good of their sick first, and second only the con- 
 sideration what it was their "place" to do — and that women who 
 wait for the housemaid to do this, or for the charwoman to do that, 
 when their patients are suffering, have not the making of a nurse in 
 them.
 
 HEALTH OF HOUSES. 19 
 
 utensils. The very lid of the old abominable close-stool is 
 enough to breed a pestilence. It becomes saturated with 
 offensive matter, which scouring is only Avanted to bring 
 out. I prefer an earthenware lid as being always cleaner. 
 But there are various good new-fashioned arrangements. 
 
 A slop-pail should never be brouglit into a sick room. It 
 should be a rule invariable, rather more important in the 
 private house than elsewhere, that the utensil should be 
 carried directly to the water-closet, emptied there, rinsed 
 there, and brouglit back." There should always be water 
 and a cock in every water-closet for rinsing. But even if 
 there is not, you must carry water there to rinse with. I 
 have actually seen, in the private sick room, the utensils 
 emptied into the foot-pan, and put back unrinsed under the 
 bed. I can hardly say which is most abominable, wlietlier 
 to do this or to rinse the untensil i)i the sick room. In the 
 best hospitals it is now a rule that no slop-pail shall ever be 
 brought into the wards, but that the utensils shall be car- 
 ried direct to be emptied and rinsed at the proper place. 
 I would it were so in the private house. 
 
 Let no one ever depend upon fumigations, "disinfect- 
 ants," and the like, for purifying the air. The offensive 
 thing, not" its smell, must be removed. A celebrated medi- 
 cal lecturer began one day, " Fumigations, gentlemen, are 
 of essential importance. They make such an abominable 
 smell that they compel you to open the window." I wish' 
 all the disinfecting fluids invented made such an " abomina- 
 ble smell " that they forced you to admit fresh air. That 
 would be a useful invention. 
 
 HEALTH OF HOUSES.* 
 
 There 
 
 are 
 
 five 
 
 essential points 
 
 in securing 
 
 the 
 
 health of 
 
 houses : - 
 
 
 
 1. 
 
 2. 
 
 Pure air. 
 Pure water. 
 
 
 
 
 
 
 
 s! 
 
 Eflicient drainage. 
 
 
 
 
 
 
 4. 
 
 Cleanliness. 
 
 
 
 
 
 
 
 5. 
 
 Lio-ht. 
 
 
 
 
 * The health of carriages, especially close carriages, is not of suffi- 
 cient universal importance to mention here, otherwise than cursorily. 
 Children, who are always the nioit delicate test of sanitary oouditiuns,
 
 20 NOTES ON NURSING. 
 
 Without these, no house can be healthy. And it will be 
 unhealthy just in proportion as they are deficient. 
 
 1. To have pure air, your house must be so constructed as 
 that the outer atmos]:>here shall find its way with ease to 
 every corner of it. House architects hardly ever consider 
 this. The object in building a house is to obtain the largest 
 interest for the money, not to save doctors' bills to the ten- 
 ants. But, if tenants should ever become so wise as to 
 refuse to occupy unhealthy constructed houses, and if 
 Insurance Companies should ever come to understand their 
 interest so thoroughly as to pay a Sanitary Surveyor to 
 look after the houses where their clients live, speculative 
 architects would- speedily be brought to their senses. As 
 it is, they build what pays best. And there are always 
 people foolish enough to take the houses they build. And 
 if in the course of time the families die off, as is so often 
 the case, nobody ever thinks of blaming any but Provi- 
 dence * for the result. Ill-informed medical men aid in 
 sustaining the delusion, by laying the blame on " current 
 contagions." Badly constructed houses do for the healthy 
 wdiat badly constructed hospitals do for the sick. Once 
 insure that the air in a house is stagnant, and sickness is 
 certain to follow. 
 
 2. Pure water is more generally introduced into houses 
 than it used to be, thanks to the exertions of the sanitary 
 reformers. Within the last few years, a large part of Lon- 
 don was in the daily habit of using water polluted by the 
 drainage of its sewers and water-closets. This has happily 
 been remedied. But, in many j^arts of the country, well 
 
 generally cannot enter a close carriage without being sick — and very- 
 lucky for them that it is so. A close carriage, with the horse-hair 
 cushions and linings always saturated with organic matter, if to this 
 be added the windows up, is one of the most unhealthy of human 
 receptacles. The idea of taking an airing in it is something preposter- 
 ous. Dr. Angus Smith has shown that a crowded railway carriage, 
 which goes at the rate of 30 miles an hour, is as unwholesome as the 
 strong smell of a sewer, or as a back yard in one of the most un- 
 healthy courts off one of the most unhealthy streets in ^lanchester. 
 
 * God lays down certain physical laws. Upon his carrying out 
 such laws depends our responsibility (that much abused word), for 
 how could we have any I'esponsibility for actions, the results of which 
 we could not foresee — which would be the case if the carrying out of 
 His laws were not certain. Yet we seem to be continually expecting 
 that he will work a miracle — i. e., break His own laws expressly to 
 relieve us of responsibility.
 
 HEALTH OP HOUSES. 21 
 
 water of a very impure kind is used for domestic purposes. 
 And when epidemic disease shows itself, persons using 
 such water are almost sure to suffer. 
 
 3. It would be curious to ascertain by inspection, how 
 many houses in London are really well drained. JVIany 
 people Avould say, surely all or most of them. But many 
 people have no idea in what good drainage consists. 
 They think that a sewer in the street, and a pipe leading 
 to it from the house, is good drainage. All the while the 
 sewer may be nothing but a laboratory from which epi- 
 demic disease and ill health is being distilled into the house. 
 No house with any untrapped drain pipe communicating 
 immediately with a sewer, whether it be from water-closet, 
 sink, or gully-grate, can ever be healthy. An untrapped 
 sink may at any time spread fever or pyaemia among the 
 inmates of a palace. 
 
 The ordinary oblong sink is an abomination. That great 
 surface of stone, which is always left wet, is always exhaling 
 into the air. I have known whole houses and hospitals 
 smell of the sink. I have met just as strong a stream of 
 sewer air coming up the back staircase of a grand London 
 house from the sink, as I have ever met at Scutari; and I 
 have seen the rooms in that house all ventilated by the 
 open doors, and the passages all i^??ventilated by the closed 
 windows, in order that as much of the sewer air as possible 
 might be conducted into and retained in the bed-rooms. 
 It is wonderful. 
 
 Another great evil in house construction is carrying 
 drains underneath the house. Such drains are never safe. 
 All house drains should begin and end outside the walls. 
 Many people will readily admit, as a theory, the importance 
 of these things. But how few are there who can intelli- 
 gently trace disease in their households to such causes! 
 Is it not a fact, that Avlien scarlet fever, measles, or small- 
 pox appear among the children, the very first thought 
 which occurs is, " where " the children can have " caught " 
 the disease? And the parents immediately run over in 
 their minds all the families with whom they may have 
 been. They never think of looking at home for the source 
 of the mischief If a neighbor's child is seized with small- 
 pox, the first question which occurs is whether it had been 
 vacchiated. No one would undervalue vaccination ; but 
 it becomes of doubtful benefit to societv when it leads
 
 22 NOTES ON NURSING. 
 
 people to look abroad for the source of evils which exist at 
 home. 
 
 4. Without cleanliness, Avithin and without your house, 
 ventilation is comparatively useless. In certain foul dis- 
 tricts of London, poor people used to object to open their 
 windows and doors because of the foul smells that came in. 
 Rich people like to have their stables and dunghill near 
 their houses. But does it ever occur to them that with 
 many an-angements of this kind it would be safer to keep 
 tlie windows shut than open ? You cannot have the air 
 of the house pure with dung-heaps under the windows. 
 These are common all over London. And yet people are 
 surprised that their children, brought up in large " well- 
 aired" nurseries and bed-rooms suffer from children's epi- 
 demics. If they studied Nature's laws in the matter of 
 children's health, they would not be so surprised. 
 
 There are other ways of having filth inside a house 
 besides having dirt in heaps. Old papered walls of years' 
 standing, dirty carpets, uncleansed furniture, are just as 
 ready sources of impurity to the air as if there were a dung- 
 heap in the basement. People are so unaccustomed from 
 education and habits to consider how to make a home 
 healthy, that they either never think of it at all, and take 
 every disease as a matter of course, to be " resigned to " 
 when it comes " as from the hand of Providence ; " or if 
 they ever entertain the idea of preserving the health of 
 their household as a duty, they are very apt to commit all 
 kinds of " negligences and ignorances" in performing- it. 
 
 5. A dark house is always an unhealthy house, always 
 an ill-aired house, always a dirty house. Waut of light 
 stops growth, and jDromotes scrofula, rickets, &c., among 
 the children. 
 
 People lose their health in a dark house, and if they get 
 ill they cannot get well again in it. More will be said 
 about this farther on. 
 
 Three out of many "negligences and ignorances" in 
 managing the health of houses generally, I will here men- 
 tion as specimens — 1. That the female head in charge of 
 any building does not think it necessary to visit every hole 
 and corner of it every day. How can she expect those 
 who are under her to be more careful to maintain her house 
 in a healthy condition than she who is in^ charge of it ? — • 
 2. That it is not considered essential to air, to sun, and to
 
 HEALTH OP HOUSES. 23 
 
 clean rooms while uninhabited ; which is simply ignoring 
 the first elementary notion of sanitary things, and laying 
 the ground ready for all kinds of diseases. — 3. That the 
 window, and one window, is considered enough to air a 
 room. Have you never observed tliat any room without a 
 fire-place is always close ? And, if you have a fire-place, 
 would you cram it up not only with a chimney-board, but 
 perhaps with a great wisp of brown paper, in the throat of 
 the chimney — to prevent the soot from coming down, you 
 say ? If your chimney is foul, sweep it ; but don't expect 
 that you can ever air a room with only one aperture ; don't 
 suppose that to shut up a room is the way to keep it clean. 
 It is the best way to foul the room and all that is in it. 
 Don't imagine that if you, who are in charge, don't look to 
 all these things yourself, those under you will be more 
 careful than you are. It appears as if the part of a mistress 
 now is to complain of her servants, and to accept their 
 excuses — not to show them how there need be neither 
 complaints made nor excuses. 
 
 But again, to look to all these things yourself does not 
 mean to do them yourself. " I always open the windows," 
 the head in charge often says. If you do it, it is by so 
 much the better, certainly, than if it were not done at all. 
 But can you not insure that it is done when not done by 
 yourself? Can you insure that it is not undone when your 
 back is turned ? This is what being " in charge " means. 
 And a very important meaning it is, too. The former 
 only implies that just what you can do with your own 
 hands is done. The latter that what ought to be done is 
 always done. 
 
 And now, you think these things trifles, or at least exag- 
 gerated. But what you "think" or what I "think" mat- 
 ters little. Let us see what God thinks of them. God 
 always justifies His ways* While we are thinking, he has 
 been teaching. I have known cases of hospital pyaemia 
 quite as severe in handsome private houses as in any of 
 the worst hospitals, and from the same cause, viz., foul air. 
 Yet nobody learnt the lesson. Nobody learnt any thing 
 at all from it. They went on thinJdng — thinking that the 
 sufferer scratched his thumb, or that it was singular that 
 " all the servants " had " whitlows " or that something was 
 "much about this year; there is always sickness in our 
 house." This is a favorite mode of thought — leading not
 
 24 NOTES ON NURSING. 
 
 to iuqnire what is the uniform cause of these general 
 "whitlows," but to stifle all inquiry. In what sense is 
 " sickness " being " always there," a justification of its being 
 "there" at all? 
 
 I will tell you what was the cause of this hospital pyae- 
 mia being in that large private house. It was that the 
 sewer air from an ill-placed sink was carefully conducted 
 into all the rooms by sedulously opening all the doors, and 
 closing all the passage windows. It was that the slops 
 were emptied into the foot-pans! — it was that the utensils 
 were never properly rinsed; — it was that the chamber 
 crockery was rinsed with dirty water; — it was that the 
 beds were never properly shaken, aired, picked to pieces, 
 or changed. It was that the carpets and curtains were 
 always musty; — it was that the furniture was always 
 dusty ; — it was that the papered walls were saturated with 
 dirt ; — it was that the floors were never cleaned ; — it was 
 that the uninhabited rooms were never sunned, or cleaned, 
 or aired; — it was that the cupboards were always reser- 
 voirs of foul air; — it Avas that the windows were always 
 tight shut up at night ; — it was that no window was ever 
 systematically opened even in the day, or that the right 
 window was not opened. A person gasping for air might 
 open a window for himself. But the servants were not 
 taught to open the windows, to shut the doors ; or they 
 opened the windows upon a dank well between high walls, 
 not upon the airier court ; or they opened the room doors 
 into the unaired halls and passages, by way of airing the 
 rooms. IS^ow all this is not fancy, but fact. In that hand- 
 some house I have known in one summer three cases of 
 hospital pyemia, one of phlebitis, two of consumptive 
 cough; all the imtnediate j^roducts of foul air. When, in 
 temperate climates, a house is more unhealthy ui summer 
 than in winter, it is a certain sign of something wrong; 
 Yet nobody learns the lesson. Yes, God always justifies 
 His ways. He is teaching while you are not learning. This 
 poor body loses his finger, that one loses his life. And all 
 from the most easily j^reventable causes.* 
 
 * I must say a -word about servants' bed-rooms. From the way 
 they are built, but oftener from the way they are kept, and from no 
 intelligent inspection whatever being exercised over them, they are al- 
 most invariably dens of foul air, and the «' servants' health" suffers in 
 an «' unaccountable " (?) way, even in the country. For I am by no
 
 HEALTH OF HOUSES. 25 
 
 The houses of the grandmothers and great grandmoth- 
 ers of this generation, at least the country houses, with 
 front door and back door always standing open, winter 
 and summer, and a tliorou<>-h drauo-ht always • blowinor 
 through — with all the scrubbing, and cleaning, and pol- 
 ishing, and scouring which used to go on, the grandmoth- 
 ers, and still more the great grandmothers, always out of 
 doors and never with a bonnet on except to go to church, 
 these things entirely account for the fact so often seen of 
 a great grandmother, who was a tower of physical vigor, 
 descending into a grandmother perhaps a little less vigor- 
 rous but still sound as a bell and healthy to the core, into 
 a mother languid and confined to her carriage and house, 
 and lastly into a daughter sickly and confined to her bed. 
 For, remember, even with a general decrease of mortality, 
 you may often find a race thus degenerating and still oft- 
 ener a family. You may see poor little feeble washed-out 
 rags, children of a noble stock, suffering morally and physi- 
 cally, throughout their useless, degenerate lives, and yet 
 people who are going to marry and to bring more such 
 into the world, will consult nothing but their own conven- 
 ience as to where they are to live, or how they are to live. 
 
 "With regard to the health of houses where there is a 
 sick person, it often happens that the sick room is made a 
 ventilating shaft for the rest of the house. For while the 
 house is kept as close, unaired, and dirty as usual, the win- 
 dow of the sick room is kept a little open always, and the 
 door occasionally. Now, there are certain sacrifices which 
 a house with one sick person in it does make to that sick 
 person : it ties up its knocker ; it lays straw before it in 
 the street. Why can't it keep itself thoroughly clean and 
 unusually well aired, in deference to the sick person ? 
 
 We must not forget what, in ordinary language, is called 
 "Infection;"* — a thing of which peoj^le are generally so 
 
 means speaking only of London houses, where too often servants jjre 
 put to live under tlio ground and over the roof. But in a country 
 " mansion" which was really a "jnansion," (not after the fashion of 
 advertisements,) I have known three maids who slept in the same 
 room ill of scarlet fever. " Hoav catching it is," was of course the 
 remark. One look at the room, one smell of the room, was quite 
 enough. It was no longer «' unaccountable." The room Avas not a 
 small one ; it was up stairs, and it had two large windows — but 
 nearlj'' every one of the neglects enumerated above was there. 
 
 * Is it not living in a continual mistake to look upon discuses, as wq 
 
 3
 
 26 NOTES ON NURSING. 
 
 afraid that they frequently follow the very practice in re- 
 gard to it which they ought to avoid. Nothing used to 
 be considered so infectious or contagious as small-pox ; and 
 people not very long ago used to cover up patients with 
 heavy bed clothes, while they kept up large fires and shut 
 the windows. Small-pox, of course, under this regime^ is 
 very "infectious." People are somewhat wiser now in their 
 management of this disease. They have ventured to cov- 
 er the 23atients lightly and to keep the windows open ; and 
 we hear much less of the "infection" of small-pox than 
 we used to do. But do people in our days act with more 
 wisdom on the subject of "infection" in fevers — scarlet 
 fever, measles, &c. — than their forefathers did with small- 
 pox? Does not the popular idea of "infection" involve 
 that people should take greater care of themselves than of 
 the patient ? that, for instance, it is safer not to be too 
 much with the patient, not to attend too much to his wants? 
 Perhaps the best illustration of the utter absurdity of this 
 view of duty in attending on "infectious" diseases is af- 
 forded by what was very recently the practice, if it is not 
 80 even now, in some of the European lazarets — in which 
 the plague-patient used to be condemned to the horrors of 
 
 do now, as separate entities, which jymst exist, like cats and dogs ? 
 instead of looking upon them as conditions, like a dirty and a clean con- 
 dition, and just as much under our own control ; or rather as the 
 reactions of kindly nature, against the conditions in which we have 
 placed ourselves. 
 
 I was brought up, both by scientific men and ignorant women, dis- 
 tinctly to believe that small-pox, for instance, was a thing of which 
 there was once a first specimen in the world, which went on propa- 
 gating itself, in a perpetual chain of descent, just as much as that there 
 was a first dog, (or a first pair of dogs,) and that small-pox would not 
 begin itself any more than a new dog would begin without there hav- 
 ing been a parent dog. 
 
 Since then I have seen with my eyes and smelt ■vv'ith my nose small- 
 pox growing up in first specimens, either in close rooms, or in over- 
 crowded wards, where it could not by any possibility have been 
 *' caught," but must have begun. 
 
 Nay, more, I have seen diseases begin, grow up, and pass into one 
 another. Now, dogs do not pass into cats. 
 
 I have seen, for instance, with a little overcrowding, continued fever 
 grow up ; and with a little more, typhoid fever ; and with a little more, 
 typhus, and all in' the same ward or hut. 
 
 Would it not be far better, truer, and more practical, if we looked 
 upon disease in this light ? 
 
 For diseases, as all experience shows, are adjectives, not noun 
 eubstantives.
 
 PETTY MANAGEMENT. 27 
 
 filth, overcrowding, and want of ventilation, while the 
 medical attendant was ordered to examine the patient's 
 tongue through an opera-glass and to toss bini a lancet to 
 open his abscesses with! 
 
 True nursing ignores infection, except to prevent it. 
 Cleanliness and fresh air from open windows, with unre- 
 mitting attention to the patient, are the only defence a 
 true nurse either asks or needs. 
 
 Wise and humane management of the patient is the best 
 safeguard against infection. 
 
 There are not a few popular opinions, in regard to which 
 it is useful at times to ask a question or two. For exam- 
 ple, it is commonly thought that children must have what 
 are commonly called "children's epidemics," "current con- 
 tagions," &c., in other words, that they are born to have 
 measles, hooping-cough, perhaps even scarlet fever, just as 
 they are born to cut their teeth, if they live. 
 
 Now, do tell us, why must a child have measles ? 
 
 O, because, you say, we cannot keep it from infection — 
 other children have measles — and it must take them — 
 and it is safer that it should. 
 
 But why must other children have measles? And if 
 they have, why must yours have them too ? 
 
 If you believed in and observed the laws for preserving 
 the health of houses which inculcate cleanliness, ventila- 
 tion, white-washing, and other means, and which, by the 
 way, are Iciims^ as implicitly as you believe in the popular 
 opinion, for it is nothing more than an opinion, that your 
 child must have children's epidemics, don't you think that 
 upon the whole your child would be more likely to escape 
 aW'ogether? 
 
 m. PETTY MANAGEMENT. 
 
 All the results of good nursing, as detailed in these 
 notes, may be spoiled or utterly negatived by one defect, 
 viz. : in petty management, or in other words, by not 
 knowing how to manage that what you do when you are 
 there, shall be done when you are not there. The most 
 devoted friend or nurse cannot be always there. Nor is it 
 desirable that she should. And she may give up her health, 
 all her other duties, and yet, for want of a little manage- 
 ment, be not one-hah[' so efficient a^ another who is not
 
 28 NOTES ON NURSING. 
 
 one-lialf so devoted, but "wlio has this art of multiplying 
 herself — that is to say, the patient of the first will not 
 really be so well cared for, as the patient of the second. 
 
 It is as ini])ossible in a book to teach a person in charge 
 of sick how to manage^ as it is to teach her how to nurse. 
 Circumstances must vary with each different case. But it 
 is possible to press upon her to think for herself: Now 
 what does happen during my absence ? I am obliged to 
 be away on Tuesday. But fresh air, or punctuality, is not 
 less important to my patient on Tuesday than it was on 
 Monday. Or: At 10 p.m. I am never with my patient; 
 but quiet is of no less consequence to him at 10 than it 
 w^as at 5 minutes to 10. 
 
 Curious as it may seem, this very obvious consideration 
 occurs comparatively to few, or, if it does occlir, it is only 
 to cause the devoted friend or nurse to be absent fewer 
 hours or fewer minutes from her patient — not to arrange 
 so as that no minute and no hour shall be for her patient 
 without the essentials of her nursing. 
 
 A very few instances will be suflicient, not as precepts, 
 but as illustrations. 
 
 A strange washerwoman, coming late at night for the 
 " things," will burst in by mistake to the patient's sick- 
 room, after he has fallen into his first doze, giving him a 
 shocks the effects of which are irremediable, though he 
 himself laughs at the cause, and p>robably never even men- 
 tions it. The nurse who is, and is quite right to be, at her 
 supper, has not provided that the washerwoman shall not 
 lose her way and go into the wrong room. 
 
 The patient'^s room may always have the window open. 
 But the passage outside the patient's room, though pfb- 
 vided with several large windows, may never have one 
 open. Because it is not understood that the charge of the 
 sick-room extends to the charge of the passage. And thus, 
 as often happens, the nui^e makes it her business to turn 
 the patient's room into a ventilating shaft for the foul air of 
 the whole house. 
 
 An uninhabited ix)om, a nevrly-painted room,* an un- 
 
 * That f'xoellent paper, the Builder, mentions the lingering of the 
 smell of paint for a month about a house as a proof of want of ventila- 
 tion. Certainly — and, where there are ample Avindows to open, and 
 these are never opened to get rid of the smell of paint, it is a proof of 
 want of management in using the means of ventilation. Of course the 
 smell will then remaiu for months. WTiy should it go ?
 
 PETTY MANAGEMENT. 29 
 
 cleaned closet or cupboard, may often become the reser- 
 Toir of foul air for the whole house, because the person in 
 charge never thinks of arranging that these j^laces shall 
 be always aired, always cleaned; she merely oi^cns the 
 window herself " when she goes in." 
 
 An agitating letter or message may be delivered, or an 
 important letter or message not delivered ; a visitor whom 
 it was of consequence to see, may be refused, or one whom 
 it was of still more consequence to 7iot see may be admitted 
 — because the person in charge has never asked herseh 
 this question, What is done when I am not there ? * 
 
 At all events, one may safely say, a nurse cannot be 
 with the patient, open the door, eat her meals, take a mes- 
 sage, all at one and the same time. Nevertheless the per- 
 son in charge never seems to look the impossibility in the 
 face. 
 
 Add to this that the attempting this impossibihty does 
 more to increase the poor patient's hurry and nervousnesss 
 than anything else. 
 
 It is never thought that the patient remembers these 
 things if you do not. He has not only to think whether 
 the visit or letter may arrive, but whether you will be in 
 the way at the particular day and hour when it may arrive. 
 So that joiiY partial measures for "being in the way" your- 
 self, only increase the necessity for his thought. Whereas, 
 if you could but arrange that the thing should always be 
 done whether you are there or not, he need never think 
 at all about it. 
 
 For the above reasons, whatever a patient ca7i do for 
 
 * Why should you let yovir patient ever be surprised, except by 
 thieves ? I do not know. In England, people do not come down the 
 chimney, or through the window, unless they are thieves. They come 
 in by the door, and somebody must open the door to them. The 
 " somebody " charged with opening the door is one of two, three, or 
 at most four persons. AVhy cannot these, at most, four persons be 
 put in charge as to what is to be done when there is a ring at the 
 door-bell ? 
 
 The sentry at a post is changed much oftener than any servant at a 
 private house or institution can possibly be. But what should we 
 think of such an excuse as this : that the enemy had entered such a 
 post because A and not B had been on guard ? Yet I have constantly 
 heard such an excuse made in the private house or institution, and 
 accepted: viz., that such a person had been "let in" or 7iot "let in," 
 and such a parcel had been wrongly delivered or lost because A and 
 not B had opened the door ! 
 
 a*
 
 80 NOTES OK NURSING. 
 
 tiraself, it is better, i. e., less anxiety, for him to do for him- 
 self, unless the person in charge has the spirit of manage- 
 ment. 
 
 It is evidently much less exertion for a patient to ans\ver 
 a letter for himself by return of post, than to have four 
 conversations, wait five days, have six anxieties before it 
 is off his mind, before the j^erson who has to answer it has 
 done so. 
 
 Apprehension, uncertainty, waiting, expectation, fear of 
 surprise, do a patient more harm than any exertion. Re- 
 member, he is face to face with his enemy all the time, 
 internally wrestling with him, having long imaginary con- 
 versations with him. You are thinkmg of something else. 
 "Rid him of his adversary quickly," is a first rule with 
 the sick.* 
 
 For the same reasons, always tell a patient and tell him 
 beforehand when you are going out and when you will be 
 back, whether it is for a day, an hour, or ten minutes. 
 You fancy perhaps that it is better for him if he does not 
 find out your going at all, better for him if you do not 
 make yourself "of too much importance" to him; or else 
 you cannot bear to give him the pain or the anxiety of 
 the temporary separation. 
 
 No such thing. You ought to go we will suppose. Health 
 or duty requires it. Then say so to the patient openly. 
 If you go without his knowing it, and he finds it out, he 
 never will feel secure again that the things which depend 
 upon you will be done when you are away, and in nine 
 cases out of ten he will be right. If you go out without 
 telling him when you will be back, he can take no meas- 
 ures nor precautions as to the things which concern you 
 both, or which you do for him. 
 
 If you look into the reports of trials or accidents, and 
 especially of suicides, or into the medical history of fital 
 cases, it is ahnost incredible how often the whole thing 
 turns upon something which has happened because "he," 
 
 * There are man)- physical operations where cfcteris paribus the dan- 
 ger is in a direct ratio to the time the operation lasts ; and ccefcris pari' 
 bics the operator's success will be in direct ratio to his quickness. Now 
 there are many mental operations where exactly the same rule holds 
 good with the sick ; c(vteris paribus their capability of bearing such 
 operations depends directly on the quickness, xcithou't hurry ^ with wliich 
 they can be got through.
 
 PETTY MANAGEMENT. 31 
 
 or Still oftener "she," "was not tliere." But it is still more 
 incredible how often, how almost always tliis is accepted 
 as a sufficient reason, a justification ; why, the very fact of 
 the thing having happened is the proof of its not being a 
 justification. The person in charge was quite right not to 
 be "^Aere," he was called away for quite sufficient reason, or 
 he was away for a daily recurring and unavoidable cause ; 
 yet no provision was made to supply his absence. The 
 fault was not in his " being away," but in there being no 
 management to supplement his "being away." AYhen the 
 sun is under a total eclipse or during his nightly absence, 
 we light candles. But it would seem as if it did not occur 
 to us that we must also supplement the person in charge 
 of sick or of children, whether under an occasional eclipse 
 or during a regular absence. 
 
 In institutions where many lives would be lost and the 
 effect of such want of management would be terrible and 
 patent, there is less of it than in the private house.* 
 
 * So true is this that I could meution two eases of women of very 
 high position, both of whom died in the same way of the consequences 
 of a surgiciil operation. And in both cases, I was told by the highest 
 authority that the fatal result would not have happened in a London 
 hospital. 
 
 But, as far as regards the art of petty management in hospitals, all 
 the military hospitals I know must l^e excluded. Upon my own expe- 
 rience I stand, and I solemnly declare that I have seen or known of 
 fatal accidents, such as suicides in ddiriiim tremens^ bleedings to death, 
 dying patients dragged out of bed by drunken Medical Staff Corps 
 men, and many other things less patent and striking, which would not 
 have happened in London civil hospitals nursed by women. The med- 
 ical officers shoiild be absolved from all blame in these accidents. 
 How can a medical officer mount guard all day and all night over a 
 patient (say) in deHrium tremens f The fault lies in there being no 
 organized system of attendance. "Were a trustworthy man in charge 
 of each ward, or set of wards, not as ofiice clerk, but as head nurse, 
 (and head nurse the best hospital sergeant, or ward master, is not now 
 and cannot be, from default of the proper regulations,) the thing would 
 not, in all probability, have happened. But were a trustworthy %coman 
 in charge of the ward, or set of wards, the thing would not, in all cer- 
 tainty, have happened. In other words, it does not happen where a 
 trustworthy woman is really in charge. And, in these remarks, I by 
 no means refer only to exceptional times of great emergency in war 
 hospitals, but also, and quite as much, to the ordinary run of military 
 hospitals at home, in time of peace ; or to a time in war when our army 
 was actually more healthy than at home in peace, and the pressure on 
 our hospitals consequently much less. 
 
 It is often said that, in regimental hospitals, patients ought to
 
 82 NOTES ON NUKSINOf, 
 
 But In both, let wlioerer is in charge keep this simple 
 question in her head (not, how can I always do this riglit 
 thing myself, but) how can I provide for this right thing 
 to be always done? 
 
 Then, when anything wrong has actually happened in 
 consequence of her absence, which absence r>'e will sup- 
 pose to haye been quite right, let her question still be {7ioty 
 how can I provide against any more of such absences? 
 which is neither possible nor desirable, but) how can I 
 provide against anything wrong arising out of my ab- 
 sence? 
 
 How few men, or even women, understand,, either in 
 great or in little things, what it is the "being in charge" — I 
 mean know how to caiTy out a "charge." From the most 
 colossal calamities, down to the most trifling accidents, 
 results are often traced (or rather 7iot traced) to such want 
 of some one "in charge" or of his knowing how to be "in 
 charge." A short time ago the bursting of a funnel-casing 
 on board the finest and strongest ship that ever was built, 
 on her trial trip, destroyed several lives and put several 
 hundreds in jeopardy — not from any undetected flaw in 
 her new and untried works — but from a tap being closed 
 which ought not to have been closed — from wliat every 
 child knows would make its mother's tea-kettle burst. And 
 
 ♦•nurse each other," because the number of sick altogether beina:, say, 
 but thirty, and out of these one only perhaps being seriously ill, and 
 the other twenty-nine ha\-ing little the matter Avith them, and nothing 
 to do, they should be set to nurse the one ; also, that soldiers are so 
 trained to obey, that they will be the most obedient, and therefore the 
 best of nurses, add to which they are always kind to their comrades. 
 
 Now, have those who say this, considered that, in order to obey, 
 you must know how to obey, and that these soldiers certainly do not 
 know how to obey in nm-sing. I have seen these "kind " fellows (and 
 how kind they are no one knows so Avell as myself) move a comrade 
 so that, in one case at least, the man died in the act. I have seen the 
 comrades' "kindness" produce abundance of spirits, to be drunk in 
 secret. Let no one understand by this that female nurses ought to, or 
 cotdd be introduced in reghnental hospitals. It would be most unde- 
 sirable, even were it not impossible. But the head nurseship of a hos- 
 pital sergeant is the more essential, the m.ore important, the more 
 inexperienced the nurses. Undoubtedly, a London hospital "sister" 
 does sometimes set relays of patients to watch a critical case ; but, 
 undoubtedly also, always under her OAvn superintendence ; and she is 
 called to whenever there is something to be done, and she knows how 
 to do it. The patients are not left to do it of their own unassisted 
 tfcnius, however "kind" and willing they may be.
 
 PETTY MANAGEMENT. S3 
 
 this simply because no one seemed to know vrhat it is to 
 be "in cliai-ge," or ichowas in clinrge. Xav more, the jury 
 at the inquest actually altogether ignored the same, and 
 apparently considered the taj) "in charge," for they gave 
 as a A^erdict " accidental death." 
 
 This is the meaning of the word, on a large scale. On 
 a much smaller scale, it happened, a short time ago, that 
 an insane person burned herself slowly and intentionally 
 to death, while in her doctor's charge, and almost in her 
 nurse's presence. Yet neither was considered " at all to 
 blame." The very fact of the accident happening proves 
 its own case. There is nothing more to be said. Either 
 they did not know their business or they did not know 
 how to peiform it. 
 
 To be "in charge" is certainly not only to caiTy out the 
 proper measures yourself but to see that every one else 
 does so too ; to see that no one either wilfully or igno- 
 rantly thwarts or prevents such measures. It is neither to^ 
 do everything yourself nor to appoint a number of people to^ 
 each duty, but to ensure that each does that duty to which 
 he is appointed. This is the meaning which must be at- 
 tached to the word by (above all) those "in charge" of 
 sick, whether of numbers or of individuals, (and indeed I 
 think it is with individual sick that it is least understood. 
 One sick person is often waited on by four with less pre- 
 cision, and is really less cared for than ten who are waited 
 on by one ; or at least than forty who are waited on by 
 four ; and all for want of this one person " in charge.") 
 
 It is often said that there are few good servants now ; I 
 say there are few good mistresses now. As the jury seems 
 to have thought the tap was in charge of the shiji's safety, 
 so mistresses now seem to think the house is in charge of 
 itself They neither know how to give orders, nor how to 
 teach their servants to obey orders — i. e., tb obey intelh- 
 gently, which is the real meaning of all discipline. 
 
 Again, people who are in charge often seem to have a 
 pride in feeling that they will be "missed," that no one 
 can understand or carry on their arrangements, their system, 
 books, accounts, &c., but themselves. It seems to me that 
 the pride is rather in carrying on a sj'stem, in keeping 
 stores, closets, books, accounts, &c., so that any body can 
 Tuidcrstand and carry them on — so that, in case of absence 
 or illness, one can deliver everything up to others and
 
 84 NOTES ON NURSING. 
 
 know that all will go on as usual, and that one shall never 
 be missed. 
 
 Note. — It is often complained, that professional nurses, brought 
 into private families, in case of sickness, make themselves intolerable 
 by "ordering about" the other servants, under pka of not neglecting 
 the patient. Both things are true ; the patient is often neglected, and 
 the servants are often unfairly "put upon." But the fault is gen- 
 erally in the want of management of the head in charge. It is surely 
 for her to arrange both that the nurse's place is, when necessary, sup- 
 plemented, and that the patient is never neglected — things with a little 
 management quite compatible, and indeed only attainable together. It 
 is certainly not for the nurse to "order about" the servants. 
 
 IV. NOISE. 
 
 Unnecessary noise, or noise that creates an expectation 
 in the mind, is that which hurts a patient. It is rarely the 
 J.oudness of the noise, the effect upon the organ of the ear 
 Itself, which appears to affect the sick. How well a patient 
 w^ill generally bear, e. g,, the putting up of a scaffolding 
 close to the house, when he cannot bear the talking, still 
 less the whispering, especially if it be of a familiar voice, 
 outside his door. 
 
 There are certain patients, no doubt, especially where 
 there is slight concussion or other disturbance of the brain, 
 who are affected by mere noise. But intermittent noise, or 
 sudden and sharp noise, in these, as in all other cases, affects 
 far more than continuous noise — noise with jar far more 
 than noise without. Of one thing you may be certain, that 
 anything which wakes a patient suddenly out of his sleep 
 will invariably put him into a state of greater excitement, 
 do him more serious, aye, and lasting mischief, than any 
 continuous noise, however loud. ,, 
 
 Never to allow a patient to be waked, intentionally or 
 accidentally, is a siiie qua non of all good nursing. If he 
 is roused out of his first sleep, he is almost certain to have 
 no more sleep. It is a curious but quite intelligible fact 
 that, if a patient is waked after a few hours' instead of a 
 few minutes' sleep,, he is much more likely to sleep again. 
 Because pain, like irritability of brain, perpetuates and in- 
 tensifies itself If you have gained a respite of either in 
 sleep you have gained more than the mere respite. Both 
 the probability of recurrence and of the same intensity
 
 NOISE. 35 
 
 Will be dimmishecl ; whereas both will be tembly increased 
 by want of sleep. This is the reason why sleep is so all- 
 important. This is the reason why a patient waked in the 
 early part of his sleep loses not only his sleep, but his 
 power to sleep. A healthy person who allows himself to 
 sleep during the day will lose his sleep at night. But it is 
 exactly the reverse with the sick generally; the more they 
 sleep, the better will they be able to sleep. 
 
 I have often been surprised at the thoughtlessness, (re- 
 sulting in cruelty, quite unintentionally) of friends or of 
 doctors who will hold a long conversation just in the room 
 or passage adjoining to the room of the patient, who is 
 either every moment expecting them to come in, or who 
 has just seen them, and knows they are talking about him. 
 If he is an amiable patient, he will try to occupy his atten- 
 tion elsewhere and not to listen — and this makes matters 
 worse — for the strain upon his attention and the eifort he 
 makes are so great that it is well if he is not worse for 
 hours after. If it is a whispered conversation in the same 
 room, then it is absolutely cruel ; for it is impossible that 
 the patient's attention should not be involuntarily strained 
 to hear. Walking on tip-toe, doing anything in the room 
 very slowly, are injurious, for exactly the same reasons. 
 A firm, light, quick step, a steady quick hand, are the de- 
 siderata ; not the slow, lingering, shuffling foot, the timid, 
 uncertain touch. Slowness is not gentleness, though it is 
 often mistaken for such : quickness, lightness, and gentle- 
 ness are quite compatible. Again, if friends and doctors 
 did but watch, as nurses can and should watch, the features 
 sharpening, the eyes growing almost wild, of fever patients 
 who are listening for the entrance from the corridor of the 
 persons whose voices they are hearing there, these would 
 never run the risk again of creating such expectation, or 
 irritation of mind. Such unnecessary noise has undoubt- 
 edly induced or aggravated delirium in many cases. I have 
 known such-— in one case death ensued. It is but fair to 
 say that this death was attributed to fright. It was the 
 result of a long whispered conversation, within sight of 
 the patient, about an impending operation ; but any one 
 who has known the more than stoicism, the cheerful cool- 
 ness, with which the certainty of an operation will be ac- 
 cepted by any patient, capable of bearing an operation at 
 all, if it is properly communicated to him, will hesitate to
 
 86 NOTES On K1JR3ING. 
 
 believe that it was mere fear which produced, as was 
 averred, the fiital result in this instance. It was rather the 
 uncertainty, the strained expectation as to what was to be 
 decided upon. 
 
 I need hardly say that the other common cause, namely, 
 for a doctor or friend to leave the patient and communi- 
 cate his opinion on the result of his visit to the friends just 
 outside the patient's door, or in the adjoining room, after 
 the visit, but within hearing or knowledge of the jDatient 
 is, if possible, worst of all. 
 
 It is, I think, alarming, peculiarly at this time, wiien 
 the female ink-bottles are perpetually impressing upon us 
 "woman's" "particular worth and general missionariness," 
 to see that the dress of women is daily more and more un- 
 fitting them for any " mission," or usefulness at all. It is 
 equally unfitted for all poetic and all domestic purposes. 
 A man is now a more handy and far less objectionable be- 
 ing in a sick room than a woman. Compelled by her dress, 
 every woman now either shuffles or waddles — only a man 
 can cross the floor of a sick-room without shaking it ! What 
 is become of woman's light step ? — the firm, light, quick 
 step we have been asking for? 
 
 Unnecessary noise, then, is the most cruel absence of 
 care which can be inflicted either on sick or well. For, in 
 all these remarks, the sick are only mentioned as suffering 
 in a greater proportion than the well from precisely the 
 same causes. 
 
 Unnecessary (although slight) noise injures a sick per- 
 son much more than necessary noise (of a much greater 
 amount.) 
 
 All doctrines about mysterious affinities and aversions 
 will be found to resolve themselves very much, if not en- 
 tirely, into presence or absence of care in these things. 
 
 A nurse w^ho rustles (I am speaking of nurses jirofes- 
 sional and unprofessional) is the horror of a patient, though 
 perhaps he does not know why. 
 
 The fidget of silk and of crinoline, the rattling of keys, 
 the creaking of stays and of shoes, will do a patient more 
 harm than all the medicines in the world will do him 
 good. 
 
 The noiseless step of woman, the noiseless drapery of 
 woman, are mere figures of speech in this day. Her skirts 
 (and well if they do not throw down some piece of furni-
 
 NOISE. 87 
 
 ture) will at least brush against every article in the room 
 as she moves.* 
 
 Again, one nurse cannot open the door without making 
 everything rattle. Or she opens the door unnecessarily 
 often, for want of remembering all the articles that might 
 be brought in at once. 
 
 A good nurse will always make sure that no door or 
 window in her patient's room shall rattle or creak ; that 
 no blind or curtain shall, by any change of wind through 
 the open Avindow be made to flap — especially will she be 
 careful of all this before she leaves her patients for the 
 night. If you wait till your patients tell you, or remind 
 you of these things, where is the use of their having a 
 nurse ? There are more shy than exacting patients, in all 
 classes ; and many a patient passes a bad night, time after 
 time, rather than remmd his nurse every night of all the 
 things she has forgotten. 
 
 If there are blinds to your windows, always take care 
 to have them well up, when they are not being used. A 
 httle piece slipping down, and flapping with every draught, 
 will distract a patient. 
 
 All hurry or bustle is peculiarly painful to the sick. 
 And when a patient has compulsory occupations to engage 
 him, instead of having simply to amuse himself, it becomes 
 doubly injurious. The friend who remains standing and 
 fidgetting about while a patient is talking business to him, 
 or the friend who sits and proses, the one from an idea of 
 not letting the patient talk, the other from an idea of 
 amusing him, — each is equally inconsiderate. Always sit 
 down when a sick person is talking business to you, show 
 no signs of hurry, give complete attention and full consid- 
 
 * Fortunate it is if her skirts do not catch fire — and if the nurse 
 docs not give herself v\p a sacrifice together with her patient, to bo 
 burnt in her own petticoats. I wish tlie llegistrar-General would tell 
 us the exact number of deaths by burning occasioned by this absurd 
 and hideous custom. But if people will be stupid, let them take 
 measures to protect themselves from their own stupidity — measures 
 •which every chemist knows, such as putting alum into starch, which 
 prevents starched articles of dress from blazing up. 
 
 I wish, too, that people who wear crinoline could see the indecency 
 of their own dress as other people see it. A respectable elderly woman 
 stooping forward, invested in crinoline, exposes quite as much of her 
 own person to the patient lying in the room as any opera dancer does 
 on the stage. But no one will ever tell her this luipleasant tiuth. 
 
 4
 
 38 NOTES ON NURSING. 
 
 eration if your advice is wanted, and go away tlie moment 
 the subject is ended. 
 
 Always sit within the patient's view, so that when you 
 speak to him he has not painfully to turn his head round in 
 order to look at you. Every body invcluntarily looks at the 
 person speaking. If you make this act a wearisome one on 
 the part of the patient you are doing him harm. So also 
 if by continuing to stand you make him continuously raise 
 his eyes to see you. Be as motionless as possible, and 
 never gesticulate in speaking to the sick. 
 
 Never make a patient repeat a message or request, 
 especially if it be some time after. Occupied patients are 
 often accused of doing too much of their own business. 
 They are instinctively right. How often you hear the per- 
 son charged with the request of giving the message or 
 writing the letter, say half an hour afterwards to the pa- 
 tient, "Did you appoint 12 o'clock?" or, "What did you 
 say was the address ? " or ask perhaps some much more agi- 
 tating question — thus causing the patient the effort of 
 memory, or, worse still, of decision, all over again. It is 
 really less exertion to him to write his letters himself. 
 Tliis is the almost universal experience of occupied invalids. 
 
 This brings us to another caution. Never speak to an 
 invalid from behind, nor from the door, nor from any dis- 
 tance from him, nor when he is doing anything. 
 
 The official politeness of servants in these things is so 
 grateful to invalids, that many prefer, without knowing 
 why, having none but servants about them. 
 
 These things are not fancy. If we consider that, with 
 sick as with well, every thought decomposes some nerv- 
 ous matter, — that decomposition as well as re-composition 
 of nervous matter is always going on, and more quickly 
 with the sick than with the well, — that, to obtrude abrupt- 
 ly another thought upon the brain while it is in the act of 
 destroying nervous matter by thinking, is calling upon it 
 to make a new exertion, — if we consider these things, 
 which are facts, not fimcies, we shall remember that we are 
 doing positive injury by interrupting, by "startling a fanci- 
 ful " person, as it is called. Alas ! it is no fancy. 
 
 If the invalid is forced, by his avocations, to continue 
 occupations requiring much thinking, the injury is doubly 
 great. In feeding a patient sufl'ering under delirium or 
 stui^or you may suffocate him, by giving him his food sud»
 
 NOISE. 39 
 
 'denly, but if you rub Lis lips gently with a spoon and thus 
 attract his attention, he will swallow the food unconscious- 
 ly, but with perfect safety. Thus it is with the brain. If 
 you ofler it a thought, especially one requiring a decision, 
 abruptly, you do it a real not fanciful injury. Xever speak 
 to a sick person suddenly; but, at the same time, do not 
 keep his expectation on the tip-toe. 
 
 This rule, indeed, applies to the well quite as much as to 
 the sick. I have never known persons who exposed them- 
 selves for years to constant interruption who did not mud- 
 dle away their intellects by it at last. The process with 
 them may be accomplished without pain. With the sick, 
 pain gives warning of the injury. 
 
 Do not meet or overtake a patient who is moving about 
 in order to speak to him, or to give him any message or let- 
 ter. You might just as well give him a box on the ear. 
 I have seen a patient fall flat on the ground "s\'ho was stand- 
 ing when his nurse came into the room. This was an acci- 
 dent which might have happened to the most careful nurse. 
 But the other is done with intention. A patient in such a 
 state is not going to the East Indies. If you would wait 
 ten seconds, or walk ten yards further, any promenade he 
 could make would be over. You do not know the eflbrt it 
 is to a patient to remain standing for even a quarter of a 
 minute to listen to you. If I had not seen the thing done 
 by the kindest nurses and friends, I should have thought 
 this caution quite superfluous.* 
 
 Patients are often accused of being able to " do much 
 more when nobody is by." It is quite true that they can. 
 Unless nurses can be brought to attend to considerations of 
 the kind of which we have given here but a few specimens, 
 
 * It is absolutely essential that a nurse should lay this down as a 
 positive rule to herself, never to speak to any patient who is standing 
 or moving, as long as she exercises so little observation as not to know 
 when a patient cannot bear it. I am satisfied that many of the acci- 
 dents which happen from feeble patients tumbling down stairs, fainting 
 after getting up, &c., happen solely from the nurse popping out of a 
 door to speak to the patient just at that moment ; or from his fearing 
 that she will do so ; and that i£ the patient were even left to himself 
 till he can sit down, such accidents would much seldomer occur. 
 If the nurse accompanies the patient, let her not call upon him to speak. 
 It is incredible that nurses cannot picture to themselves the strain 
 upon the heart, the lungs, and the brain, Avhich the act of moving is to 
 any feeble patient.
 
 40 'NOTES ON NURSING. 
 
 a very weak patient finds it really much less exertion to do 
 tliino-s for himself than to ask for tliem. And he will, in or- 
 der to do them, (very innocently and from instinct) calculate 
 the time his nurse is likely to be absent from a fear of her 
 "coming in upon" him or speaking to him, just at the mo- 
 ment when he finds it quite as much as he can do to crawl 
 from his bed to his chair, or from one room to another, or 
 down stairs, or out of doors for a few minutes. Some ex- 
 tra call made upon his attention at that moment will quite 
 upset him. In these cases you may be sure that a patient 
 in the state we have described does not make such exer- 
 tions more than once or twice a day, and probably much 
 about the same hour every day. And it is hard, indeed, if 
 nurse and friends cannot calculate so as to let him make 
 them undisturbed. Remember, that many patients can 
 walk who cannot stand or even sit up. Standing is, of all 
 positions, the most trying to a weak patient. 
 
 Everything you do in a jDatient's room after he is "put 
 up " for the night, increases tenfold the risk of his having 
 a bad night. But, if you rouse him up after he has fallen 
 asleep, you do not risk, you secure him a bad night. 
 
 One hint I would give to all who attend or visit the sick, 
 to all who have to pronounce an opinion upon sickness or 
 its progress. Come back and look at your patient after he 
 has had an hour's animated conversation with you. It is 
 the best test of his real state we know. But never pro- 
 nounce upon him from merely seeing what he does, or how 
 he looks, during such a conversation. Learn also careful- 
 ly and exactly, if you can, how he passed the night after it. 
 
 People rarely, if ever, feint while making an exertion. 
 It is after it is over. Indeed, almost every effect of over- 
 exertion appears after, not during such exertion. It is the 
 highest folly to judge of the sick, as is so often done, when 
 you see them merely during a period of excitement. Peo- 
 ple have very often died of that which, it has been pro- 
 claimed at the time, has " done them no harm." * 
 
 * As an old experienced nurse, I do most earnestly deprecate all 
 such careless words. I have known patients delirious all night, after 
 seeing a visitor who called thern "better," thought they " only wanted 
 a little amusement," and who came again, saying,- "I hope you were 
 not the worse for my ^dsit," neither waiting for an answer, nor even 
 looking at the case. No real patient will ever say, "Yes, but I was a 
 great deal the worse." 
 
 It is not, however, either death or delirium of which, in these cases,
 
 NOISE. 41 
 
 Remember never to lean against, sit upon, or nnneces- 
 sarily shake, or even touch the bed in which a patient lies. 
 This is invariably a painful annoyance. If you shake the 
 chair on which he sits, he has a point by which to steady 
 himself, in his feet. But on a bed or sofa, he is entirely 
 at your mercy, and he feels every jar you give him all 
 through him. 
 
 In all that we have said, both here and elsewhere, let it 
 be distinctly understood that we are not speaking of hypo- 
 chondriacs. To distinguish between real and fancied dis- 
 ease forms an important branch of the education of a 
 nurse. To manage flmcy patients forms an important 
 branch of her duties. But the nursing which real and that 
 which fancied patients require is of different, or rather of 
 opposite character. And the latter will not be spoken of 
 here. Indeed, many of the symptoms which are here 
 mentioned are those which distinguish real from fancied 
 disease. 
 
 It is true that hj^iochondriacs very often do that behind 
 a nurse's back which they would not do before her flice. 
 Many such I have had as patients who scarcely ate any- 
 thing at their regular meals ; but if you concealed food for 
 them in a drawer, they would take it at night or in secret. 
 But this is from quite a difiei-ent motive. They do it from 
 the wish to conceal. Whereas the real patient will often 
 boast to his nurse or doctor, if these do not shake their 
 heads at him, of how much he has done, or eaten, or walked. 
 To return to real disease. 
 
 Conciseness and decision are, above all things, neces- 
 sary with the sick. Let your thought expressed to them 
 be concisely and decidedly expressed. What doubt and 
 hesitation there may be in your own mind must never be 
 communicated to theirs, not even (I would rather say es- 
 pecially not) in little things. Let your doubt be to your- 
 self, your decision to them. People who think outside 
 their heads, the whole process of whose thought appears, 
 like Homer's, in the act of secretion, who tell everything 
 
 there is most danger to the patient. ITnperceived consequences are 
 far more likely to ensue. You will have impunity — the poor patient 
 will not. That is, the patient will suffer, although neither he nor the 
 inflictor of the injury will attribute it to its real cause. It will not be 
 directly traceable, except by a very careful, observant nurse. The pa- 
 tient will often not even mention what has done him most harm. 
 4*
 
 42 NOTES ON NURSING. 
 
 that led them toward^ this conchision and away from that, 
 ouoht never to be with the siek. 
 
 Irresohition is what all patients most dread. Rather 
 than meet this in others, they will collect all their data, 
 and make up their minds for themselves. A change of 
 mind in others, whether it is regarding an operation, or 
 re-writing a letter, always injures the patient more than 
 the being called upon to make up his mind to the most 
 dreaded or difficult decision. Farther than this, in very 
 many cases, the imagination in disease is far more active 
 and vivid than it is in health. If you propose to the pa- 
 tient change of air to one place one hour, and to another 
 the next, he has, in each case, immediately constituted 
 himself in imagination the tenant of the place, gone over 
 the whole premises in idea, and you have tired him as 
 much by displacing his imagination, as if you had actually 
 carried him over both places. 
 
 Above all, leave the sick room quickly and come into it 
 quickly, not suddenly, not with a rush. But don't let the 
 patient be wearily waiting for when you will be out of the 
 room or when you will be in it. Conciseness and decision 
 in your movements, as well as your words, are necessary 
 in the sick room, as necessary as absence of hurry and 
 bustle. To possess yourself entirely will ensure you from 
 eitlier failing — either loitering or hurrying. 
 
 If a patient has to see, not only to his own but also to 
 his nurse's punctuality, or perseverance, or readiness, or 
 calmness, to any or all of these things, he is far better 
 without that nurse than with her — however valuable and 
 handy her services may otherwise be to him, and however 
 incapable he may be of rendering them to himself 
 
 With regard to reading aloud in the sick room, my 
 experience is, that when the sick are too ill to read to 
 themselves, they can seldom bear to be read to. Children, 
 eye-patients, and uneducated persons are exceptions, or 
 where there is any mechanical difficulty in reading. People 
 who like to be read to, have generally not much the mat- 
 ter with them ; while in fevers, or where there is much 
 irritability of brain, the effort of listening to reading aloud 
 has often brought on delirium. I speak with great diffi- 
 dence ; because there is an almost universal impression 
 that it is sparing the sick to read aloud to them. But 
 two thin«'s are certain: —
 
 NOISE. 43 
 
 (1.) If tliere is some matter wliich must be read to a 
 sick person, do it slowly. People often think that the way 
 to get it over with least fati.Gjue to him is to get it over in 
 least time. They gabble ; they plunge and gallop through 
 the reading. There never was a greater mistake. Hou- 
 din, the conjuror, says that the way to make a story seem 
 short is to tell it slowly. So it is with reading to the sick, 
 I have often heard a patient say to such a mistaken reader, 
 "Don't read it to me; tell it me."* Unconsciously he is 
 aware that this will regulate the plunging, the reading 
 with unequal paces, slurring over one part, instead of leav- 
 ing it out altogether, if it is unimportant, and mumbling 
 an'other. If the reader lets his own attention wander, and 
 then stops to read up to himself, or finds he has read the 
 wrong bit, then it is all over with the poor j^atient's chance 
 of not suffering. Very few people know how to read to 
 the sick ; very few read aloud as pleasantly even as they 
 speak. In reading they sing, they hesitate, they stammer, 
 they hurry, they mumble ; when in speaking they do none 
 of these things. Reading aloud to the sick ought always 
 to be rather slow, and exceedingly distinct, but not mouth- 
 ing — rather monotonous, but not sing song — rather loud, 
 but not noisy — and, above all, not too long. Be very 
 sure of what your patient can bear. 
 
 (2.) The extraordinary habit of reading to oneself in a 
 sick room, and reading aloud to the patient any bits which 
 will amuse him or more often the reader, is unaccountably 
 thoughtless. What do you think the patient is thinking 
 of during your gaps pf non-reading ? Do you think that 
 he amuses himself upon what you have read for precisely 
 the time it pleases you to go on reading to yourself^ and 
 that his attention is ready for something else at precisely 
 the time it pleases you to begin reading again ? Whether 
 the person thus read to be sick or well, whether he be 
 doing nothing or doing something else while being thus 
 read to, the self-absorption and want of observation of the 
 person who does it, is equally difficult to understand — ■ 
 although very often the readet^ is too amiable to say how 
 much it hurts him. 
 
 * Sick children, if not too shy to speak, will always express this 
 wish. They invariably prefer a story to be told to them rather than 
 read to them.
 
 44 NOTES ON NURSING. 
 
 One thing more: — From the flimsy manner in which 
 most modern houses are built, where every step on the 
 stairs, and along the floors, is felt all over the house ; the 
 higher the story, the greater the vibration. It is incon- 
 ceivable how much the sick suflTer by having anybody 
 overhead. In the solidly built old houses, which fortu- 
 nately, most hospitals are, the noise and shaking is com- 
 paratively trifling. But it is a serious cause of suftering, 
 in lightly built houses, and with the irritability pecuhar to 
 some diseases. Better for put such patients at the top of 
 the house, even with the additional fatigue of stairs, if you 
 cannot secure the room above them being untenanted; 
 you may otherwise bring on a state of restlessness which 
 no opium will subdue. Do not neglect the warning, when 
 a patient tells you that he "feels every step above him 
 to cross his heart." Remember that every noise a patient 
 cannot see partakes of the character of suddenness to him ; 
 and I am persuaded that patients with these peculiarly 
 irritable nerves, are positively less injured by having per- 
 sons in the same room with them than overhead, or sep- 
 arated by only a thin compartment. Any sacrifice to 
 secure silence for these cases is worth while, because no 
 air, however good, no attendance, however careful, will do 
 anything for such cases without quiet. 
 
 Note. — The effect of music upon the sick has been scarcely at all 
 noticed. In fact, its expensiveness, as it is now, makes any general 
 application of it quite out of the question. I will only remark here, 
 that wind instrimaents, including the human voice, and stringed instru- 
 ments capable of continuous sound, have generally a beneficent effect ; 
 Avhile the piano-forte, with such instruments as have no continuity of 
 sound, has just the reverse. The finest piano-forte playing will dam- 
 age the sick, while an air, like "Home, sweet home," or " Assisa a 
 pie d'un salice," on the most ordinary grindmg organ, will sensibly 
 soothe them — and this quite independent of association. 
 
 Y. VARIETY. 
 
 To any but an old nurse, or an old patient, the degree 
 would be quite inconceivable to which the nerves of the 
 sick suffer from seeing the same walls, the same ceiling, 
 the same surroundings during a long confinement to cne 
 or two rooms.
 
 VARIETY. 45 
 
 The superior cheerfulness of persons suffering severe 
 paroxysms of pain over that of persons suffering from ner- 
 vous debiUty has often been remarked upon, and attrib- 
 uted to the enjoyment of the former of their intervals of 
 resj^ite. I incline to think that the majority of cheerful 
 cases is to be found among those patients who are not con- 
 fined to one room, whatever their suffering, and that tlie 
 majority of depressed cases will be seen among those sub- 
 jected to a long monotony of objects about them. 
 
 The nervous frame really suffers as much from this as 
 the digestive organs from long monotony of diet, as, e, g.^ 
 the soldier from his twenty-one years' " boiled beef." 
 
 The effect in sickness of beautiful objects, of variety of 
 objects, and especially of brilliancy of color, is hardly at 
 all appreciated. 
 
 Such cravings are usually called the "fancies" of pa- 
 tients. And often doubtless patients have "fancies," as, 
 e. g.^ when they desire two contradictions. But much more 
 often, their (so called) "fancies" are the most valuable 
 indications of what is necessary for their recovery. And 
 it would be well if nurses would watch these (so called) 
 "fancies" closely. 
 
 I have seen, in fevers, (and felt, when I was a fever 
 patient myself,) the most acute suffering produced from 
 the patient (in a hut) not being able to see out of window, 
 and the knots in the wood being the only view. I shall 
 never forget the rapture of fever patients over a bunch of 
 bright-colored flowers. I remember (in my own case) 
 a nosegay of wild flowers being sent me, and from that 
 moment recovery becoming more rapid. 
 
 People say the effect is only on the mind. It is no such 
 thing. The effect is on the body, too. Little as we know 
 about the way in which we are affected by form, by color, 
 and light, we do know this, that they have an actual 
 })hysical effect. 
 
 Variety of form and brilliancy of color in the objects 
 presented to patients are actual means of recovery. 
 
 But it must be sloio variety, e. g.^ if you show a patient 
 ten or twelve engravings successively, ten-to-one that he 
 does not become cold and faint, or feverish, or even sick ; 
 but hang one up opposite to him, on each successive day, 
 or week, or month, and he will revel in the variety. 
 
 The folly and ignorance which reign too often supreme
 
 46 NOTES ON NURSING. 
 
 over the sick-room, cannot be better exemplified than by 
 uhis. While the nurse will leave the patient stewing in a 
 corrupting atmosphere, the. best ingredient of which is car- 
 bonic acid, she will deny him, on the plea of unhealthiness, 
 a glass of cut-flowers, or a gi'owing plant. Now, no one 
 ever saw "overcrowding" by plants in a room or ward. 
 And the carbonic acid they give off at nights would not 
 poison a fly. Nay, in overcrowded rooms, they actually 
 absorb carbonic acid and give off oxygen. Cut-flowers 
 also decompose water and produce oxygen gas. It is true 
 there are certam flowei-s, e. g.^ the lilies, the smell of which 
 is said to depress the nervous system. These are easily 
 known by the smell, and can be avoided. 
 
 Volumes are now written and spoken upon the effect of 
 the mind upon the body. Much of it is true. But I wish 
 a httle more was thought of the effect of the body on the 
 mind. You who believe yourselves overwhelmed with 
 anxieties, but are able every day to walk up Regent Street, 
 or out in the country, to take your meals with others in 
 other rooms, &c., &c., you little know how much your anx- 
 ieties are thereby lightened ; you little know how inten- 
 sified they become to those who can have no change ; * 
 how the very walls of their sick rooms seem hung with 
 their cares ; how the ghosts of their troubles haunt their 
 beds ; how impossible it is for them to escape from a pur- 
 suing thought without some help from variety. 
 
 A patient can just as much move liis leg when it is frac- 
 tured as change his thoughts when no external help from 
 variety is given him. This is, indeed, one of the main suf- 
 ferings of Sickness; just as the fixed posture is one of the 
 main sufferings of the broken limb. 
 
 It is an ever recurring wonder to see educated people, 
 
 * It is a matter of painful wonder to the sick themselves, how much 
 painful ideas predominate over pleasurable ones in their impressions. 
 They reason with themselves ; they think themselves ungrateful. It 
 is all of no use. The fact is, that these painful impressions are for 
 better dismissed by a real laugh, if you can excite one by books or 
 conversation, than by any direct reasoning ; or if the patient is too weak 
 to laugh, some impression from nature is what he wants. I have 
 mentioned the cruelty of letting him stare at a dead wall. In many dis- 
 eases, especially in convalescence from fever, that wall will appear to 
 make all sorts of faces at him ; now flowers never 'do this. Form, 
 color, wQl free your patient from his painful ideas better than any 
 argument.
 
 VARIETY. 47 
 
 who call themselves nurses, acting thus. They vary their 
 own objects, their own employments, many times a day; 
 and while nursing (!) some bed-ridden sufferer, they let him 
 lie there staring at a dead wall, without any change of ob- 
 ject to enable him to vary his thoughts ; and it never even 
 occurs to them, at least to move his bed so that he can 
 look out of window. No, the bed is to be always left in 
 the darkest, dullest, remotest part of the room.* 
 
 I think it is a very common error among the well to 
 think that, " with a little more self-control," the sick might, 
 if they choose, " dismiss painful thoughts " which " aggra- 
 vate their disease," &c. Believe me, almost any sick per- 
 son, who behaves decently Avell, exercises more self-control 
 every moment of his day than you will ever know till you 
 are sick yourself. Almost every step that crosses his room 
 is painful to him ; almost every thought that crosses his 
 brain is painful to J^im : and if he can speak without being 
 savage, and look without being unpleasant, he is exercising 
 self-controh 
 
 Suppose you have been up all night, and instead of being 
 allowed to have your cup of tea, you were to be told that 
 you ought to " exercise self-control," what should you say ? 
 Now, the nerves of the sick are always in the state that 
 yours are in after you have been up all night. 
 
 We Avill suppose the diet of the sick to be cared for. 
 Then, this state of nerves is most frequently to be relieved 
 by care in affording them a pleasant view, a judicious va- 
 
 * I remember a case in point. A man received an injury to the 
 spine, from an accident, which, after a long confinement, ended in 
 death. He was a workman — had not in his composition a single 
 grain of what is called "enthusiasm for nature" — but he was des- 
 perate to •' see once more ovit of window." His nurse actually got 
 him on her back, and managed to perch him up at the window for an 
 instant, " to see out." The consequence to the poor nurse was a seri- 
 ous illness, which nearly proved fatal. The man never knew it ; but 
 a great many other people did. Yet the consequence in none of their 
 minds, so far as I know, was the conviction that the craving for 
 variety in the starving eye, is just as desperate as that of food in the 
 starving stomach, and tempts the famishing creature in either case to 
 steal for its satisfaction. No other Avord will express it but " despera- 
 tion." And it sets the seal of ignorance and stupidity just as much 
 on the governors and attendants of the sick if they do not provide the 
 sick-bed \A\X\ a " view" of some kind, as if they did not provide the 
 hospital with a Idtchcn.
 
 48 NOTES ON NURSING. 
 
 riety as to flowers,* and pretty things. Light by itself 
 will often relieve it. The craving for " the return of day," 
 which tlie sick so constantly evince, is generally nothing 
 but the desire for light, the remembrance of the relief 
 which a variety of objects before the eye affords to the 
 harassed sick mind. 
 
 Again, every man and every woman has some amount 
 of manual emplopnent, excepting a few fine ladies, who 
 do not even dress themselves, and who are virtually in the 
 same category, as to nerves, as the sick. Now, you can 
 have no idea of the relief which manual labor is to you — 
 of the degree to which the deprivation of manual employ- 
 ment increases the peculiar irritabiUty from which many 
 sick suffer. 
 
 A little needle-work, a little writing, a little cleaning, 
 would be the greatest relief the sick could have, if they 
 could do it ; these are the greatest r^ief to you, though 
 you do not know it. Reading, though it is often the only 
 thing the sick can do, is not this relief Bearing this in 
 mind, bearing in mind that you have all these varieties of 
 employment which the sick cannot have, bear also in mind 
 to obtain for them all the varieties which they can enjoy. 
 
 I need hardly say that I am well aware that excess in 
 needle-work, in writing, in any other continuous employ- 
 ment, will produce the same irritability that defect in man- 
 ual emj^loyment (as one cause) produces in the sick. 
 
 A^. TAKING FOOD. 
 
 Every careful observer of the sick will agree in this that 
 thousands of patients are annually starved in the midst of 
 jDlenty, from want of attention to the ways which alone 
 make it possible for them to take food. This want of at- 
 tention is as remarkable in those who urge ujDon the sick 
 to do what is quite impossible to them, as in the sick 
 themselves who will not rnako the effort to do what is per- 
 fectly possible to them. 
 
 For instance, to the large majority of very weak patients 
 
 * Xo one Avho has watched the sick can doubt the fact, that some 
 feel stimulus from looking at scarlet flowers, exhaustion from looking 
 at deep blue, &c.
 
 TAKING FOOD. 49 
 
 it is quite impossible to take any solid food before 11 a.m., 
 nor then, if their strength is still further exhausted by fast- 
 ing till that hour. For weak patients have generally fe- 
 verish nights and, in the morning, dry mouths; and, if 
 they could eat with those dry mouths, it would be the 
 worse for them. A spoonful of beef-tea, of arrowroot and 
 wine, of egg flip, every hour, will give them the requisite 
 nourishment, and j^revent them from being too much ex- 
 hausted to take at a later hour the solid food, which is 
 necessary for their recovery. And every patient who can 
 swallow at all can swallow these liquid things, if he 
 chooses. But how often do we hear a mutton-chop, an 
 egg, a bit of bacon, ordered to a patient for breakfast, to 
 whom (as a moment's consideration would show us) it 
 must be quite impossible to masticate such things at that 
 hour. 
 
 Again, a nurse is ordered to give a patient a tea-cup full 
 of some article of food every three hours. The patient's 
 stomach rejects it. If so, try a table-spoon full every 
 hour ; if this will not do, a tea-spoon full every quarter of 
 an hour. 
 
 I am bound to say, that I think more patients are lost 
 by want of care and ingenuity in these momentous mi- 
 nutiae in private nursing than in public hospitals. And 1 
 think there is more of the entente cordiale to assist one 
 another's hands between the doctor and his head nurse in 
 the latter institutions, than between the doctor and the jDa- 
 tient's friends in the private house. 
 
 If we did but know the consequences which may ensue, 
 in very weak patients, from ten minutes' fasting ' or reple- 
 tion (I call it repletion when they are obliged to let too 
 small an interval elapse betAveen taking food and some 
 other exertion, owing to the nurse's unpunctuality), we 
 should be more careful never to let this occur. In very 
 weak patients there is often a nervous difficulty of swal- 
 lowing, which is so much increased by any other call upon 
 their strength that, unless they have their food punctually 
 at the minute, which minute again must be arranged so as 
 to fall in with no other minute's occupation, they can take 
 nothing till the next respite occurs — so that an unpunctu- 
 ality or delay of ten minutes may very well turn out to be 
 one of two or three hours. And why is it not as easy to
 
 60 NOTES ON NURSING. 
 
 be punctual to a minute ? Life often literally hangs upon 
 these minutes. 
 
 In acute cases, where life or death is to be determined 
 in a few hours, these matters are very generally attended 
 to, especially in hospitals ; and the number of cases is 
 large where the patient is, as it were, brought back to life 
 by exceeding care on the part of the doctor or nurse, or 
 both, in ordering and giving nourishment with minute se- 
 lection and punctuaUty. 
 
 But in chronic cases, lasting over months and years, 
 where the fatal issue is often determined at last by mere 
 protracted starvation, I had rather not enumerate the in- 
 stances which I have known where a little ingenuity, and 
 a great deal of perseverance, might, in all probability, have 
 averted the result. The consulting the hours when the 
 l^atient can take food, the observation of the times, often 
 varying, when he is most faint, the altering seasons of 
 taking food, in order to anticipate and prevent such times 
 — all this, which requires observation, ingenuity, and per- 
 severance (and these really constitute the good nurse), 
 might save more lives than we wot of. 
 
 To leave the patient's untasted food by his side, from 
 meal to meal, in hopes that he will eat it in the interval is 
 simply to prevent him from taking any food at all. I have 
 known patients literally incapacitated from taking one 
 article of food after another, by this piece of ignorance. 
 Let the food come at the right time, and be taken away, 
 eaten or uneaten, at the right time ; but never let a patient 
 have " something always standing " by him, if you don't 
 wish to disgust him of every thing. 
 
 On the other hand, I have known a patient's life saved 
 (he was sinking for want of food) by the simple question, 
 put to him by the doctor, " But is there no hour when you 
 feel you could eat ? " " O, yes," he said, " I could always 
 take something at — o'clock and — o'clock." The thing 
 was tried and succeeded. Patients very seldom, however, 
 can tell this ; it is for you to watch and find it out. 
 
 A patient should, if possible, not see or smell either the 
 food of others, or a greater amount of food than he him- 
 self can consume at one time, or even hear food talked 
 about or see it in the raw state. I know of no exception 
 to the above rule. The breaking of it always induces a 
 greater or less incapacity of taking food.
 
 TAKING FOOD. 51 
 
 In hospital wards it is of course impossible to observe 
 all this ; and in single wards, where a patient must be con- 
 tinuously and closely watched, it is frequently impossible 
 to relieve the attendant, so that his or her own meals can 
 be taken out of the ward. But it is not the less true that, 
 in such cases, even where the patient is not himself aware 
 of it, his possibility of taking food is limited by seeing the 
 attendant eating meals under his observation. In some 
 cases the sick are aware of it, and complain. A case 
 where the patient was supposed to be insensible, but com- 
 plained as soon as able to speak, is now present to my 
 recollection. 
 
 Remember, however, that the extreme punctuality in 
 well-ordered hospitals, the rule that nothing shall be done 
 in the ward while the patients are having their meals, go 
 f:ir to counterbalance what unavoidable evil there is in 
 having patients together. I have often seen the private 
 nurse go on dusting or fidgeting about in a sick room all 
 the while the patient is eating, or trying to eat. 
 
 That the more alone an invalid can be when taking 
 food, the better, is unquestionable ; and, even if he must 
 be fed, the nurse should not allow him to talk, or talk to 
 him, especially about food, while eating. 
 
 When a person is compelled, by the pressure of occupa- 
 tion, to continue his business while sick, it ought to be a 
 rule WITHOUT axy exceptiox whateveb, that no one 
 shall bring business to him or talk to him while he is 
 taking food, nor go on talking to him on interesting sub- 
 jects up to the last moment before his meals, nor make an 
 engagement with him in\mediately after, so that there be 
 any hurry of mind while taking them. 
 
 Upon the observance of these rules, especially the first, 
 often depends the patient's capability of taking food at all, 
 or, if he is amiable and forces himself to take food, of de- 
 riving any nourishment from it. 
 
 A nurse should never put before a patient milk that is 
 sour, meat or soup that is turned, an egg that is bad, or 
 vegetables underdone. Yet often I have seen these things 
 brought in to the sick in a state perfectly perceptible to 
 every nose or eye except the nurse's. It is here that the 
 clever nurse appears ; she will not bring in the peccant 
 article, but, not to disappoint the patient, she will whip up 
 somcthincj else in a few minutes. Remember that sick
 
 52 NOTES ON NURSING. 
 
 cookery should half do the work of your poor patient's 
 weak digestion. But if you further impair it with your 
 bad articles, I know not what is to become of him or 
 of it. 
 
 If the nurse is an intelligent being, and not a mere car- 
 rier of diets to and from the patient, let her exercise her 
 intelligence in these things. How often we have known 
 a patient eat nothing at all in the day, because one meal 
 was left untasted (at that time he was incapable of eating), 
 at another the milk was sour, the third was spoiled by 
 some other accident. And it never occurred to the nurse 
 to extemporize some expedient, — it never occurred to her 
 that as he had had no solid food that day he might eat a 
 bit of toast (say) with his tea in the evening, or he might 
 have some meal an hour earlier. A patient who cannot 
 touch his dinner at two, will often accept it gladly, if 
 brought to him at seven. But somehow nurses never 
 " think of these things." One would imagine they did 
 not consider themselves bound to exercise their judgment ; 
 they leave it to the patient. Now I am quite sure that it 
 is better for a patient rather to suffer these neglects than 
 to try to teach his nurse to nurse him, if she does not 
 know how. It ruffles him, and if he is ill he is in no condi- 
 tion to teach, especially upon himself. The above remarks 
 apply much more to private nursing than to hospitals. 
 
 I would say to the nurse, have a rule of thought about 
 your patient's diet; consider, remember how much he has 
 had, and how much he ought to have to-day. Generally, 
 the only rule of the private patient's diet is what the nurse 
 has to give. It is true she cannot give him what she has 
 not got ; but his stomach does not wait for her conven- 
 ience, or even her necessity.* If it is used to having its 
 stimulus at one hour to-day, and to-morrow it does not 
 have it, because she has filled in getting it, he will suffer. 
 
 * 'Why, because the nurse has not got some food to-day which the pa- 
 tient takes, can the patient wait four hours for food to-day, who could 
 not wait t\A-o hours yesterday ? Yet this is the only logic one generally 
 hears. On the other hand, the other logic, viz., of the nurse giving a 
 patient a thing because she /las got it, is equally ftital. K she happens 
 to have fresh jelly or fresh fruit, she will frequently give it to the 
 patient half an hour after his dinner, or at his dinner," when he cannot 
 possibly eat that and the broth too — or worse still, leave it by his bed- 
 side till he is so sickened with the sight of it that he cannot eat it 
 at all.
 
 WHAT POOD? 68 
 
 She must be always exercising her ingenuity to supj^ly de- 
 fects, and to remedy accidents which will happen among 
 the best contrivers, but from which the patient does not 
 suffer the less, because " they cannot be helped." 
 
 One very minute caution, -— take care not to spill into 
 your patient's saucer, in other words, take care that the 
 outside bottom rim of his cup shall be quite dry and clean; 
 if, every time he lifts his cup to his lips, he has to carry 
 the saucer with it, or else -to drop the liquid upon, and to 
 soil his sheet, or his bed-gown, or pillow, or if he is sitting 
 up, his dress, you have no idea what a difference this 
 minute want of care on your part makes to his comfort 
 and even to his willincrness for food. 
 
 Vn. WHAT FOOD? 
 
 I will mention one or two of the most common errors 
 among women in charge of sick respecting sick diet. One 
 is the belief that beef tea is the most nutritive of all arti- 
 cles. Now, just try and boil dov^n a lb. of beef into beef 
 tea, evaporate your beef tea, and see what is left of your 
 beef You will find that there is barely a teaspoonful of 
 sohd nourishment to half a pint of water in beef tea ; — 
 nevertheless there is a certain reparative quality in it, we 
 do not know what, as there is in tea; — but it may safely 
 be given in almost any inflammatory disease, and is as little 
 to be depended upon with the healthy or convalescent 
 where much nourishment is required. Again, it is an ever 
 ready saw that an egg is equivalent to a lb. of meat, — - 
 whereas it is not at all so. Also, it is seldom noticed with 
 how many patients, particularly of nervous or bilious tem- 
 perament, eggs disagree. All puddings made with eggs, 
 are distasteftil to them in consequence. An egg whipped 
 up with wine, is often the only form in which they can 
 take this kind of nourishment. Again, if the patient has 
 attained to eating meat, it is sup])osed that to give liim 
 meat is the only thing needful for his recovery ; whereas 
 scorbutic sores have been actually known to appear among 
 sick persons living in the midst of plenty in England, 
 which could be traced to no other source than this, viz. : 
 that the nurse, depending on meat alone, had allowed the 
 patient to be without vegetables for a considerable time, 
 5*
 
 54 NOTKS ON NURSING. 
 
 these Ipittcr being so badly cooked that he always left 
 them untouched. Arrovrroot is another grand depend- 
 ence of the nurse. As a vehicle for wine^ and as a restor- 
 ative quickly prepared, it is all very well. But it is noth- 
 ing but starch and water. Flour is both more nutritive, 
 and less liable to ferment, and is preferable wherever it 
 can be used. 
 
 Again, milk and the preparations from milk, are a most 
 important article of food for theisick. Butter is the liglit- 
 est kind of animal fat, and though it wants the sugar and 
 some of the other elements which there are in milk, yet it 
 is most valuable both in itself and in enabling the patient 
 to eat more bread. Flour, oats, groats, barley, and their 
 kind, are, as we have already said, preferable in all their 
 preparations to all the preparations of arrowroot, sago, 
 tapioca, and their kind. Cream, in many long chronic 
 diseases, is quite irreplaceable by any other article what- 
 ever. It seems to act in the same manner as beef tea, and 
 to most it is much easier of digestion than milk. In fact, it 
 seldom disagrees. Cheese is not usually digestible by the 
 sick, but it is pure nourishment for repairing waste ; and I 
 have seen sick, and not a few either, whose craving for 
 cheese shewed how much it was needed by them.* 
 
 But, if fresh milk is so valuable a food for the sick, the 
 least change or sourness in it, makes it of all articles, per- 
 haps, the most injurious ; diarrhcsa is a common result of 
 fresh milk allowed to become at all sour. The nurse there- 
 fore ought to exercise her utmost care in this. In larsje 
 institutions for the sick, even the poorest, the utmost care 
 is exercised. Wenham Lake ice is used for this express 
 purpose every summer, while the private patient, perhaps, 
 never tastes a drop of milk that is not sour, all through 
 the hot weather, so little does the private nurse understand 
 
 * In the diseases produced by bad food, such as scorbutic dysentery 
 and diarrhoea, the patient's stomach often craves for and digests things, 
 some of which certainly would be laid down in no dietary that ever 
 was invented for sick, and especially not for such sick. The-e are 
 fruit, pickles, jams, gingerbread, fat of ham or bacon, suet, cheese, but- 
 ter, milk. These cases I have seen not by ones, nor by tens, but by 
 hundreds. And the patient's stomach was right and the book v/as 
 wrong. The articles craved for, in these cases, might have l:)een princi- 
 pally arranged under the two heads of fat and vegetable acids. 
 
 There is often a marked difference between men and women in thia 
 matter of sick feeding. Women' .s digestion is generally slower.
 
 WHAT FOOD ? 65 
 
 the necessity of such care. Yet, if you consider that the 
 only drop of real nourishment in your ]xatient's tea is the 
 drop of milk, and how much almost all English patients 
 depend upon their tea, you will see the great importance 
 of not depriving your patient of this drop of milk. But- 
 termilk, a totally different thing, is often very useful, 
 especially in fevers. 
 
 In laying down rules of diet, by the amounts of " solid 
 nutriment" in different kinds of food, it is constantly lost 
 sight of what the patient requires to repair his v/aste, what 
 he can take and what he can't. You cannot diet a patient 
 from a book, you cannot make up the human body as you 
 would make up a prescription, — so many parts " carbonif- 
 erous," so many parts " nitrogenous " will constitute a per- 
 fect diet for the patient. The nui-se's observation here 
 will materially assist the doctor — the patient's "fancies" 
 will materially assist the nurse. For instance, sugar is one 
 of the most nutritive of all articles, being pure carbon, 
 and is particularly recommended in some books. But the 
 vast majority of all patients in England, young^ and old, 
 male and female, rich and poor, hospital and private, dis- 
 like sweet things, — and while I have never known a per- 
 son take to sweets when he was ill who disliked them 
 when he was well, I have known many fond of them when 
 in health, who in sickness would leave off any thing sweet, 
 even to sugar in tea, — sweet puddings, sweet drinks, are 
 their aversion ; the furred tongue almost always likes what 
 is sharp or pungent. Scorbutic patients are an exception, 
 they often crave for sweetmeats and jams. 
 
 Jelly is another article of diet in great favor with nurses 
 and friends of the sick ; even if it could be eaten solid, it 
 would not nourish, but it is simply the height of folly to 
 take I oz. of gelatine and make it into a certain bulk by 
 dissolving it in water and then to give it to the sick, as if 
 the mere bulk represented nourishment. It is now known 
 that jelly does not nourish, that it has a tendency to pro- 
 duce diarrhoea, — and to trust to it to repair the waste of 
 a diseased constitution is simply to starve the sick under 
 the guise of feeding them. If 100 spoonfuls of jelly were 
 given in the course of the day, you Avould have given one 
 spoonful of gelatine, which spoonful has no nutritive power 
 whatever. 
 
 And, nevertheless, gelatine contains a large quantity of
 
 66 NOTES ON NtTRglNG, 
 
 nitrogen, which is one of the most poweiful elements in 
 nutrition ; on the other hand, beef tea may be chosen as 
 an ilhistration of great nutrient power in sickness, co- 
 existing with a very small amount of solid nitrogenous 
 matter. 
 
 Dr. Christison says that "erery one will be struck with 
 the readiness with which " certain classes of " patients will 
 often take diluted meat juice or beef tea repeatedly, when 
 they refuse all other kinds of food/' This is particularly 
 remarkable in " cases of gastric fever, in which,^' he says, 
 "little or nothing else besides beef tea or diluted meat 
 juice " has been taken for weeks or even months, " and yet 
 a pint of beef tea contains scarcely ^ oz. of anything but 
 water," — the result is so striking that he asks what is its 
 mode of action? "Not simply nutrient — ^ oz. of the 
 most nutritive material cannot nearly replace the daily 
 wear and tear of the tissues in any circumstances. Pos- 
 sibly," he saySj "it belongs to a new denomination of 
 remedies." 
 
 It has been obseiwed that a small quantity of beef tea 
 added to other articles of nutrition augments their power 
 out of all proportion to the additional amount of solid 
 matter. 
 
 The reason why jelly should be innutritions and beef tea 
 nutritious to the sick, is a secret yet undiscovered, but it 
 clearly shows that careful observation of the sick is the only 
 clue to the best dietary. 
 
 Chemistry has as yet afforded little insight into the 
 dieting of sick. All that chemistry can tell us is the 
 amount of " carboniferous " or " nitrogenous " elements dis- 
 coverable in different dietetic articles. It hns given us 
 lists of dietetic substances, arranged in the order of their 
 richness in one or other of these principles; but that is all. 
 In the great majority of cases, the stomach of the patient 
 is guided by other principles of selection than merely the 
 amount of carbon or nitrogen in the diet. Xo doubt, in 
 this as in other things, nature has very definite niles for 
 her guidance, but these rules can onl}'^ be ascertained by 
 the most careful observation at the bed-side. She there 
 teaches us that living chemistry, the chemistry of repara- 
 tion, is something different from tlie chemistry of the labo- 
 ratory. Organic cliemistry is useful, as all knowledge is, 
 when we come face to face with nature ; but it by no
 
 WHAT FOOD ? 57 
 
 means follows that we shoiild learn in the laboratory any 
 one of the reparative processes going on in disease. 
 
 Again, the nutritive power of milk and of the prepara- 
 tions from milk, is very much undervalued ; there is nearly 
 as much nourishment in half a pint of milk as there is in a 
 quarter of a lb. of meat. But this is not the whole ques- 
 tion or nearly the whole. The main question is what the 
 patient's stomach can assimilate or derive nourishment 
 from, and of this the patient's stomach is the sole judge. 
 Chemistry cannot tell this. The patient's stomach must 
 be its own chemist. The diet which will keep the healthy 
 man healthy, will kill the sick one. The same beef which 
 is the most nutritive of all meat which nourishes the 
 healthy man, is the least nouiishing of all food to the sick 
 man, whose half-dead stomach can assimilate no part of it, 
 that is, make no food out of it. On a diet of beef tea 
 healthy men on the other hand speedily lose their strength. 
 
 I have known patients live for many months without 
 touching bread, because they could not eat baker's bread. 
 These were mostly country patients, but not all. Home- 
 made bread or brown bread is a most important article of 
 diet for many patients. The use of aperients may be 
 entirely superseded by it. Oat cake is another. 
 
 To watch for the opinions, then, which the patient's 
 stomach gives, rather than to read " analyses of foods," is 
 the business of all those who have to settle what the patient 
 is to eat — perhaps the most important thing to be 2)ro- 
 vided for him after the air he is to breathe. 
 
 Now the medical man who sees the patient only once a 
 day or even only once or twice a week, cannot possibly tell 
 this without the assistance of the patient himself, or of 
 those who are in constant obser\"ation on the patient. The 
 utmost the medical man can tell is whether the patient is 
 weaker or stronger at this visit than he was at the last visit. 
 I should therefore say, that incomparably the most impor- 
 tant office of the nurse, after she has taken care of the 
 patient's air, is to take care to observe the effect of his food, 
 and report it to the medical attendant. 
 
 It is quite incalculable the good that would certainly 
 come from such sound and close observation in this almost 
 neglected branch of nursing, or the help it would give to 
 tlie medical man.
 
 68 NOTES ON NURSING. 
 
 A great deal too much against tea* is said by wise peo- 
 ple, and a great deal too much of tea is given to the sick 
 by foolish people. When you see the natural and almost 
 universal craving in English sick for their " tea," you cannot 
 but feel that nature knows what she is about. But a little 
 tea or coifee restores them quite as much as a great deal, 
 and a great deal of tea and especially of coffee impairs the 
 little power of digestion they have. Yet a nurse, because 
 she sees how one or two cups of tea or coffee restoresLher 
 patient, thinks that three or four cups will do twice as 
 much. This is not the case at all ; it is however certain 
 that there is nothing yet discovered which is a substitute 
 to the English patient for his cup of tea ; he can take it 
 when he can take nothing else, and he often can't take 
 anything else if he has it not. I should be very glad if any 
 of the abusers of tea would point out what to give to an 
 English patient after a sleepless night, instead of tea. If 
 you give it at five or six o'clock in the morning, he may 
 even sometimes fall asleep after it, and get perhaps his only 
 two or three hours' sleep during the twenty-four. At the 
 same time you never should give tea or coffee to the sick, 
 as a rule, after five o'clock in the afternoon. Sleeplessness 
 in the early night is from excitement generally and is 
 
 * It is made a frequent recommendation to persons about to incur 
 great exhaustion, either from the nature of the service, or from their 
 being not in a state fit for it, to eat a piece of bread before they go. I 
 wish the recommenders would themselves try the experiment of substi- 
 tuting a piece of bread for a cup of tea or coffee, or beef tea, as a 
 refresher. They M^ould find it a very poor comfort. When soldiers 
 have to set out fasting on fatiguing duty, when nurses have to go fast- 
 ing in to their patients, it is a hot restorative they want, and ought to 
 have, before they go, not a cold bit of bread. And dreadful have been 
 the consequences of neglecting this. If they can take a bit of bread 
 with the hot cup of tea, so much the better, but not instead of it. The 
 fact that there is more nourishment in bread than in almost anything 
 else, has probably induced the mistake. That it is a fatal mistake, 
 there is no doubt. It seems, though very little is known on the subject, 
 that what "assimilates" itself directly, and with the least trouble of 
 digestion with the human body, is the best for the above circiimstances. 
 Bread requires two or three processes of assimilation, before it becomes 
 like the human body. 
 
 The almost universal testimony of English men and women who have 
 undergone great fatigue, such as riding long journeys without stopping, 
 or sitting up for several nights in succession, is that they could do it 
 best upon an occasional cup of tea — and nothing else. 
 
 Let experience, not theory, decide upon this as uj^on all other things.
 
 WHAT FOOD? 69 
 
 increased by tea or coffee ; sleeplessness which continues 
 to the early morning is from exhaustion often, and is re- 
 lieved by tea. The only English patients I have ever 
 known refuse tea, have been typhus cases, and the first sign 
 of their getting better was their craving again for tea. In 
 general, the dry and dirty tongue always prefers tea to cof- 
 fee, and will quite decline milk, unless with tea. Coffee is 
 a better restorative than tea, but a greater impairer of the 
 digestion. Let the patient's taste decide. You will say 
 that, in cases of great thirst, the patient's craving decides 
 that it will drink a great deal of tea, and that you cannot 
 help it. But in these cases be sure that the patient 
 requires diluents for quite other purposes than quenching 
 the thirst ; he wants a great deal of some drink, not only 
 of tea, and the doctor will order what he is to have, bar- 
 ley water or lemonade, or soda water and milk, as the case 
 may be. 
 
 Lehman, quoted by Dr. Christison, says that, among the 
 well and active " the infusion of 1 oz. of roasted coffee daily 
 will diminish the waste " going on in the body " by one- 
 fourth," and Dr. Christison adds that tea has the same 
 property. Now this is actual experiment. Lehman weighs 
 the man and finds the fact from his weight. It is not 
 deduced from any "analysis" of food. All experience 
 among the sick shows the same thing.* 
 
 Cocoa is often recommended to the sick in lieu of tea or 
 coffee. But independently of the fact that English sick 
 
 * In making coffee, it is absolutely necessary to buy it in the berry 
 and grind it at home. Otherwise you may reckon upon its contahiing 
 a certain amount of chiccory, at least. This is not a question of the 
 taste or the wholcsomeness of chiccory. It is that chiccory has nothing 
 at all of the properties for which you give coffee.* And therefore you 
 may as well not give it. 
 
 Again, all laundresses, mistresses of dairy-farms, head nurses, (I 
 speak of the good old sort only — women who \mite a good deal of hard 
 manual labor with the head-work necessary for arranging the day's 
 business, so that none of it shall tread upon the heeU of something 
 else,) set great value, I have observed, upon having a high-priced tea. 
 This is called extravagant. But these women are "extravagant" in 
 nothing else. And they are right in this. Real tea-leaf tea alone con- 
 tains the restorative they want ; which is not to be fovmd in sloe-leaf tea. 
 
 The mivStresses of houses, who cannot even go over their own house 
 once a day, are iAcapable of judging for these women. For they are 
 incapable themselves, to all appearance, of the spirit of arrangement 
 (no small task) necessary for managing a large ward or dairy.
 
 6.0 NOTES ON NURSING. 
 
 very generally dislike cocoa, it has quite a different effect 
 from tea or coffee. It is an oily starchy nut having no 
 restorative power at all, but simply increasing fat. It is 
 pure mockery of the sick, therefore, to call it a substitute 
 for tea. For any renovating stimulus it has, you might 
 just as well offer them chestnuts instead of tea. 
 
 An almost universal error among nurses is in the bulk 
 of the food and especially the drinks they offer to their 
 patients. Suppose a patient ordered 4 oz. brandy during 
 the day, how is he to take this if you make it into four 
 pints with diluting it ? The same with tea and beef tea, 
 with arrowroot, milk, &c. You have not increased the 
 nourishment, you have not increased the renovating power 
 of these articles, by increasing their bulk, — you have very 
 likely diminished both by giving the patient's digestion 
 more to do, and most likely of all, the patient will leave 
 half of what he has been ordered to take, because he can- 
 not swallow the bulk with which you have been pleased to 
 invest it. It requires very nice observation and care (and 
 meets with hardly any) to determine what will not be too 
 thick or strong for the patient to take, while giving him no 
 more than the bulk which he is able to swallow. 
 
 Vm. BED AXD BEDDING. 
 
 A few words upon bedsteads and bedding ; and princi- 
 pally as regards patients who are entirely, or almost 
 entirely, confined to bed. 
 
 Feverishness is generally supposed to be a sjnnptom of 
 fever — in nine cases out often it is a symptom of bedding.* 
 The patient has had re-introduced into the body the ema- 
 nations from himself which day after day and week after 
 week saturate his unaired bedding. How can it be other- 
 wise ? Look at the ordinary bed in which a patient lies. 
 
 If I were looking out for an example in order to show 
 what 7iot to do, I should take the specimen of an ordinary 
 
 * I once told a "very good niirse " that the way in which her 
 patient's room was kept was quite enough to account for her sleepless- 
 ness ; and she answered quite good-humoredly she was not at all sur- 
 prised at it — as if the state of the room were, like the state of the 
 weather, entirely out of her power. Now in what sense was this 
 woman to be culled a •' nurse ? "
 
 BED AND BEDDING. 61 
 
 bed in a private house : a wooden bedstead, two or even 
 three mattresses piled up to above the height of a table ; a 
 vallance attached to the frame — nothing but a miracle 
 could ever thoroughly dry or air such a bed and bedding. 
 The patient must inevitably alternate between cold damp 
 after his bed is made, and warm damp before, both satu- 
 rated with organic matter,* and this from the time the 
 mattresses are put under him till the time they are picked 
 to pieces, if this is ever done. 
 
 If you consider that an adult in health exhales by the 
 lungs and skin in the twenty-four hours three pints at least 
 of moisture, loaded with organic matter ready to enter into 
 putrefaction ; that in sickness the quantity is often greatly 
 increased, the quahty is always more noxious — just ask 
 yourself next where does all this moisture go to ? Chiefly 
 into the bedding, because it cannot go anywhere else. 
 And it stays there; because, except perhaps a weekly 
 change of sheets, scarcely any other airing is attempted. 
 A nurse will be careful to fidgetiness about airing the clean 
 sheets from clean damp, but airing the dirty sheets from 
 noxious damp will never even occur to her. Besides this, 
 the most dangerous eflluvia we know of are from the 
 excreta of the sick — these are placed, at least temporarily, 
 where they must throw their eflluvia into the under side 
 of the bed, and the space under the bed is never aired ; it 
 cannot be, with our arrangements. Must not such a bed 
 be always saturated, and be always the means of re-intro- 
 ducing into the system of the unfortunate patient who lies 
 in it, that excrementitious matter to eliminate which from 
 the body nature had expressly appointed the disease ? 
 
 My heart always sinks within me when I hear the good 
 house-wife, of every class, say, " I assure you the bed has 
 been well slept in," and I can only hope it is not true. 
 What ? is the bed already saturated with somebody else's 
 damp before my patient comes to exhale in it his own 
 damp? Has it not had a single chance to be aired? No, 
 not one. " It has been slept in every night." 
 
 * For the same reason if, after -washing a patient, yoxi must put the 
 same night-dress on him again, always give it a preliminary warm at 
 the fire. The night-gown he has worn must be, to a certain extent, 
 damp. It has now got cold from having been off him for a few min- 
 utes. The fire will dry and at tlie same time air it. This is much more 
 important than with clean things. 
 
 6
 
 62 NOTES ON NURSING. 
 
 The only way of really nursing a real patient is to have an 
 iron bedstead, with rheocline springs, which are permeable 
 by the air up to the very mattress (no vallance, of course), 
 the mattress to be a thin hair one ; the bed to be not above 
 3^ feet wide. If the patient be entirely confined to his bed, 
 there should be ti/)o such bedsteads; each bed to be 
 " made " with mattress, sheets, blankets, <fcc., complete — 
 the patient to pass twelve hours in each l)ed ; on no account 
 to carry his sheets with him. The whole of the bedding 
 to be hung uj) to air for each intermediate twelve hours. 
 Of course there are many cases where this cannot be done 
 at all — many more where only an approach to it can be 
 made. I am indicating the ideal of nursing, and what I 
 have actually had done. But about the kind of bedstead 
 there can be no doubt, whether there be one or two 
 provided. 
 
 There is a prejudice in favor of a wide bed — I believe 
 it^to be a prejudice. All the refreshment of moving a 
 patient from one side to the other of his bed is far more 
 effectually secured by putting him into a fresh bed ; and a 
 patient w^ho is really very ill does not stray far in bed. 
 But it is said there is no room to put a tray down on a 
 narrow bed. No good nurse will ever put a tray on a bed 
 at all. If the patient can turn on his side, he will eat more 
 comfortably from a bed-side table ; and on no account 
 whatever should a bed ever be higher than a sofa. Other- 
 w^ise the patient feels himself " out of humanity's reach ; " 
 he can get at nothing for himself: he can move nothing 
 for himself. If the j^atient cannot turn, a table over the 
 bed is a better thing. I need hardly say that a patient's 
 bed should never have its side against the wall. The nurse 
 must be able to get easily to both sides of the bed, and to 
 reach easily every part of the patient without stretching — 
 a thing impossible if the bed be either too wide or too high. 
 
 When I see a patient in a room nine or ten feet high 
 upon a bed between four and five feet high, with his head, 
 when he is sitting up in bed, actually within two or three 
 feet of the ceiling, I ask myself, is this expressly planned 
 to produce that peculiarly distressing feeUng common to 
 the sick, viz., as if the walls and ceiling were closing in 
 upon them, and they becoming sandwiches between floor 
 and ceiling, which imagination is not, indeed, here so far 
 from the truth ? If, over and above this, the window stops
 
 BED AND BEDDING. 63 
 
 short of the ceiling, then the patient's head may literally 
 be raised above the stratum of fresh air, even when the 
 window is open. Can human perversity any farther go, 
 in unmaking the process of restoration which God has 
 made ? The flict is, that the heads of sleepers or of sick 
 should never be higher than the throat of the chimney, 
 which ensures their being in the current of best air. And 
 we will not suppose it possible that you have closed your 
 chimney with a chimney-board. 
 
 If a bed is higher than a sofa, the diiference of the 
 fatigue of getting in and out of bed will just make the 
 difference, very often, to the patient (who can get in and 
 out of bed at all) of being able to take a few minutes' exer- 
 cise, either in the open air or in another room. It is so 
 very odd that people never think of this, or of how many 
 more times a patient who is in bed for the twenty-four 
 hours is obliged to get in and out of bed than they are, Avho 
 only, it is to be hoped, get into bed once and out of bed 
 once during the twenty-four hours. 
 
 A patient's bed should always be in the lightest spot in 
 the room ; and he should be able to see out of window. 
 
 I need scarcely say that the old four-post bed with cur- 
 tains is utterly inadmissible, whether for sick or well. Hos- 
 pital bedsteads are in many respects very much less objec- 
 tionable than private ones. 
 
 There is reason to believe that not a few of the appar- 
 ently unaccountable cases of scrofula among children pro- 
 ceed from the habit of sleeping with the head under the 
 bed clothes, and so inhaling air already breathed, which is 
 farther contaminated by exhalations from the skin. Pa- 
 tients are sometimes given to a similar habit, and it often 
 happens that the bed clothes are so disposed that the 
 patient must necessarily breathe air more or less contami- 
 nated by exhalations from his skin. A good nurse will be 
 careful to attend to this. It is an important part, so to 
 sj^eak, of ventilation. 
 
 It may be worth while to remark, that where there is 
 any danger of bed-sores a blanket should never be placed 
 under the patient. It retains dam^) and acts like a poul- 
 tice. 
 
 ISTever use anything but light Whitney blankets as bed 
 covei-ing for the sick. The heavy cotton impervious coun- 
 terpane is bad, for the very reason that it keeps in the
 
 64 NOTES ON NURSING. 
 
 emanations from the sick person, while the blanket allows 
 them to pass through. AVeak patients are invaiiably dis- 
 tressed by a great weight of bed clothes, which often pre- 
 vents their getting any sound sleep whatever. 
 
 Note. — One word about pillows. Every weak patient, be his ill- 
 ness what it may, suffers more or less from difficulty in breathing. To 
 take the weight of the body off the poor chest, which is hardly up to 
 its work as it is, ought therefore to be the object of the nurse in arrang- 
 ing his pillows. Now what does she do and Avhat are the conse- 
 quences ? She piles the pillows one a-top of the other like a wall of 
 bricks. The head is thrown upon the chest. And the shoulders are 
 pushed forward, so as not to allow the lungs room to expand. The 
 pillows, in fact, lean upon the patient, not the patient upon the pillows. 
 It is impossible to give a rule for this, because it must vary with the 
 figure of the patient. And tall patients suffer much more than short 
 ones, because of the drag of the long limbs upon the waist. But the 
 object is to support, with the pillows, the back helow the breathing ap- 
 paratus, to allow the shoulders room to fall back, and to support the 
 head, without throwing it forward. The suffering of dying patients is 
 immensely increased by neglect of these points. And many an invalid, 
 too weak to drag about his pillows himself, slips his book or anything 
 at hand behind the lower part of his back to support it. 
 
 IX. LIGHT. 
 
 It is the unqualified result of all my experience with the 
 sick, that second only to their need of fi-esh air is their 
 need of light ; that, after a close room, what hurts them 
 most is a dark room. And that it is not only light but 
 sunlight they want. I had rather have the power of car- 
 rying my patient about after the sun, according to the 
 aspect of the rooms, if circumstances permit, than let him 
 linger in a room when the sun is off. People think tlie 
 effect is upon the spirits only. This is by no means the 
 case. The sun is not only a j^ainter but a sculptor. You 
 admit that he does the photograph. Without going into 
 any scientific exposition we must admit that hght has quite 
 as real and tangible effects upon the hitman body. But 
 this is not all. Who has not observed the j^urifying effect 
 of light, and especially of direct sunlight, upon the air of 
 a room ? Here is an observation within everybody's ex- 
 perience. Go into a room where the shutters are always 
 shut (in a sick room or a bed-room there never should be 
 shutters shut,) and though the room be uninhabited, though
 
 LIGHT. 65 
 
 the air has never been polluted by the breathing of human 
 beings, you will observe a close, musty smell of corrupt air, 
 i. e. of air unpurified by the effect of the sun's rays. The 
 mustiness of dark rooms and corners, indeed, is proverbial. 
 The cheerfulness of a room, the usefulness of light in treat- 
 ing disease is all-important. > 
 
 A very high authority in hospital construction has said 
 that people do not enough consider the difference between 
 wards and dormitories in planning their buildings. But I 
 go farther, and say, that healthy people never remember 
 the difference between ^ec?-rooms and sicA-rooms, in mak- 
 ing arrangements for the sick. To a sleeper in health it 
 does not signify what the view is from his bed. He ought 
 never to be in it excepting when asleep, and at night. As- 
 pect does not very much signify either (provided the sun 
 reach his bed-room some time in every day, to purify the 
 air), because he ought never to be in his bed-room except 
 during the hours when there is no sun. But the case is 
 exactly reversed with the sick, even should they be as 
 many hours out of their beds as you are in yours, which 
 probably they are not. Therefore, that they should be 
 able, without raising themselves or turning in bed, to see 
 out of window from their beds, to see sky and sunlight at 
 least, if you can show them nothing else, I assert to be, if 
 not of the very first importance for recovery, at least some- 
 thing very near it. And you should therefore look to the 
 position of the beds of your sick one of the very first things. 
 If they can see out of two windows instead of one, so much 
 the better. Again, the morning sun and the mid-day sun 
 — the hours when they are quite certain not to be up, are 
 of more importance to them, if a choice must be made, 
 than the afternoon sun. Perhaps you can take them out 
 of bed in the afternoon and set them by the window, where 
 they can see the sun. But the best rule is, if possible, to 
 give them direct sunlight from the moment he rises till the 
 moment he sets. 
 
 Another great difference between the hed-YOom. and the 
 sick-Yooxn. is, that the sleeper has a very large balance of 
 fresh air to begin with, when he be*gins the night, if his 
 room has been open all day as it ought to be ; the sick man 
 has not, because all day he has been breathing the air in 
 the same room, and dirtying it by the emanations from 
 6*
 
 66 NOTES ON NURSING. 
 
 himself. Far more care is therefore necessary to keep up 
 a constant change of air in the sick-room. 
 
 It is hardly necessary to add that there are acute cases 
 (particularly a few ophthalmic cases, and diseases where 
 the eye is morbidly sensitive), where a subdued light is 
 necessary. But a dark north room is inadmissible even 
 for these. You can always moderate the light by blinds 
 and curtains. 
 
 Heavy, thick, dark window or bed curtains should, how- 
 ever, hardly ever be used for any kind of sick in this coun- 
 try. A light white curtain at the head of the bed is, in 
 general, all that is necessary, and a green blind to the 
 window, to be drawn down only when necessary. 
 
 One of the greatest observers of human things (not phys- 
 iological), says, in another language, "Where there is sun 
 there is thought." All physiology goes to confirm this. 
 Where is the shady side of deep vallies, there is cretinism. 
 Where are cellai's and the unsunned sides of narrow streets, 
 there is the degeneracy and w^eakliness of the human race 
 
 — mind and body equally degenerating. Put the pale 
 withering plant and human being into the sun, and, if not 
 too fir gone, each will recover health and spirit. 
 
 It is a curious thing to observe how almost all patients 
 lie with their faces turned to the light, exactly as plants 
 always make their way towards the light; a patient will 
 even complain that it gives him pain " lying on that side." 
 "Then why do you lie on that side?" He does not know, 
 
 — but we do. It is because it is the side towards the 
 window. A fashionable physician has recently published 
 in a government report that he always turns his patients' 
 faces from the light. Yes, but nature is stronger than fash- 
 ionable physicians, and depend upon it she turns the faces 
 back and toicards such light as she can get. Walk through 
 the wards of a hospital, remember the bed sides of private 
 patients you have seen, and count how many sick you ever 
 saw l^ing with their faces towards the wall. 
 
 X. CLEANLINESS OF ROOMS AND WALLS. 
 
 It cannot be necessary to tell a nurse that she should be 
 clean, or that she should keep her patient clean, — seeing 
 that the greater part of nursing consists in preserving
 
 CLEANLINESS OF ROOMS AND WALLS. 67 
 
 cleanliness. No ventilation can freshen a room or ward 
 where the most scrupulous cleanliness is not observed. 
 Unless the wind be blowing through the windows at the 
 rate of twenty miles an hour, dusty carpets, dirty wainscots, 
 musty curtains and furniture, will infalhbly produce a close 
 smell. I have lived in a large and expensively furnished 
 London house, where the only constant inmate in two very 
 lofty rooms, with opposite windows, was myself, and yet, 
 owing to the above-mentioned dirty circumstances, no open- 
 ing of windows could ever keep those rooms free from close- 
 ness ; but the carpet and curtains having been turned out 
 of the rooms altogether, they became instantly as fresh as 
 could be wished. It is pure nonsense to say that in Lon- 
 don a room cannot be kept clean. Many of our hosj^itals 
 show the exact reverse. 
 
 But no particle of dust is ever or can ever be removed 
 or really got rid of by the present system of dusting. 
 Dusting in these days means nothing but flapping the dust 
 from one part of a room to another with doors and win- 
 dows closed. What you do it for I cannot think. You 
 had much better leave the dust alone, if you are not going 
 to take it away altogether. For from the time a room be- 
 gins to be a room up to the time when it ceases to be one, 
 no one atom of dust ever actually leaves its precincts. 
 Tidying a room means nothing now but removing a thing 
 from one place, which it has kept clean for itself, on to an- 
 other and a dirtier one.* Flapping by way of cleaning is 
 only admissible in the case of pictures, or anything made 
 o£ paper. The only way i know to remove dust, the plague 
 of all lovers of fresh air, is to wipe everything with a damp 
 cloth. And all furniture ouo-ht to be so made as that it 
 
 * If you like to clean your furniture by laying out your clean clothes 
 upon yoiir dirty chairs or sofa, this is one way certainly of doing it. 
 Having witnessed the morning process called "tidying the room" for 
 many years, and with ever-increasing astonishment, I can describe 
 what it is. From the chairs, tables, or sofa, upon which the '* things" 
 have lain during the night, and which are therefore comparatively clean 
 from dust or blacks, the poor ^^ things" having "caught" it, they are 
 removed to other chairs, tables, solas, upon which you could write 
 your name with your finger in the dust or blacks. The other side of the 
 "things" is therefore now evenly dirtied or dusted. The housemaid 
 then tlaps everything, or some things, not out of her reach, with a thing 
 called a duster — the dust flies up, then re-settles more equally than it 
 lay before the operation. The room has now been " put to rights."
 
 68 NOTES ON NURSING. 
 
 may be wiped with a damp cloth without injury to itself 
 and so polislied as that it may be damped without injury 
 to others. To dust, as it is now practised, truly means to 
 distribute dust more equally over a room. 
 
 As to floors, the only really clean floor I know is the 
 Berlin lackered floor, which is wet rubbed and dry rubbed 
 every morning to remove the dust. The YY(i,wQ\\ parquet 
 is always more or less dusty, although infinitely superior 
 in point of cleanliness and healthiness to our absorbent 
 floor. 
 
 For a sick room, a carpet is jierhaps the worst expedient 
 which could by any possibility have been invented. If you 
 must have a carpet, the only safety is to take it up two or 
 three times a year, instead of once. A dirty carpet liter- 
 ally infects the room. And if you consider the enormous 
 quantity of organic matter from the feet of people coming 
 in, which must saturate it, this is by no means surprising. 
 
 As for walls, the worst is the papered wall; the next 
 worst is plaster. But the plaster can be redeemed by fre- 
 quent lime-washing; the paper requires frequent renewing. 
 A glazed paper gets rid of a good deal of the danger. 
 But the ordinary bed-room paper is all that it ought not 
 to be.* 
 
 The close connection between ventilation and cleanli- 
 ness is shown in this. An ordinary light paper will last 
 clean much longer if there is an Arnott's ventilator in the 
 chimney than it otherwise would. 
 
 The best wall now extant is oil paint. From this you 
 can wash the animal exuvi£e. t • 
 
 These are what make a room musty. 
 
 The best wall for a sick-room or ward that could be 
 made is pure white non-absorbent cement or glass, or 
 glazed tiles, if they were made sightly enough. 
 
 Air can be soiled just like water. If 3'ou blow into wa- 
 ter you will soil it with the animal matter from your breath. 
 
 * I am sure that a person who has accustomed her senses to compare 
 atmospheres proper and improper, for the sick and for children, could 
 tell, blindfold, the difference of the air in old painted and in old papered 
 rooms, ccetcris paribus. The latter "will always be musty, even with all 
 the windows open. 
 
 t K you like to wipe your dirty door, or some portion of your dirty 
 wall, by hanging up your clean gown or shawl against it on a peg, this 
 is one way certainly, and the most usual way, and generally the only 
 way of cleaning either door or wall in a bed-room !
 
 CLEANLLNESS OF ROOMS AND WALLS. 69 
 
 So it is with air. Air is always soiled in a room where 
 walls and carpets are saturated with animal exhalations. 
 
 Want of cleanliness, then, in rooms and wards, which 
 you have to guard against, may arise in three ways. 
 
 1. Dirty air coming in from without, soiled by sewer 
 emanations, the evaporation from dirty streets, smoke, bits 
 of unburnt fuel, bits of straw, bits of horse dung. 
 
 If people would but cover the outside walls of their 
 houses with plain or encaustic tiles, what an incalculable 
 improvement would there be in light, cleanliness, dryness, 
 warmth, and consequently economy. The play of a fire- 
 engine would then effectually wash the outside of a house. 
 This kind of icalling would stand next to paving in improv- 
 ing the health of towns. 
 
 2. Dirty air coming from within, from dust, which you 
 often displace, but never remove. And this recalls what 
 ought to be a sine qua non. Have as few ledges in your 
 room or ward as possible. And under no pretence have 
 any ledge whatever out of sight. Dust accumulates there, 
 and will never be wiped oif. This is a certain way to soil 
 the air. Besides this, the animal exhalations from your 
 inmates saturate your furniture. And if you never clean 
 your furniture properly, how can your rooms or wards be 
 anything but musty ? Ventilate as you please, the rooms 
 will never be sweet. Besides this, there is a constant 
 degradation^ as it is called, taking place from everything 
 except polished or glazed articles — e. ^., in coloring cer- 
 tain green papers arsenic is used. Now in the very dust 
 even, which is lying about in rooms hung with this kind of 
 green paper, arsenic has been distinctly detected. You see 
 your dust is anything but harmless ; yet you will let such 
 dust lie about your ledges for months, your rooms forever. 
 
 Again, the fire fills the room with coal dust. 
 
 3. Dirty air coming from the carpet. Above all, take 
 care of the carpets, that the animal dirt left there by the 
 feet of visitors does not stay there. Floors, unless the 
 grain is filled up and polished, are just as bad. The smell 
 from the floor of a school-room or ward, when any mois- 
 ture brings out the organic matter by which it is satui-ated, 
 might alone be enougli to warn us of the mischief that is 
 going on. 
 
 The outer air, then, can oidy be kept clean by sanitary 
 improvements, and by consuming smoke. The expense in
 
 70 NOTES ON NURSING. 
 
 soap, which this single improvement would save, is quite 
 incalculable. 
 
 The inside air can only be kept clean by excessive care 
 in the ways mentioned above — to rid the walls, carpets, 
 furniture, ledges, &C., of the organic matter and dust — 
 dust consisting gTcatly of this organic matter — with which 
 they become saturated, and which is what really makes the 
 room musty. 
 
 Without cleanliness, you cannot have all the effect of 
 ventilation ; without ventilation, you can have no thorough 
 cleanliness. 
 
 Very few people, be they of what class they may, have 
 any idea of the exquisite cleanliness required in the sick- 
 room. For much of what I have said applies less to the 
 hospital than to the private sick-room. The smoky chim- 
 ney, the dusty furniture, the utensils emptied but once a 
 day, often keep the air of the sick constantly dirty in the 
 best private houses. 
 
 The well have a curious habit of forgetting that what is 
 to them but a trifling inconvenience, to be patiently "put 
 up" with, is to the sick a source of suffering, delaying 
 recovery, if not actually hastening death. The well are 
 scarcely ever more than eight hours, at most, in the same 
 room. Some change they can always make, if only for a 
 few minutes. Even during the supposed eight hours, they 
 can change their posture or their position in the room. But 
 the sick man, who never leaves his bed, Avho cannot change 
 by any movement of his own his air, or his light, or his 
 warmth ; who cannot obtain quiet, or get out of the smoke, 
 or the smell, or the dust ; he is really poisoned or depressed 
 by what is to you the merest trifle. 
 
 " What can't be cured must be endured," is the very 
 worst and most dangerous maxim for a nurse which ever 
 was made. Patience and resignation in her are but other 
 words for carelessness or indifference — contemptible, if in 
 regard to herself; culpable, if in regard to her sick. 
 
 XI. PERSONAL CLEANLINESS. 
 
 In almost all diseases, the function of the skin is, more 
 or less, disordered ; and in many most important diseases 
 nature relieves herself almost entirely by the skin, This
 
 PERSONAL CLEANLINESS. ll 
 
 is particularly the case with children. But the excretion, 
 which comes from the skin, is left there, unless removed by 
 washing or by the clothes. Every nurse should keep this 
 fact constantly in mind, — for, if she allow her sick to re- 
 main unwashed, or their clotliing to remain on them after 
 being saturated with perspiration or other excretion, she is 
 interfering injuriously with the natural processes of health 
 just as eftectually as if she were to give the patient a dose 
 of slow poison by the mouth. Poisoning by the skin is 
 no less certain than poisoning by the mouth — only it is 
 slower in its operation. 
 
 The amount of relief and comfort experienced by sick 
 after the skin has been carefully washed and dried, is one 
 of the commonest observations made at a sick bed. But 
 it must not be forgotten that the comfort and relief so ob- 
 tained are not all. They are, in fact, nothing more than a 
 sign that the vital powers have been relieved by removing 
 something that was oppressing them. The nurse, therefore, 
 must never put off attending to the personal cleanliness 
 of her patient under the plea that all that is to be gained 
 is a little relief, which can be quite as well given later. 
 
 In all well-regulated hospitals this ought to be, and gen- 
 erally is, attended to. But it is very generally neglected 
 with private sick. 
 
 Just as it is necessary to renew the air round a sick per- 
 son frequently, to carry off morbid effluvia from the lungs 
 and skin, by maintaining free ventilation, so it is necessary 
 to keep the pores of the skin free from all obstructing 
 excretions. The object, both of ventilation and of skin- 
 cleanliness, is pretty much the same, — to wit, removing 
 noxious matter from the system as rapidly as possible. 
 
 Cai-e should be taken in all tliese o]>erations of sponging, 
 washing, and cleansing the skin, not to expose too great 
 a surface at once, so as to check the perspiration, wliich 
 would renew tlie evil in another form. 
 
 The various ways of wasliing the sick need not here be 
 specilied, — the less so as the doctors ought to say which 
 is to be used. 
 
 In several forms of diar]-ha?a, dysentery, &c., where the 
 skin is hard and harsh, the relief afforded by washing with 
 a great deal of soft soap is incalcuhible. In otlier cases, 
 sponging with tepid soap and water, then with tepid water 
 and drying Avith a hot towel will be ordered.
 
 72 NOTES ON NURSING. 
 
 Every nurse ought to be careful to wash her hands very 
 frequently during the day. If her face too, so much the 
 better. 
 
 One word as to cleanUness merely as cleanliness. 
 
 Compare the dirtiness of the water in which you have 
 washed when it is cold without soap, cold with soap, hot 
 with soap. You will find the first has hardly removed any 
 dirt at all, the second a little more, the third a great deal 
 more. But hold your hand over a cup of hot water for a 
 minute or two, and then, by merely rubbing with the fin- 
 ger, you will bring of flakes off dirt or dirty skin. After 
 a vapor bath you may peel your whole self clean in this 
 way. What I mean is, that by simply washing or spong- 
 ing with water you do not really clean your skin. Take a 
 rough towel, dip one corner in very hot water, — if a little 
 spirit be added to it it will be more effectual, — and then 
 rub as if you were rubbing the towel into your skin with 
 jour fingers. The black iiakes which will come off will 
 eonvince you that you were not clean before, however 
 much soap and water you have used. These flakes are 
 what require removing. And you can really keep your- 
 self cleaner with a tumbler of hot water and a rough towel 
 and rubbing, than with a whole apparatus of bath and 
 soap and sponge, without rubbing. It is quite nonsense to 
 say that anybody need be dirty. Patients have been kept 
 as clean by these means on a long voyage, when a basin 
 full of water could not be aflbrded, and when they could 
 not be moved out of their berths, as if all the appurte- 
 nances of home had been at hand. 
 
 Washing, however, with a large quantity of water lias 
 quite other eftects than those of mere cleanliness. The 
 skin absorbs the water and becomes softer and more per- 
 spirable. To wash with soap and soft water is, therefore, 
 desirable from other points of view than that of cleanli- 
 ness. 
 
 Xn. CHATTERING HOPES AND ADVICES. 
 
 The sick man to his advisers. 
 
 " ]My advisers ! Their name is legion. * * * 
 Somehow or other, it seems a provision of the universal 
 destinies, that every man, woman, and child should con- 
 sider him, her, or itself privileged especially to advise me.
 
 CHATTERING HOPES AND ADVICES. 73 
 
 "Wliy ? That is precisely what I want to know." And 
 this is what I have to say to them. I have been advised 
 to go to every place extant in and out of England — to 
 take every kind of exercise by every kind of cart, car- 
 riage — yes, and even swing (I) and dnmb-bell (!) in exist- 
 ence ; to imbibe every different kind of stimulus that ever 
 has been invented. And this when those best fitted to 
 know, viz., medical men, after long und close attendance, 
 }iad declared any journey out of the question, had prohib- 
 ited any kind of motion whatever, had closely laid down 
 the diet and drink. What would my advisers say, were 
 they the medical attendants, and I the patient left their 
 advice, and took the casual adviser's ? But the singularity 
 in Legion's mind is this : it never occurs to liim that 
 everybody else is doing the same tiling, and that I the pa- 
 tient must perforce say, in sheer self-defence, like Rosalind, 
 " I could not do with all." 
 
 " Chattering Hopes " may seem an odd heading. But I 
 really believe there is scarcely a gi'eater worry which in- 
 valids have to endure than the incurable hopes of their 
 friends. There is no one practice against which I can 
 speak more strongly from actual personal experience, wide 
 and long, of its effects during sickness observed both upon 
 others and upon myself. I would appeal most seriously to 
 all friends, visitors, and attendants of the sick to leave off 
 this practice of attempting to " cheer " the sick by making 
 light of their danger and by exaggerating their probabili- 
 ties of recovery. 
 
 Far more now than formerly does the medical attendant 
 tell the truth to the sick who are really desirous to hear it 
 about their own state. 
 
 How intense is the folly, then, to say the least of it, of 
 the friend, be he even a medical man, who thinks that his 
 opinion, given after a cursory observation, will weigh with 
 the patient, against the opinion of the medical attendant, 
 given, perhaps, after years of observation, after using every 
 help to diagnosis afforded by the stethosco]>e, the exami- 
 nation of pulse, tongue, &c. ; and certainly after much more 
 observation than the friend can possibly liave had. 
 
 Supposing the ])atient to be possessed of common sense 
 
 — how can the "favourable" opinion, if it is to be called 
 
 an opinion at all, of the casual visitor "cheer" him, — 
 
 when different from that of the experienced attendant? 
 
 7
 
 74 NOTES ON NURSING. 
 
 Unquestionably the latter may, and often does, turn out 
 to be ^Vrong. But which is most likely to be wrong? 
 
 The fact is, that the patient * is not " cheered " at all by 
 these well-meaning, most tiresome friends. On the con- 
 trary, he is depressed and wearied. If, on the one hand, 
 he exerts himself to tell each successive member of this 
 too numerous conspiracy, w^hose name is legion, why he 
 does not think as they do, — in what respect he is worse, 
 — what symptoms exist that they know nothing of, — lie 
 is fatigued instead of " cheered," and his attention is fixed 
 uj^on himself. In general, patients who are really ill, do 
 not want to talk about themselves. Hypochondriacs do, 
 but again I say we are not on the subject of hypochon- 
 driacs. 
 
 If, on the other hand, and w^hich is much more fi-e- 
 quently the case, the patient says nothing, but the Shake- 
 spearian «0h!" "Ah!" "Go to!" and '^n good sooth!" 
 in order to escape from the conversation about himself the 
 sooner, he is depressed by want of sympathy. He feels 
 isolated in the midst of friends. He feels what a conven- 
 ience it would be, if there were any single person to whom 
 
 * There are, of course, cases, as in first confinements, when an 
 assurance from the doctor or experienced nurse •to the frightened suf- 
 fering woman that there is nothing unusual in her case, that she has 
 nothing to fear but a few hours' pain, may cheer her most effectually. 
 This is ad\'ice of quite another order. It is the advice of experience to 
 utter inexperience. But the advice we have been referring to is the 
 advice of inexperience to bitter experience ; and, in general, amounts to 
 nothing more than this, that you think I shall recover from consump- 
 tion because somebody knows somebody somewhere who has recovered 
 from fever. 
 
 I have heard a doctor condemned whose patient did not, alas ! 
 recover, because another doctor's patient of a different sex, of a different 
 age, recovered from a different disease, in a different place. Yes, this is 
 really true. If people who make these comparisons did but know 
 (only they do not care to know), the care and preciseness Avith v/hich 
 such comparisons require to be made, (and are made,) in order to be 
 of any value Avhatever, they would spare their tongues. In comparing 
 the deaths of one hospital with those of another, any statistics are justly 
 considered absolutely valueless which do not give the ages, the sexes, 
 and the diseases of all the cases. It does not seem necessary to mention 
 this. It does not seem necessary to say that there can be no compari- 
 son between old men with dropsies and young women with consump- 
 tions. Yet the cleverest men and the cleverest women are often lieard 
 making such comparisons, ignoring entirely sex, age, disease, place — 
 in fact, all the conditions essential to the question. It is the merest 
 gossip.
 
 CHATTERING HOPES AND ADVICES. 75 
 
 he could speak simply and openly, without pulling the string 
 upon himself of this shower-bath of silly hopes and en- 
 couragements; to whom he could express liis wishes and 
 directions without that pei-son persisting in saying " I ho])e 
 that it will please God yet to give you twenty years," or, 
 " You have a long life of activity before you." How often 
 we see at the end of biographies or of cases recorded in 
 medical papers, " after a long illness A. died rather sud- 
 denly," or, " unexpectedly both to himself and to others." 
 "Unexpectedly" to others, perhaps, who did not see, be- 
 cause they did not look; but by no means "unexpectedly 
 to himself," as I feel entitled to believe, both from the in- 
 ternal evidence in such stories, and from watching similar 
 cases : there was every reason to expect that A. would die, 
 and he knew it; but he found it useless to insist upon his 
 own knowledge to his friends. 
 
 In these remarks I am alluding neither to acute cases 
 which terminate rapidly nor to " nervous " cases. 
 
 By the first much interest in their own danger is very 
 rarely felt. In writings of fiction, whether novels or biog- 
 raphies, these death-beds are generally depicted as almost 
 seraphic in lucidity of intelhgence. Sadly large has been 
 my experience in death-beds, and I can only say that I 
 have seldom or never seen such. Indifference, excepting 
 with regard to bodily suffering, or to some duty the dying 
 man desires to perform, is the far more usual state. 
 
 The "nervous case," on the other hand, delights in fig- 
 uring to himself and others a fictitious danger. 
 
 But the long chronic case, who knows too well himself, 
 and who has been told by his physician that he wdll never 
 enter active life again, who feels that every month he has 
 to give up something he could do the month before — oh ! 
 spare such sufferers your chattering hopes. You do not 
 know how you worry and weary them. Such real suffer- 
 ers cannot bear to talk of themselves, still less to hope for 
 what they cannot at all expect. 
 
 So also as to all the advice showered so profusely upon 
 such sick, to leave off some occupation, to try some other 
 doctor, some other house, climate, pill, powder, or specific ; 
 I say nothing of the inconsistency — for these advisers are 
 sure to be the same persons who exhorted the sick man 
 not to beUeve his own doctor's prognostics, because " doc- 
 tors are always mistaken," but to believe some other
 
 76 NOTES ON NURSING. 
 
 doctor, because " this doctor is always right." Sure also 
 are these advisers to be the persons to bring the sick man 
 fresh occupation, while exhorting him to leave his own. 
 
 Wonderful is the foce with which friends, lay and medi- 
 cal, will come in and wony the patient with recommenda- 
 tions to do something or other, having just as little knowl- 
 edge as to its being feasible, or even safe for him, as if 
 they were to recommend a man to take exercise, not 
 knowing he had broken his leg. What would the friend 
 say, if he were the medical attendant, and if the patient, 
 because some other Mend had come in, because somebody, 
 anybody, nobody, had recommended something, anything, 
 nothing, were to disregard his orders, and take that other 
 body's recommendation ? But people never think of this. 
 
 A celebrated historical personage has related the com- 
 monplaces which, when on the eve of executing a remark- 
 able resolution, were showered in nearly the same words 
 by every one around successively for a period of six 
 nionths. To these the personage states that it was found 
 least trouble always to reply the same thing, viz., that it 
 could not be supj^osed that such a resolution had been 
 taken without sufficient previous consideration. To pa- 
 tients enduring every day for years from every friend or 
 acquaintance, either by letter or m^ya voce, some torment 
 of this kind, I would suggest the same answer. It would 
 indeed be spared, if such friends and acquaintances would 
 but consider for one moment, that it is probable the pa- 
 tient has heard sueh advice at least fifty times before, and 
 that, had it been practicable, it would have been practised 
 long ago. But of such consideration there appear to be 
 no chance. Strange, though true, that people should be 
 just the same in these things as they were a few hundred 
 years ago ! 
 
 To me these commonplaces, leaving their smear upon 
 the cheerful, single-hearted, constant devotion to duty, 
 which is so often seen in the decline of such sufferers, re- 
 call the slimy tmil left by the snail on the sunny southern 
 garden-wall loaded with fruit. 
 
 No mockery in the world is so hollow as the advice 
 showered upon the sick. It is of no use for the sick to 
 say anything, for what the adviser wants is, not to know 
 the truth about the state of the patient, but to turn what- 
 ever the sick may say to the support of his own argument,
 
 CHATTERING HOPES AND ADVICES. 77 
 
 get forth, it must be repeated, without any inquiry what- 
 ever into the jD^tient's real condition. " But it would be 
 impertinent or indecent in me to make such an inquiry," 
 says the adviser. True ; and how much more impertinent 
 is it to give your advice when you can know nothing about 
 the truth, and admit you could not inquire into it. 
 
 To nurses I say — these are the visitors Avho do your 
 patient harm. When you hear him told: — 1. That he 
 has nothing the matter with him, and that he wants cheer- 
 ing. 2. That he is committing suicide, and that he wants 
 preventing. 3. That he is the tool of somebody who 
 makes use of him for a purpose. 4. That he will listen to 
 nobody, but is obstinately bent upon his own way ; and 5. 
 That he ought to be called to a sense of duty, and is fly- 
 ing in the face of Providence ; — then know that your pa- 
 tient is receiving all the injury that he can receive from a 
 visitor. 
 
 How little the real sufferings of illness are known or 
 understood. How little does any one in good health fancy 
 him or even Aerself into the life of a sick person. 
 
 Do, you who are about the sick or who visit the sick, try 
 and give them pleasure, remember to tell them what will 
 do so. How often in such visits the sick person has to do 
 the whole conversation, exerting his own imagination and 
 memory, while you would take the visitor, absorbed in-his 
 own anxieties, making no effort of memory or imagination, 
 for the sick person. " Oh ! my dear, I have so much to 
 think of, I really quite forgot to tell him that ; besides, I 
 thought he would know it," says the visitor to another 
 friend. How could "he know it?" Depend upon it, the 
 people who say this are really those who have little " to 
 think of" There are many burthened with business who 
 always manage to keep a pigeon-hole in their minds, full 
 of things to tell the " invalid." 
 
 I do not say, don't tell him your anxieties — I believe it 
 is good for him and good for you too ; but if you tell him 
 what is anxious, surely you can remember to tell him what 
 is pleasant too. 
 
 A sick person does so enjoy hearing good news: — for 
 
 instance, of a love and courtship, while in progress to a 
 
 good ending. If you tell him only when the marriage 
 
 takes place, he loses half the pleasure, which God knows 
 
 7*
 
 78 KOTES ON NUriSIKG. 
 
 he lias little cnoiigli of; and ten to one but you have told 
 him of some love-making with a had ending. 
 
 A sick person also intensely enjoys hearing of any m«- 
 terial good, any positive or practical success of the light. 
 He has so much of books and fiction, of principles, and 
 precepts, and theories ; do, instead of advising him with 
 advice he has heard at least fifty times before, tell him of 
 one benevolent act which has really succeeded practically, 
 — it is like a day's health to him.* 
 
 You have no idea what the craving of sick w^ith undi- 
 minished power of thinking, but little power of doing, is 
 to hear of good j^ractical action, when they can no longer 
 partake in it. 
 
 Do observe these things with the sick. Do remember 
 how their life is to them disappointed and incomplete. 
 You see them lying there with miserable disappointments, 
 from which they can have no escape but death, and you 
 can't remember to tell them of what would give them so 
 much pleasure, or at least an hour's variety. 
 
 They don't w%ant you to be lachrymose and whining with 
 them; "they like you to be fresh and active and interested, 
 but they cannot bear absence of mind, and they are so 
 tired of the advice and preaching they receive from every- 
 body, no matter whom it is, they see. 
 
 TKere is no better society than babies and sick pe(tj)le 
 for one another. Of course you must manage this so that 
 neither shall suffer from it, which is perfectly possible. If 
 you think the " air of the sick room " bad for the baby, wliy 
 It is bad for the invalid too, and therefore you will of course 
 correct it for both. It freshens up a sick person's whole 
 mental atmosphere to see " the baby." And a very young 
 child, if unspoiled, w^ill generally adapt itself wonderfully 
 to the ways of a sick person, if the time they spend together 
 is not too long. 
 
 If you knew how unreasonably sick people suifer from 
 reasonable causes of distress, you would take more pains 
 about all these things. An infant laid upon the sick bed 
 will do the sick person, thus suffering, more good than all 
 
 * A small pet animal is often an excellent companion for the sick, 
 for long chronic cases especially. A pet bird in a cage is sometimes 
 the only pleasure of an invalid confined for years to the same room. 
 If he can feed and clean the animal himself, he oiight always to be 
 encouraoed to do so.
 
 OBSERVATION OP THE SICK. 79 
 
 your logic. A piece of good news will do the same. Per- 
 haj^s you are afraid of "disturbing" him. You say there 
 is no comfort for his present cause of affliction. It is per- 
 fectly reasonable. The distinction is this : if he is obliged 
 to act, do not "disturb" him with another subject of 
 thought just yet; help him to do what he wants to do; 
 but, if he has done this, or if nothing can be done, then 
 " disturb " him by all means. You will relieve, more effect- 
 ually, unreasonable suffering from reasonable causes by 
 telling him " the news," showing him " the baby," or giv- 
 ing him something new to think of or to look at than by 
 all the logic in the world. 
 
 It has been very justly said that the sick are like chil- 
 dren in this, that there is no proportion in events to them. 
 Now it is your business a^ their visitor to restore this right 
 proportion for them — to show them what the rest of the 
 world is doing. How can they find it out otherwise ? 
 You will find them fir more open to conviction than chil- 
 dren in this. And you will find that their unreasonable 
 intensity of suffering from unkindness, from want of sym- 
 pathy, &c., will disappear Avith their freshened interest in 
 the big workfs events. But then you must be able to give 
 them real interests, not gossip. 
 
 Note. — There are two classes of patients which are unfortunately 
 becoming more common every day, e.^pecially among women of the 
 richer orders, to whom all these remarks are preeminently inapplicable. 
 
 1. Those who make health an excuse for doing nothing, and at the 
 same time allege that the being able to do nothing is their only grief. 
 
 2. Those who have brought upon themselves ill-health by over pursuit 
 of amusement, which they and their friends have most unhappily called 
 intellectual activity. I scarcely know a greater injury that can be 
 inflicted than the advice too often given to the first class to " vegetate " 
 — or than the admiration too often bestowed on the latter class for 
 " pluck." 
 
 Xni. OBSERVATION OF THE SICK. 
 
 There is no more silly or universal question scarcely 
 asked than this, " Is he better ? " Ask it of the medical 
 attendant, if you please. But of whom else, if you wish 
 for a real answer to your question, would you ask it? Cer- 
 tainly not of the casual visitor; certainly not of the nurse, 
 while the nurse's obseiwation is so little exercised as it is
 
 so NOTES ON t^vmtm. 
 
 now* What you want are fact;?, not opinions ; for who can 
 have any opinion of any vahxe a» to whether the patient is 
 better or wor&e, excepting the constant medical attendant, 
 or the really observing nurse ? 
 
 The most important practical lesson that can be given 
 to nur»es is to teach them what to obsen^e — how to ob- 
 geiwe — what symptoms indicate improvement — what the 
 reverse — -which are of importance — which are of none 
 — which are the evidence of neglect — and of what kind 
 of neglect. 
 
 All this is what ought to make pait, and an essential 
 part, of the training of every nurse. At present, how few 
 there are, either professional or unprofessional, who really 
 know at all whether any sick person they may be with is 
 better or worse. 
 
 The vagueness and looseness of the infoiination one re- 
 ceives in answer to that much abused question, "Is he 
 better ? " would be ludicrous, if it were not painful. The 
 only sensible answer (in the present state of knowledge 
 about sickness) Tvould be " How can I know ? I cannot tell 
 how he was when I was not with him." 
 
 I can record but a very few ^^pecimens of the answers * 
 
 * It is a much more difficult thing to speak the truth than people 
 commonly imagine. There is the want of observation simple, and the 
 ivant of observation compoimd, compounded, that is, with the imagina- 
 tive faculty. Both may equally intend to speak the truth. The 
 information of the first is simply defective. That of the second is much 
 more dangerous. The first gives, in answer to a question asked about 
 a thing that has been before his eyes perhaps for years, information 
 exceedingly imperfect, or says, he does not know. He has never 
 observed. And people simply think him stupid. 
 
 The second has observed just as little, but imagination immediately 
 steps in, and he describes the whole thing from imagination merely, 
 being perfectly convinced all the while that he has seen or heard it ; or 
 he will repeat a whole conversation, as if it were information which had 
 been addressed to him ; whereas it is merely what he has himself said 
 to somebody else. This is the commonest of all. These people do not 
 even observe that they have 7iot observed, nor remember that they have 
 forgotten. 
 
 Courts of justice seem to think that anybody can speak "the whole 
 truth, and nothing but the truth," if he does but intend it. It requires 
 many faculties combined of observation and memory to speak " the 
 whole truth," and to say " nothing but the truth." 
 
 "I knows I fibs dreadful; but believe me. Miss, I never finds out I 
 have fibbed until they tells me so," was a remark actually made. It is 
 also one of much more extended application than most people have the 
 least idea of.
 
 OBSERVATION OF THE SICK. 81 
 
 which I have heard made by friends and nurses, and ac- 
 cepted by physicians and surgeons at the very bed-side of 
 the patient, who could have contradicted every word, but 
 did not — sometimes from amiability, often from shyness, 
 oftenest from languor ! 
 
 " How often have the bowels acted, nurse ? " " Once, sir." 
 This generally means that the utensil has been emptied 
 once, it having been used perhaps seven or eight times. 
 
 "I)o you think the patient is much weaker than he was 
 six weeks ago ? " " Oh no, sir ; you know it is very long 
 since he has been up and dressed, and he can get across 
 the room now." This means that the nurse has not ob- 
 seiwed that whereas six weeks ago he sat up and occupied 
 himself in bed, he now lies still doing nothing ; that al- 
 though he can "get across the room," he cannot stand for 
 five seconds. 
 
 Another patient who is eating well, recovering steadily, 
 although slowly, from fever, but cannot Avalk or stand, is 
 represented to the doctor as making no progress at all. 
 
 Questions, too, as asked now (but too generally) of or 
 about patients, would obtain no information at all about 
 them, even if the person asked of had every information 
 to give. The question is generally a leading question ; 
 and it is singular that people never think what must be 
 the answer to this question before they ask it : for instance, 
 " Has he had a good night ? " Now, one patient will think 
 he has had a bad night if he has not slept ten hours with- 
 out waking. Another does not think he has had a bad 
 night if he has had intervals of dozing occasionally. The 
 same answer has actually been given as regarded two pa- 
 
 Concurrence of testimony, which is so often adduced as final proof, 
 may prove nothing more, as is well, known to those accustomed to deal 
 with the unobservant imaginative, than that one person has told his 
 story a great many times. 
 
 I have heard thirteen persons •♦concur" in declaring that a four- 
 teenth, who had never left his bed, went to a distant chapel every morn- 
 ing at seven o'clock. 
 
 I have heard persons in perfect good faith declare, that a man came 
 to dine every day at the house where they lived, who had never dined 
 there once ; that a person had never taken the saci-ament, by whose side 
 they liad twice at least knelt at Communion ; that but one meal a day 
 came out of a hospital kitchen, which for six weeks they had seen pro- 
 vide from three to five and six meals a day. Such instances might be 
 multiplied ad infiuUuin if necessary.
 
 82 NOTES ON NURSING. 
 
 tients — one who had been entirely sleepless for five thnea 
 twenty-four hours, and died of it, and another who had 
 not slept the sleep of a regular night, without waking. 
 Why cannot the question be asked, How many hours' 
 
 sleep has had ? and at what hours, of the night ? * 
 
 "I have never closed ray eyes all night," an answer as fre- 
 quently made when the speaker has had several hours' 
 sleep as when he has had none, would then be less often 
 said. Lies, intentional and unintentional, are much sel- 
 domer told in answer to precise than to leading questions. 
 
 Another frequent error is to inquire whether one cause 
 remains, and not whether the effect which may be j)ro- 
 duced by a great many different causes, 7iot inquired after, 
 remains. As when it is asked, whether there was noise in 
 the street last night ; and if there were not, the patient is 
 reported, without more ado, to have had a good night. 
 Patients are completely taken aback by these kinds of 
 leading questions, and give only the exact amount of in- 
 formation asked for, even when they know it to be com- 
 pletely misleading. The shyness of patients is seldom al- 
 lowed for. 
 
 How few there are who, by five or six pointed questions, 
 can elicit the whole case, and get accurately to know and 
 to be able to report ivhere the patient is. 
 
 I knew a very clever physician, of large dispensary and 
 hospital practice, who invariably began his examination of 
 each patient with "Put your linger where you be Ijad." 
 That man would never- waste his time with collecting in- 
 accurate information from nurse or patient. Leading ques- 
 tions always collect inaccurate information. 
 
 At a recent celebrated trial, the following leading ques- 
 tion was put successively to nine distinguished medical 
 men. " Can you attribute these symptoms to anything 
 else but poison ? " And out of the nine, eight answered 
 " No ! " without any qualification whatever. It appeared, 
 
 * This is important, because on this depends Avhat the remedy will 
 be. If a patient sleeps two or three hours early in the night, and then 
 does not sleep again at all, ten to one it is not a narcotic he wants, but 
 food or stimulus, or perhaps only warmth. If, on the other hand, he 
 is restless and awake all night, and is drowsy in the morning, he proba- 
 bly wants sedatives, either quiet, coolness, or medicine, a lighter diet, 
 or all four. Now the doctor should be told this, or how can he judge 
 what to give r
 
 OBSERVATION OP THE SICK. 83 
 
 upon cross-examination : — 1. That none of them had 
 ever seen a case of the kind of poisoning supposed. 2. 
 That none of them had ever seen a case of the kind of dis- 
 ease to which the death, if not to poison, was attributa- 
 ble. 3. That none of them were even aware of the main 
 fact of the disease and condition to which the death was 
 attributable. 
 
 Surely nothing stronger can be adduced to prove what 
 use leading questions are of, and what they lead to. 
 
 I had rather not say how many instances I have known, 
 w^here, owing to this system of leading questions, the pa- 
 tient has died, and the attendants have been actually un- 
 aware of the principal feature of the case. 
 
 It is useless to go through all the particulars, besides 
 sleep, in which people have a peculiar talent for gleaning 
 inaccurate information. As to food, for instance, I often 
 think that most common question, How^ is your appetite ? can 
 only be put because the questioner believes the questioned 
 has really nothing the matter with him, which is very oft- 
 en the case. But where there is, the remark holds good 
 which has been made about sleep. The same answer will 
 often be made as regards a patient who cannot take two 
 ounces of solid food per diem, and a patient who does not 
 enjoy five meals a day as much as usual. 
 
 Again, the question. How is your appetite ? is often put 
 when How is your digestion ? is the question meant. No 
 doubt the two things depend on one another. But they 
 are quite different. Many a patient can eat, if you can 
 only " tempt his appetite." The fault lies in your not hav- 
 ing got him the thing he fancies. But many another pa- 
 tient does not care between grapes and turnips — every 
 thing is equally distasteful to him. He would try to eat 
 anything which would do him good ; but everything 
 "makes him worse." The fault here generally lies in the 
 cooking. It is not his " appetite " which requires " tempt- 
 ing," it is his digestion which requires sparing. And good 
 sick cookery will save the digestion half its work. 
 
 There may be four different causes, any one of which 
 will produce the same result, viz., the patient slowly starv- 
 ing to death from want of nutrition : 
 
 1. Defect in cooking ; 
 
 2. Defect in choice of diet ; 
 
 3. Defect in choice of hours for taking diet ;
 
 84 NOTES ON NURSING. 
 
 4. Defect of appetite in patient. 
 Yet all these are generally comprehended in the one sweep- 
 ing assertion that the patient has " no appetite." 
 
 Surely many lives might be saved by drawing closer dis- 
 tinction ; for the remedies are as diverse as the causes. 
 The remedy for the first is to cook better ; for the second, 
 to choose other articles of diet ; for the third, to watch for 
 the hours when the patient is in want of food; for the 
 fourth, to show him what he likes and sometimes unex- 
 pectedly. But no one of these remedies will do for any 
 other of the defects not corresponding with it. 
 
 I cannot too often repeat that patients are generally 
 either too languid to observe these things, or too shy to 
 speak about them ; nor is it well that they should be made 
 to observe them, it fixes their attention upon themselves. 
 
 Again, I say, what is the nurse or friend there for except 
 to take note of these things, instead of the patient domg 
 so?* 
 
 Again, the question is sometimes put. Is there diarrhcea ? 
 And the answer will be the same, whether it is just mer- 
 ging into cholera, whether it is a trifling degree brought on 
 by some trifling indiscretion, which will cease the moment 
 the cause is removed, or whether there is no diarrhoea at 
 all but simply relaxed bowels. 
 
 It is useless to multiply instances of this kind. As long 
 as observation is so little cultivated as it is now, I do be- 
 lieve that it is better for the physician 7iot to see the friends 
 of the patient at all. They will oftener mislead him than 
 not. And as often by making the patient out worse as 
 better than he really is. 
 
 In the case of infants, everything must depend upon the 
 accurate observation of the nurse or mother who has to 
 report. And how seldom is this condition of accuracy 
 fulfilled. 
 
 A celebrated man, though celebrated only for fooUsh 
 
 * It is commonly supposed that the nurse is there to spare the patient 
 from making physical exertion for himself — I would rather say that she 
 ought to be there to spare him from taking thought for himself. And 
 I am quite sure, that if the patient were spared all thought for himself, 
 and 7iot spared all physical exertion, he would be intinitely the gamer. 
 The reverse is generally the case in the private house. In the hospital 
 it is the relief from all anxiety, afforded by the rules of a well-regulated 
 institution, which has often such a beneticial etiect upon the patient.
 
 OBSERVATION OF THE SICK. 85 
 
 things, has told us that one of his main objects in the edu- 
 cation of his son, was to give hiin a ready habit of accurate 
 observation, a certainty of perception, and that for this pur- 
 pose one of his means was a month's course as follows : — 
 he took the boy rapidly past a toy-shop ; the father and son 
 then described to each other as many of the objects as 
 they could, which they had seen in passing the windows, 
 noting them down with pencil and paper, and returning 
 afterwards to verify their own accuracy. The boy always 
 succeeded best, e. g.^ if the father described 30 objects, the 
 boy did 40, and scarcely ever made a mistake. 
 
 I have often thought how wise a piece of education 
 this would be for much higher objects ; and in our calling 
 of nurses the thing itself is essential. For it may safely 
 be said, not that the habit of ready and correct observa- 
 tion will by itself make us useful nurses, but that without 
 it we shall be useless with all our devotion. 
 
 I have known a nurse in charge of a set of wards, who 
 not only carried in her head all the little varieties in the 
 diets which each patient was allowed to fix for himself, but 
 also exactly what each patient had taken during each day. 
 J have known another nurse in charge of one single pa- 
 tient, who took away his meals day after day all but un- 
 touched, and never knew it. 
 
 If you find it helps you to note down such things on a 
 bit of paper, in pencil, by all means do so. I think.it more 
 often lames than strengthens the memory and observation. 
 But if you cannot get the habit of observation one way or 
 other, you had better give up the being a nurse, for it is not 
 your calhng, however kind and anxious you may be. 
 
 Surely you can learn at least to judge with the eye how 
 much an oz. of solid food is, how much an oz. of liquid. 
 You will find this helps your observation and memory very 
 much ; you will then say to yourself, " A. took about an oz. 
 of his meat to-day ; " " B. took three times in 24 hours 
 about \ pint of beef tea ; " instead of saying " B. has taken 
 nothing all day," or " I gave A. his dinner as usual." 
 
 I have known several of our real old-fashioned hospital 
 "sisters," who could, as accurately as a measuring glass, 
 measure out all their patients' wine and medicine by the 
 eye, and never be wrong. I do not recommend this ; one 
 must be very sure of one's self to do it. I only mention it, 
 because if a nurse can by practice measure medicine by the
 
 86 NOTES ON NURSING. 
 
 eye, surely she is no nurse who cannot measure by the eye 
 about liow much food (in oz.) her patient has taken* In hos- 
 pitals those who cut up the diets give with quite sufficient 
 accuracy, to each patient, his 12 oz. or his 6 oz. of meat 
 without weighing. Yet a nurse will often have patients 
 loathing all food and incapable of any will to get well, who 
 just tumble over the contents of the plate or dip the spoon 
 in the cup to deceive the nurse, and she Avill take it away 
 without ever seeing that there is just the same quantity of 
 
 * It may be too broad an assertion, and it certainly sounds like a para- 
 dox. But I think that in no country are women to be found so deficient 
 in ready and sound observation as in England, -while peculiarly capable 
 of being trained to it. The French or Irish woman is too quick of per- 
 ception to be so sound an observer — the Teuton is too slow to be so 
 ready an observer as the English woman might be. Yet English 
 women lay themselves open to the charge so often made against them 
 by men, viz., that they are not to be trusted in handicrafts to which 
 their strength is quite equal, for want of a practised and steady obser- 
 vation. In countries where women (with average intelligence certainly 
 not superior to that of English women) are employed, e. g., in dispen- 
 sing, men responsible for what these women do (not theorizing about 
 man's and woman's «' missions,") have stated that they preferred the 
 service of women to that of men, as being more exact, more careful, 
 and incurring fewer mistakes of inadvertence. 
 
 Now certainly English women are peculiarly capable of attaining to 
 this. 
 
 I remember when a child, hearing the story of an accident, related 
 by some one who sent two girls to fetch a "bottle of salvolatile from 
 her room; " '« Mary could not stir," she said, "Fanny ran and fetched 
 a bottle that was not salvolatile, and that was not in my room." 
 
 Now this sort of thing pursues every one through life. A woman is 
 asked to fetch a large new bound red book, lying on the table by the 
 window, and she fetches five small old boarded brown books lying on 
 the shelf by the fire. And this, though she has '< put that room to 
 rights " every day for a month perhaps, and must have observed the 
 books every day, lying in the same places, for a month, if she had any 
 observation. 
 
 Habitual observation is the more necessary, when any sudden call 
 arises. If "Fanny" had observed "the bottle of salvolatile" in "the 
 aunt's room," every day she was there, she would more probably have 
 found it when it was suddenly wanted. 
 
 There are two causes for these mistakes of inadvertence. 1. A want 
 of ready attention ; only part of the request is heard at all. 2. A 
 want of the habit of observation. 
 
 To a nurse I would add, take care that you always put the same 
 things in the sarne places ; you don't know how suddenly you may be 
 called on some day to find something, and may not be able to remem- 
 ber in your haste where you yourself had put it, if your memory is not 
 there always,
 
 OBSERVATION OF THE SICK. 87 
 
 food as when she brought it, and she will tell the doctor, 
 too, that the patient has eaten all his diets as usual, when 
 all she ought to have meant is that she has taken away his 
 diets as usual. 
 
 Now what kind of a nurse is this. 
 
 I would call attention to something else, in which nurses 
 frequently fail in observation. There is a well-marked dis- 
 tinction between the excitable and what I will call the 
 accumulative temperament in jDatients. One will blaze up 
 at once, under any shock or anxiety, and sleep very com- 
 fortably after it ; another will seem quite calm and even 
 torpid, under the same shock, and people say, " He hardly 
 felt it at all," yet you will find him some time after slowly 
 sinking. The same remark applies to the action of nar- 
 cotics, of aperients, which, in the one, take eftect directly, 
 in the other not perhaps for twenty-four hours. A journey, 
 a visit, an unwonted exertion, will aflTect the one immedi- 
 ately, but he recovers after it ; the other bears it very well 
 at the time, apparently, and dies or is prostrated for life by 
 it. People often say how difficult the excitable tempera- 
 ment is to manage. I say how difficult is tlie accumulative 
 temperament. With the first you have an out-break which 
 you could anticipate, and it is all over. With the second 
 you never know Avhere you are — you never know when 
 the consequences are over. And it requires your closest 
 observation to know what «re the consequences of what — 
 for the consequent by no means follows immediately upon 
 the antecedent — and coarse observation is utterly at fault. 
 
 Almost all superstitions are owing to bad observation, to 
 the ^9<9s^ Aoc, ergo propter hoc; and bad observers are 
 almost all superstitious. Farmers used to attribute disease 
 among cattle to witchcraft ; weddings have been attrib- 
 uted to seeing one magpie, deaths to seeing three ; and I 
 have heard the most highly educated now-a-days draw 
 consequences for the sick closely resembling these. 
 
 Another remark : although there is unquestionably a phys- 
 iognomy of disease as well as of health; of all parts of the 
 body, the face is perhaps the one which tells the least to the 
 common observer or the casual visitor. Because, of all parts 
 of the body it is the one most exposed to other influences, 
 besides health. And people never, or scarcely e^ er, ob- 
 serve enough to know how to distinguish between the ef- 
 fect of exposure, of robust health, of a tender skin of a
 
 88 NOTES ON NURSING. 
 
 tendency to congestion, of suffusion, flushing, or many 
 other things. Again, the face is often the hist to sliow 
 emaciation. I should say that the hand was a much surer 
 test than the face, both as to flesh, color, circulation, &c., 
 &c. It is true that there are some diseases which are only 
 betrayed at all by something in the face, e. g.^ the eye or 
 the tongue, as great irritability of brain by the appearance 
 of the pupil of the eye. But we are talking of casual, 
 not minute, observation. And few minute observers will 
 hesitate to say that far more untruth than truth is con- 
 veyed by the oft repeated words, He looks well, or ill, or 
 better or worse. 
 
 Wonderful is the way in which people will go upon the 
 slightest observation, or often upon no observation at all, 
 or upon some saic^ which the world's experience, if it had 
 any, would have pronounced utterly false long ago 
 
 I have known patients dying of sheer pain, exhaustion, 
 and want of sleep, from one of the most lingering and 
 painful diseases known, preserve, till within a few days of 
 death, not only the healthy color of the cheek, but the 
 mottled appearance of a robust child. And scores of times 
 have I heard these unfortunate creatures assailed with, " I 
 am glad to see you looking so well." " I see no reason why 
 you should not live till ninety years of age." " AVhy don't 
 y(fti take a little more exercise and amusement ? " with all 
 the other commonplaces with which we are so familiar. 
 
 There is, unquestionably, a physiognomy of disease. 
 Let the nurse learn it. 
 
 The experienced nurse can always tell that a person has 
 taken a narcotic the night before by the pat chin ess of the 
 color about the face, when the re-action of depression has 
 set in ; that very color which the inexperienced will point 
 to as a proof of health. 
 
 There is, again, a faintness which does not betray itself 
 by the color at all, or in which the patient becomes brown 
 instead of white. There is a faintness of another kind 
 which, it is true, can always be seen by the paleness. 
 
 But the nurse seldom distinguishes. She will talk to 
 the patient who is too faint to move, without the least scru- 
 ple, unless he is pale and unless, luckily for him, the mus- 
 cles of the throat are aflected and he loses his voice. 
 
 Yet these two faintnesses are perfectly distinguishable, 
 by the mere countenance of the patient.
 
 OBSERVATION OF THE SICK. 89 
 
 Again, the nurse must distinguish between the idiosyn- 
 crasies of patients. One Hkes to suffer out all his suffer- 
 ing alone, to be as little looked after as possible. Another 
 likes to be perpetually made much of and pitied, and to 
 have some one always by him. Both these peculiarities 
 might be observed and indulged much more than they 
 are. For quite as often does it happen that a busy attend- 
 ance is forced upon the first patient, who wishes for noth- 
 ing but to be " let alone," as that the second is left to think 
 himself neglected. 
 
 Again, I think that few things press so heavily on one 
 suffering from long and incurable illness, as the necessity 
 of recording in Avords from time to time, for the informa- 
 tion of the. nurse, who Avill not otherwise see, that he can- 
 not do this or that, which he could do a month or a year 
 ago. AYliat is a nurse there for if she cannot observe these 
 things for herself? Yet I have known — and known too 
 among those — and chiefly among those — whom money 
 and position put in possession of everything which money 
 and position could give — I have known, I say, more acci- 
 dents, (fatal, slowly or rapidly,) arising from this want of 
 observation among nurses than from almost anything else. 
 Because a patient could get out of a warm-bath alone a 
 month ago — because a patient could walk as far as his bell 
 a week ago, the nurse concludes that he can do so now. 
 She has never observed the change; and the patient is 
 lost from being left in a helpless state of exhaustion, till 
 some one accidentally comes in. And this not from any un- 
 expected apoplectic, paralytic, or fainting fit (though even 
 these could be expected far more, at least, than they are 
 now, if we did but observe). No, from the expected, or to 
 be expected, inevitable, visible, calculable, uninterrupted 
 increase of weakness, which none need fail to observe. 
 
 Again, a patient not usually confined to bed, is compelled 
 by an attack of diarrhoea, vomiting, or other accident, to 
 keep his bed for a few days ; he gets up for the first time, 
 and the nurse lets him go into another room, without com- 
 ing in, a few minutes afterwards, to look after him. It 
 never occurs to her that he is quite certain to be faint, or 
 cold, or to want something. She says, as her excuse. Oh, 
 he does not like to be fidgetted after. Yes, he said so 
 some weeks ago ; but he never said he did not like to be 
 " fidgetted after," when he is in the state he is in now ; 
 8*
 
 90 NOTES ON NURSING. 
 
 and if lie did, you ought to make some excuse to go in to 
 him. More patients have been lost in this way than is 
 at all generally known, viz.,, from relapses brought on by 
 being left for an hour or two faint, or cold, or hungry, after 
 getting up for the first time. 
 
 Yet it appears that scarcely any improvement in the 
 faculty of observing is being made. Vast has been the 
 increase of knowledge in pathology — that science which 
 teaches us the final change produced by disease on the hu- 
 man frame — scarce any in the art of observing the signs 
 of the change while in progress. Or, rather, is it not to be 
 feared that observation, as an essential part of medicine, 
 has been declining? 
 
 Which of us has not heard fifty times, from one or 
 another, a nurse, or a friend of the sick, aye, and a medical 
 friend too, the following remark : — " So A is worse, or B 
 is dead. I saw him the day before ; I thought him so much 
 better; there certainly was no appearance from which one 
 could have expected so sudden (?) a change." I have 
 never heard any one say, though one would think it the 
 more natural thing, " There must have been some appear- 
 ance, which I should have seen if I had but looked; let me 
 try and remember what there was, that I may observe 
 another time." No, this is not what people say. They 
 boldly assert that there was nothing to observe, not that 
 their observation was at fault. 
 
 Let people who have to observe sickness and death look 
 back and try to register in their observation the appear- 
 ances which have preceded relapse, attack, or death, and 
 not assert that there were none, or that there were not the 
 right ones.* 
 
 A want of the habit of observing conditions and an in- 
 
 * It falls to few ever to have had the opportunity of observing the 
 different aspects which the human face puts on at the sudden approach 
 of certain forms of death by violence ; and as it is a knowledge of little 
 use, I only mention it here as being the most startling exam.ple of what 
 I mean. In the nervous temperament the face becomes pale (this is the 
 only recognized effect) ; in the sanguine temperament purple ; in the 
 bilious yellow, or every manner of color in patches. Now, it is gen- 
 erally supposed that paleness is the one indication of almost any violent 
 change in the human being, whether from terror, disease, or anything 
 else. There can be no more false observation. Granted, it is the one 
 recognized livery, as I have said — de rigueur in novels, but nowhere 
 else.
 
 OBSERVATION OF THE SICK. 91 
 
 veterate habit of taking averages are each of tliem often 
 equally misleading. 
 
 Men whose profession like that of medical men leads 
 them to observe only, or chiefly, palpable and permanent 
 organic changes are often just as wrong in their opinion of 
 the result as those who do not observe at all. For instance, 
 there is a broken leg ; the surgeon has only to look at it 
 once to know ; it will not be diiferent if he sees it in the 
 morning to what it would have been had he seen it in the 
 evening. And in whatever conditions the patient is, or is 
 likely to be, there will still be the broken leg, until it is set. 
 The same with many organic diseases. An experienced 
 physician has but to feel the pulse once, and he knows that 
 there is aneurism which will kill some time or other. 
 
 But with the great majority of cases, there is nothing of 
 the kind ; and the power of forming any correct opinion as 
 to the result must entirely depend upon an inquiry into all 
 the conditions in which the patient lives. In a complicated 
 state of society in large towns, death, as every one of great 
 experience knows, is far less often produced by any one 
 organic disease than by some illness, after many other dis- 
 eases, producing just the sum of exhaustion necessary for 
 death. There is nothing so absurd, nothing so misleading 
 as the verdict one so often hears : So-and-so has no organic 
 disease, — there is no reason why he should not live to 
 extreme old age; sometimes the clause is added, some- 
 times not : Provided he has quiet, good food, good air, 
 &c., &c., &c. ; the verdict is repeated by ignorant people 
 without the latter clause ; or there is no possibility of the 
 conditions of the latter clause being obtained ; and this, 
 the only essential part of the whole, is made of no effect. 
 I have heard a physician, deservedly eminent, assure the 
 friends of a patient of his recovery. Why? Because he 
 had now prescribed a course, every detail of which the pa- 
 tient had followed for years. And because he had forbid- 
 den a course which the patient could not by any possibil- 
 ity alter.* 
 
 * I have known two cases, the one of a man who intentionally and 
 repeatedly displaced a di.slocation, and was kept and petted by all the 
 surgeons ; the other of one who was pronounced to have nothing the 
 matter with him, there being no organic change perceptible, but who 
 died within the week. In both these cases, it was the nurse who, by 
 accurately pointing out what she had accurately observed, to the doc-
 
 92 NOTES ON NURSING. 
 
 Undoubtedly a person of no scientific knowledge what- 
 ever but of observation and experience in these kinds of 
 conditions, will be able to arrive at a much truer guess as 
 
 tors, saved the one case from persevering in a fraud, the other from 
 being discharged when actually in a djHng state. 
 
 I will even go further and say, that in diseases which have their ori- 
 gin in the feeble or irregular action of some function, and not in organic 
 change, it is quite an accident if the doctor who sees the case only once 
 a day, and generally at the same time, can form any but a negative idea 
 of its real condition. In the middle of the daj^ when such a patient 
 has been refreshed by light and air, by his tea, his beef-tea, and his 
 brandy, by hot bottles to his feet, by being washed and by clean linen, 
 you can scarcely believe that he is the same person as lay with a rapid 
 fluttering pulse, with puffed eye-lids, with short breath, cold limbs, and 
 unsteady hands, this morning. Now what is a nurse to do in such a 
 case ? Not cry, " Lord, bless you, sir, why you'd have thought he were 
 a dying all night." This may be true, but it is not the way to impress 
 with the truth a doctor more capable of forming a judgment from the 
 facts, if he did but know them, than you are. What he wants is not 
 your opinion, however respectfully given, but your facts. In all dis- 
 eases it is important, but in diseases which do not run a distinct and 
 fixed course, it is not only important, it is essential that the facts the 
 nurse alone can observe, should be accurately observed, and accurately 
 reported to the doctor. 
 
 I must direct the nurse's attention to the extreme variation there is 
 not unfrequently in the pulse of such patients during the day. A very 
 common case is this : Between 3 and 4 a. m., the pulse becomes quick, 
 perhaps 130, and so thready it is not like a pulse at all, but like a 
 string \ibrating just underneath the skin. After this the patient gets 
 no more sleep. About mid-day the pulse has come down to 80 ; and 
 though feeble and compressible, is a very respectable pulse. At night, 
 if the patient has had a day of excitement, it is almost imperceptible. 
 But, if the patient has had a good day, it is stronger and steadier, and 
 not quicker than at mid- day. This is a common history of a common 
 pulse ; and others, equally varying during the day, might be given. 
 Now, in inflammation, which may almost always be detected by the 
 pulse, in typhoid fever, which is accompanied by the low pulse that 
 nothing will raise, there is no such great variation. And doctors and 
 nurses become accustomed not to look for it. The doctor indeed can- 
 not. But the variation is in itself an important feature. 
 
 Cases like the above often " go off rather suddenly," as it is called, 
 from some trifling ailment of a few days, which just makes up the sum 
 of exhaustion necessary to produce death. And everybody cries, "Who 
 would have thought it r except the observing nurse, if there is one, who 
 had always expected the exhaustion to come, from which there would 
 be no rally, because she knew the patient had no capital in strength on 
 which to draw, if he failed for a few days to make his barely daily in- 
 come in sleep and nutrition. 
 
 I have often seen really good nurses distressed, because they could 
 not impress the doctor with the real danger of their patient ; and quite 
 provoked because the patient " would look" cither " so much better"
 
 OBSERVATION OF THE SICK. 93 
 
 to the probable duration of life of members of a family or 
 inmates of a house, than the most scientific physician to 
 whom the same persons are brought to haye their pulse 
 felt ; no inquiry being made into their conditions. 
 
 In Life Insurance and such like societies, Avere they in- 
 stead of haying the person examined by a medical man, 
 to haye the houses, conditions, ways of life, of these per- 
 sons examined, at how much truer results would they ar- 
 rive ! W. Smith appears a fine hale man, but it might be 
 known that the next cholera epidemic he runs a bad 
 cliance. Mr. and Mrs. J. are a strong healthy couple, but 
 it might be known that they liye in such a house, in such 
 part of London, so near the riyer that they will kill four- 
 fifths of their children ; which of the children will be the 
 ones to suryiye might also be known. 
 
 Averages again seduce us away from minute observa- 
 tion. " Average mortalities " merely tell that so many per 
 cent, die in this town and so many in that, per annum. 
 But whether A or B will be among these, the " average 
 rate " of course does not tell. We know, say, that from 
 22 to 24 per 1,000 will die in London next year. But mi- 
 nute inquiries into conditions enable us to know that in 
 such a district, nay, in such a street, — or even on one side 
 of that street, in such a particular house, or even on one 
 floor of that particular house, will be the excess of mortal- 
 ity, that is, the person will die wlio ought not to have died 
 before old age. 
 
 Xow, would it not very materially alter the opinion of 
 whoever were endeavoring to form one, if he knew that 
 from that floor, of that house, of that street the man came. 
 
 Much more precise might be our observations even than 
 this, and much more correct our conclusions. 
 
 It is well known that the same names may be seen con- 
 stantly recurring on workhouse books for generations. That 
 is, the persons were born and brought uj), and will be born 
 and brought up, generation after generation, in the condi- 
 
 or " so much worse" than he really is " when the doctor was there." 
 The distress is very legitimate, but it generally arises from the nurse 
 not having the power of laying clearly and shortly before the doctor 
 the facts from which she derives her opinion, or from the doctor being 
 hasty and inexperienced, and not capable of eliciting tliem. A man who 
 really cares for his patients, will soon learn to ask for and appreciate 
 the information of a nurse, who is at once a careful observer and a 
 clear reporter.
 
 94 NOTES ON NURSING. 
 
 lions which make paupers. Death and disease are like the 
 workhouse, they take from the same family, the same 
 house, or in other words, the same conditions. Why will 
 we not observe Avhat they are? 
 
 The close observer may safely predict that such a fam- 
 ily, whether its members marry or not, Avill become extinct ; 
 til at such another will degenerate morally and physically. 
 But who learns the lesson ? On the contrary, it may be 
 well known that the children die in such a house at the rate 
 of 8 out of 10; one would think that nothing more need 
 be said ; for how could Providence speak more distinctly ? 
 yet nobody listens, the family goes on living there till it 
 dies out, and then some other family takes it. Neither 
 would they listen "if one rose from the dead." 
 
 In dwelling upon the vital importance of sound obser- 
 vation, it must never be lost sight of what observation is 
 for. It is not for the sake of piling up miscellaneous in- 
 formation or curious facts, but for the sake of saving life 
 and increasing health and comfort. The caution may 
 seem useless, but it is quite surprising how many men 
 (some women do it too), practically behave as if the scien- 
 tific end were the only one in view, or as if the sick body 
 were but a reservoir for stowing medicines into, and the 
 surgical disease only a curious case the sufferer has made 
 for the attendant's special information. This is really no ex- 
 aggeration. You think, if you suspected your patient was 
 being poisoned, say, by a copper kettle, you would in- 
 stantly, as you ought, cut off* all possible connection be- 
 tween him and the suspected source of injury, Avithout 
 regard to the fact that a curious mine of observation is 
 thereby lost. But it is not everybody who does so, and 
 it has actually been made a question of medical ethics, what 
 should the medical man do if he suspected poisoning? 
 The answer seems a very simple one, — insist on a confi- 
 dential nurse being placed with the patient, or give up the 
 case. 
 
 And remember every nurse should be one who is to be 
 depended upon, in other words, capable of being a " con- 
 fidential " nurse. She does not know how soon she may 
 find herself placed in such a situation ; she must be no 
 gossip, no vain talker; she should never answer questions 
 about her sick except to those who have a right to ask 
 them ; she must, I need not say, be strictly sober and hon-
 
 CONCLUSION. 95 
 
 est; but more than this, she must be a rehgious and de- 
 voted woman ; she must have a respect for her own calUng, 
 because God's precious gift of life is often literally placed 
 in her hands ; she must be a sound, and close, and quick 
 observer; and she must be a woman of delicate and de- 
 cent feeling. 
 
 To return to the question of what observation is for: — 
 It would really seem as if some had considered it as its 
 own end, as if detection, not cure, was their business; nay 
 more, in a recent celebrated trial, three medical men, ac- 
 cording to their own account, suspected poison, prescribed 
 for dysentery, and left the patient to the poisoner. This 
 is an extreme case. But in a small way, the same manner 
 of acting fills under the cognizance of us all. How often 
 the attendants of a case have stated that they knew per- 
 fectly well that the patient could not get well in such an 
 air, in such a room, or under such circumstances, yet have 
 gone on dosing him with medicine, and making no effort 
 to remove the poison from him, or him from the poison 
 which they knew was killing him ; nay, more, have some- 
 times not so much as mentioned their conviction in the 
 right quarter — that is, to the only person who could act 
 in the matter. 
 
 CONCLUSION. 
 
 The whole of the preceding remarks apply even more to 
 children and to puerperal women than to patients in gen- 
 eral. They also apply to the nursing of surgical, quite as 
 much as to that of medical cases. Indeed, if it be possi- 
 ble, cases of external injury require such care even more 
 than sick. In surgical wards, one duty of every nurse 
 certainly is prevention. Fever, or hospital gangrene, or 
 pyccmia, or purulent discharge of some kind may else su- 
 pervene. Has she a case of compound fracture, of am})u- 
 tation, or of erysipelas, it may depend very much on how 
 she looks upon the things enumerated in these notes, 
 Avhether one or other of these hospital diseases attacks her 
 patient or not. If she allows her ward to become filled 
 with the peculiar close foetid smell, so apt to be produced 
 among surgical cases, especially where there is great sup- 
 puration and discharge, she may see a vigorous patient in 
 the prime of life gradually sink and die where, according
 
 96 NOTES ON NURSING. 
 
 to all human probability, he ought to have recoTered. The 
 surgical nurse must be ever on the watch, ever on her 
 guard, against want of cleanliness, foul air, want of light, 
 and of warmth. 
 
 Xevertheless let no one think that because sanitary 
 nursing is the subject of these notes, therefore, what may- 
 be called the handicraft of nursing is to be undervalued. 
 A patient may be left to bleed to death in a sanitary 
 palace. Another who cannot move himself may die of 
 bed-sores, because the nurse does not know how to change 
 and clean him, while he has every requisite of air, light, 
 and quiet. But nursing, as a handicraft, has not been 
 treated of here for three reasons : 1. That these notes do 
 not pretend to be a manual for nursing, any more than for 
 cooking for the sick ; 2. That the writer, who has herself 
 seen more of what may be called surgical nursing, i. e. 
 practical manual nursing, than, perhaps, any one in Europe, 
 honestly believes that it is impossible to learn it from 
 any book, and that it can only be thoroughly learnt in the 
 -wards of a hospital ; and she also honestly believes that 
 the perfection of surgical nursing may be seen practised 
 by the old-fashioned "Sister" of a London hospital, as it 
 can be seen nowhere else in Europe. 3. While thousands 
 die of foul air, &c., w^ho have this surgical nursing to per- 
 fection, the converse is comparatively rare. 
 
 To revert to children. They are much more susceptible 
 than grown people to all noxious influences. They are 
 affected by the same things, but much more quickly and 
 seriously, viz., by want of fresh air, of proper warmth, 
 want of cleanliness in house, clothes, bedding, or body, by 
 startling noises, improper food, or want of punctuality, by 
 dulness and by want of light, by too much or too little 
 covering in bed, or w4ien up, by want of the spirit of man- 
 agement generally in those in charge of them. One can, 
 therefore, only press the importance, as being yet greater 
 in the case of children, greatest in the case of sick chil- 
 dren, of attending to these things. 
 
 That which, however, above all, is known to injure chil- 
 dren seriously is foul air, and most seriously at night. 
 Keeping the rooms where they sleep tight shut up, is de- 
 struction to them. And, if the child's breathing be dis- 
 ordered by disease, a few hours only of such foul air may 
 endanger its life, even where no inconvenience is felt by 
 grown-up persons in the same room.
 
 CONCLUSION. 97 
 
 The folloT^ing passages, taken out of an excellent "Lec- 
 ture on Sudden Death in Infancy and Childhood," just 
 published, show the vital importance of careful nursing of 
 children. " In the great majority of instances, when death 
 suddenly befalls the infant or young child, it is an acci- 
 dent ; it is not a necessary, inevitable result of any disease 
 from which it is suifering." 
 
 It may be here added, that it would be very desirable to 
 know how often death is, with adults, " not a necessary, 
 inevitable result of any disease." Omit the word " sud- 
 den ; " (for sudden death is comparatively rare in middle 
 age ;) and the sentence is almost equally true for all ages. 
 
 The following causes of "accidental" death in sick chil- 
 dren are enumerated: — "Sudden noises, which startle — • 
 a rapid change of temperature, which chills the surface, 
 though only for a moment — a rude awakening from sleep 
 — or even an over-hasty, or an over-full meal" — "any 
 sudden impression on the nervous system — any hasty al- 
 teration of posture — in short, any cause whatever by 
 which the respiratory process may be disturbed." 
 
 It may again be added, that, with very weak adult pa- 
 tients, these cases are also (not often "suddenly fatal," it 
 is true, but) very much often er than is at all generally 
 known, irreparable in their consequences. 
 
 Both for children and for adults, both for sick and for well 
 (although more certainly in the case of sick children than 
 in any others), I would here again repeat, the most fre- 
 quent and most fatal cause of all is sleeping, for even a 
 few hours, much more for weeks and months, in foul air, a 
 condition which, more than any other condition, disturbs 
 the respiratory process, and tends to produce "accidental" 
 death in disease. 
 
 I need hardly here repeat the warning agahist any con- 
 fusion of ideas between cold and fresh air. You may chill 
 a patient fitally without giving him fresh air at all. And 
 you can quite well, nay, much better, give him fresh air 
 without chilling him. This is the test of a good nurse. 
 
 In cases of long recurring laintnesses from disease, for 
 instance, especially disease which aftects the organs of 
 breathing, fresh air to the lungs, warmth to the surf ice, 
 and often (as soon as the patient can swallow) hot drink, 
 these are the right remedies and the only ones. Yet, 
 oftener than not, you see the nurse or mother just reversing
 
 98 NOTES ON NURSING. 
 
 tiiis; shuttii\2^ ^ip ovcry cranny throngli wlilch fresh ah 
 can enter, and leaving the body cold, or j^erhaps throwing 
 a greater weiglit of clothes npon it, when already it is gen- 
 erating too little heat. 
 
 "Breathing carefully, anxionsly, as thongh respiration 
 were a function Avhich required all the attention for its 
 performance," is cited as a not unusual state in children, 
 and as one calling for care in all the things enumerated 
 above. That breathing becomes an almost voluntary act, 
 even in grown up patients who are very weak, must often 
 have been remarked. 
 
 "Disease having interfered with the perfect accomplish- 
 ment of the respiratory function, some sudden demand for 
 its complete exercise, issues in the sudden stand-still of the 
 whole machinery," is given as one process : — " life goes 
 out for want of nervous power to keep the vital functions 
 in acti^4ty," is given as another, by which " accidental" 
 death is most often brought to pass in infancy. 
 
 Also in middle age, both these processes may be seen 
 ending in death, although generally not suddenly. And I 
 have seen, even in middle age, the '•'-sudden stand-still" 
 here mentioned, and from the same causes. 
 
 To sum up : — the answer to two of the commonest ob- 
 jections urged, one by women themselves, the other by 
 men, against the desirableness of sanitary knowledge for 
 women, plus a caution, comprises the whole argument for 
 the art of nursing. 
 
 (1.) It is often said by men, that it is unwise to teach 
 women anything about these laws of health, because they 
 Vv^ill take to physicking, — that there is a great deal too 
 much of amateur physicking as it is, which is indeed true. 
 One eminent physician told me that he had known more 
 calomel given, both at a pinch and for a continuance, by 
 mothers, governesses, and nurses, to children than he had 
 ever heard of a physician prescribing in all his experience. 
 Another says, that women's only idea in medicine is calo- 
 mel and aperients. This is undeniably too often the case. 
 There is nothing ever seen in any professional practice like 
 the reckless j^hysicking by amateur females.* But this is 
 
 * I have known many ladies who, having once obtained a "blue 
 pill" prescription from a physician, gave and took it as a common 
 aperient two or three times a week ■ — witli >^•hat effect may be supposed.
 
 CONCLUSION. 99 
 
 just ^vllat the really experienced and deserving nurse does 
 not do ; she neither physics herself nor others. And to 
 cultivate in things pertaining to health, observation and 
 experience in women who are mothers, governesses or 
 nurses, is just the way to do away with amateur physicking, 
 and if the doctors did but know it, to make the nurses 
 obedient to them,-— helps to them instead of hindrances. 
 Such education in women would indeed diminish the doc- 
 tor's work — but no one really believes that doctors wish 
 
 In one case I happened to be the person to inform the physician of it, 
 who substituted for the prescription a comparatively harmless aperient 
 pill. The lady came to me and complained that it " did not suit her 
 half so well." 
 
 If women will take or give physic, by far the safest plan is to send 
 for •' the doctor " every time — for I have known ladies who both gave 
 and took physic, who would not take the pains to learn the names of 
 the commonest medicines, and confounded, e. </., colocynth with colchi- 
 cum. This is playing with sharp-edged tools " with a vengeance." 
 
 There are excellent women who will write to London to their physi- 
 cian that there is much sickness in their neighborhood in the country, 
 and ask for some prescription from him which they used to like them- 
 selves, and then give it to all their friends and to all their poorer 
 neighbors who will take it. Now, instead of giving medicine, of which 
 you cannot possibly know the exact and proper application, nor all its 
 consequences, would it not be better if you were to persuade and help 
 your poorer neighbors to remove the dung-hill from before the door, 
 to put in a window which opens, or an Arnott's ventilator, or to cleanse 
 and limewash the cottages ? Of these things the benefits are sure. 
 The benefits of the inexperienced administration of medicines are by no 
 means so sure. 
 
 Homoeopathy has introduced one essential amelioration in the prac- 
 tice of physic by amateur females ; for its rules are excellent, its 
 physicking comparatively harmless — the "globule" is the one grain 
 of folly which appears to be necessary to make any good thing accepta- 
 ble. Let then women, if they will give medicine, give homoeopathic 
 medicine. It won't do any harm. 
 
 An almost universal error among women is the supposition that 
 everybody must have the bowels opened once in every twenty-four 
 hours, or must fly immediately to aperients. The reverse is the con- 
 clusion of experience. 
 
 This is a doctor's subject, and I will not enter more uito it ; but will 
 simply repeat, do not go on taking or giving to your children your 
 abominable «' courses of aperients," without calling in the doctor. 
 
 It is verj' seldom indeed, that by choosing your diet, you cannot 
 regulate your own bowels ; and every woman may watch herself to 
 know what kind of diet will do this ; I have known deficiency of meat 
 produce constipation, quite as often as deficiency of vegetables ; baker's 
 bread much oftener than either. Home made brown bread will oftener 
 cure it than anything else.
 
 100 NOTES ON NURSING. 
 
 that there should be more ilhiess, in order to have more 
 work. 
 
 (2.) It is often said by women, that they cannot know 
 anything of the Laws of health, or what to do to preserve 
 their children's health, because they can know nothing of 
 " Pathology," or cannot " dissect," — a confusion of ideas 
 which it is hard to attempt to disentangle. Pathology 
 teaches the harm that disease has done. But it teaches 
 nothing more. We know nothing of the principle of 
 health, the positive of which pathology is the negative, 
 except from observation and experience. And nothing 
 but observation and experience will teach us the ways to 
 maintain or to bring back the state of health. It is often 
 thought that medicine is the curative process. It is no 
 suchthing ; medicine is the surgery of functions, as sur- 
 gery proper is that of limbs and organs. Neither can do 
 anything but remove obstructions; neither can cure; na- 
 ture alone cures. Surgery removes the bullet out of the 
 limb, which is an obstruction to cure, but nature heals the 
 wound. So it is with medicine ; the function of an organ 
 becomes obstructed ; medicine, so far as we know, assists 
 nature to remove the obstruction, but does nothing more. 
 And what nursing has to do in either case, is to put the 
 patient in the best condition for nature to act upon him. 
 Generally, just the contrary is done. You think fresh air, 
 and quiet and cleanliness extravagant, perhaps dangerous, 
 luxuries, which should be given to the patient only when 
 quite convenient, and medicine the sine qua oion^ the pan- 
 acea. If I have succeeded in any measure in dispelling 
 this illusion, and in showing what true nursing is, and what 
 it is not, my object will have been answered. 
 
 Now for the caution : — 
 
 (3.) It seems a commonly receiA^ed idea among men and 
 even among women themselves that it requires nothing 
 but a disappointment in love, the want of an object, a gen- 
 eral disgust, or incapacity for other things, to turn a wo- 
 man into a good nurse. 
 
 This reminds one of the parish where a stupid old man 
 was set to be schoolmaster because he was "past keeping 
 the pigs." 
 
 Apply the above receipt for making a good nurse to 
 making' a good servant. And the receipt will be found to 
 fail.
 
 CONCLUSION. 
 
 101 
 
 Yet popular novelists of recent days have invented 
 ladies disappointed in love or fresh out of the drawing- 
 room turnip into the war-hospitals to find their wounded 
 lovers, and when found, forthwith abandoning their siek- 
 ward for their lover as might be expected, let m the 
 estimation of the authors, these ladies were none the 
 worse for that, but, on the contrary, were heroines ot 
 
 ^^' Whft cruel mistakes are sometimes made by bcneyo- 
 lentmen and women in matters of business about >yhich 
 they can know nothing and think they know a gicat 
 
 ^iie everyday management of a large ward, let alone of 
 ahospital-the knowing what are the laws of h.e and 
 death for men, and what the laws of health for wards - 
 rand wards are healthy or unhealthy, mainly according to 
 the knowledge or io-norance of the nurse) -are not these 
 rnatte^-s of sufficieirt importance and difficulty to require 
 learning by experience and careful inqmry, just as much 
 as any'other art? They do not come by mspiration to 
 the ladv disappointed in love, nor to the poor workhouse 
 drudo-e hard up for a livelihood. 
 
 And terribli is the injury which has followed to the sick 
 
 from such wild notions ! ox • t» no^L.Jw. 
 
 In this respect (and why is it so?), in Roman Catholic 
 countries, both writers and workers are, in theoiy at least, 
 far before ours. They would never think of such a begm- 
 nino- for a good working Superior or bister of Chanty 
 And manv a Superior has refused to admit ^Postulant 
 who appeared to have no better "vocation" or reasons for 
 offering herself than these. ^ 
 
 ll is'true ,o« make " no vows." But is a " vow neees- 
 sai-v to convince ns that the true spirit for learning any art, 
 moit especially an art of charity, aright, is not a disgust to 
 everything or something else? Do we '-^^'"y P^^e the 
 love of our kind (and of nursing, as one branch of it) so 
 low as this? What would the Mere Angeliqne of 1 ort 
 Royal, what would our own Mra. try have said to this .■■ 
 
 Note. -I would earnestly aA my risters to keep eleav of both the 
 ,„^,„„.„o..eu.enteve;,«.e. 
 
 rSX meJ; c*rcludh.«"ae medical and ot.er V^^^fT^^ 
 because men do it, and without regard to whether this ,» the be»t that 
 9*
 
 102 NOTES ON NURSING. 
 
 ■women can do ; and of the jargon Avhicli urges -women to do nothing 
 that men do, merely because they are -women, and should be " recalled 
 to a sense of their duty as Avomcn," and because "this is -women's 
 •work," and " that is men's," and " these are things ^vhich -women 
 should not do," -which is all assertion, and nothing more. Surely 
 woman should bring the best she has, ichatever that is, to the work of 
 God's world, Avithout attending to either of these cries. For what are 
 they, both of them, the one just as much as the other, but listening to 
 the " what people will say," to opinion, to the " voices from without r " 
 And as a wise man has said, no one has ever done anything great or 
 useful by listening to the voices from without. 
 
 You do not want the effect of your good things to be, ** How won- 
 derful for a rrotnan ! " nor would you be deterred from good things by 
 hearing it said, "Yes, but she ought not to have done this, because it 
 is not suitable for a woman." But you want to do the thing that is 
 good, whether it is " suitable for a woman" or not. 
 
 It does not make a thing good, that it is remarkable that a woman 
 should have been able to do it. Neither does it make a thing bad, 
 which would have been good had a man done it, that it has been done 
 by a woman. 
 
 Oh, leave these jargons, and go your way straight to God's work, in 
 simplicity and singleness of heart.
 
 APPENDIX. 
 
 NOTE AS TO THE NUMBER OF AVOMEN EMPLOYED AS 
 NURSES IN GREAT BRITAN, 
 
 25,466 were returned, at the census of 1851, as nurses by profession, 
 39,139 nurses in domestic service,* and 2,822 midwives. The num- 
 bers of diiferent ages are shown in table A, and in table B their distri- 
 bution over Great Britain. 
 
 To increase the efficiency of this class, and to make as many of them 
 as possible the disciples of the true doctrines of health, would be a 
 great national work. 
 
 For there the material exists, and will be used for nursing, whether 
 the real *' conclusion of the matter " be to nurse or poison the sick. A 
 man, who stands perhaps at the head of our medical profession, once 
 said to me, " I send a nurse into a private family to nurse the sick, but 
 I know that is only to do them harm." 
 
 Now a nurse means any person in charge of the personal health of 
 another. And, in the preceding notes, the term nurse is used indiscrim- 
 inately for amateur and professional nurses. For, besides nurses of 
 the sick and nurses of children, the numbers of whom are hei'e given, 
 there are friends or relations who take temporary charge of a sick per- 
 son, there are mothers of families. It appears as if these unprofes- 
 sional nurses were just as much in want of knowledge of the laws of 
 health as professional ones. 
 
 Then there are the schoolmistresses of all national and other schools 
 throughout the kingdom. IIo w many of children's epidemics originate in 
 these ! Then the proportion of girls in these schools who become mothers 
 or members among the 64,000 nurses recorded above, or schoolmistresses 
 in their turn. If the laws of health, as far as regards fresh air, clean- 
 liness, light, &c., were taught to these, would this not prevent some 
 children being killed, some evil being perpetuated ? On women we must 
 depend, first and last, for personal and household hygiene — for pre- 
 venting the race from degenerating in as far as these things are con- 
 cerned. Would not the true way of infusing the art of preserving its 
 own health into the human race be to teach the female part of it in 
 schools and hospitals, both by practical teaching and by simple exper- 
 iments, in as far as these illustrate what may be called the theory of it. 
 
 * A curious fact will be shown by Tablo A ; viz., that 18,1C*2 out of :}0,-.3!», or 
 nearly one half of all thu uurucs ia (loniestic service, arc l)ct\v«en 5 and 'iO years 
 ofa'^e. (IO.J)
 
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