Notes on Nursing
Florence Nightingale

Part 3 out of 3

Again, the nurse must distinguish between the idiosyncracies of
patients. One likes to suffer out all his suffering 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 attendance is forced upon
the first patient, who wishes for nothing but to be "let alone," as that
the second is left to think himself neglected.

[Sidenote: Nurse must observe for herself increase of patient's
weakness, patient will not tell her.]

Again, I think that few things press so heavily on one suffering from
long and incurable illness, as the necessity of recording in words from
time to time, for the information of the nurse, who will not otherwise
see, that he cannot do this or that, which he could do a month or a year
ago. What 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 accidents
(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 unexpected 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 unexpected, or to be
expected, inevitable, visible, calculable, uninterrupted increase of
weakness, which none need fail to observe.

[Sidenote: Accidents arising from the nurse's want of observation.]

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 coming 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; and if he 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.

[Sidenote: Is the faculty of observing on the decline?]

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 human 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_ appearance, 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 appearances which have preceded
relapse, attack, or death, and not assert that there were none, or that
there were not the _right_ ones.[5]

[Sidenote: Observation of general conditions.]

A want of the habit of observing conditions and an inveterate habit of
taking averages are each of them 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 different 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 enquiry 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 diseases,
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,
sometimes 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 patient had followed for
years. And because he had forbidden a course which the patient could not
by any possibility alter.[6]

Undoubtedly a person of no scientific knowledge whatever but of
observation and experience in these kinds of conditions, will be able to
arrive at a much truer guess as 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 have their pulse felt;
no enquiry being made into their conditions.

In Life Insurance and such like societies, were they instead of having
the person examined by the medical man, to have the houses, conditions,
ways of life, of these persons examined, at how much truer results would
they arrive! W. Smith appears a fine hale man, but it might be known
that the next cholera epidemic he runs a bad chance. Mr. and Mrs. J. are
a strong healthy couple, but it might be known that they live in such a
house, in such a part of London, so near the river that they will kill
four-fifths of their children; which of the children will be the ones to
survive might also be known.

[Sidenote: "Average rate of mortality" tells us only that so many per
cent. will die. Observation must tell us _which_ in the hundred they
will be who will die.]

Averages again seduce us away from minute observation. "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 minute enquiries 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
mortality, that is, the person will die who ought not to have died
before old age.

Now, would it not very materially alter the opinion of whoever were
endeavouring 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 constantly recurring on
workhouse books for generations. That is, the persons were born and
brought up, and will be born and brought up, generation after
generation, in the conditions 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 what they

The close observer may safely predict that such a family, whether its
members marry or not, will become extinct; that 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."

[Sidenote: What observation is for.]

In dwelling upon the vital importance of _sound_ observation, it must
never be lost sight of what observation is for. It is not for the sake
of piling up miscellaneous information 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 scientific 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 exaggeration.
You think, if you suspected your patient was being poisoned, say, by a
copper kettle, you would instantly, as you ought, cut off all possible
connection between him and the suspected source of injury, without
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
confidential nurse being placed with the patient, or give up the case.

[Sidenote: What a confidential nurse should be.]

And remember every nurse should be one who is to be depended upon, in
other words, capable of being, a "confidential" 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 honest; but more than this, she must be a
religious and devoted woman; she must have a respect for her own
calling, 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 decent feeling.

[Sidenote: Observation is for practical purposes.]

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, according 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 falls
under the cognizance of us all. How often the attendants of a case have
stated that they knew perfectly 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 sometimes not so much as mentioned their conviction in
the right quarter--that is, to the only person who could act in the

It is a much more difficult thing to speak the truth than people
commonly imagine. There is the want of observation _simple_, and the
want of observation _compound_, compounded, that is, with the
imaginative 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 _not_ observed, nor remember that they have

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.

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 fourteenth, who
had never left his bed, went to a distant chapel every morning at seven

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 sacrament, by whose side they
had 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 provide from
three to five and six meals a day. Such instances might be multiplied
_ad infinitum_ if necessary.

This is important, because on this depends what 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 probably
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?

[Sidenote: More important to spare the patient thought than physical

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 _not_ spared all physical exertion, he
would be infinitely the gainer. 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 beneficial effect upon the patient.

[Sidenote: English women have great capacity of, but little practice in
close observation.]

It may be too broad an assertion, and it certainly sounds like a
paradox. 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 perception 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 observation.
In countries where women (with average intelligence certainly not
superior to that of English women) are employed, e.g., in dispensing,
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 a 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 same places; you don't know how suddenly you may be called on some
day to find something, and may not be able to remember in your haste
where you yourself had put it, if your memory is not in the habit of
seeing the thing there always.

[Sidenote: Approach of death, paleness by no means an invariable
effect, as we find in novels.]

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 example of what
I mean. In the nervous temperament the face becomes pale (this is the
only _recognised_ effect); in the sanguine temperament purple; in the
bilious yellow, or every manner of colour in patches. Now, it is
generally 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 recognised livery, as I have said--_de rigueur_ in novels, but
nowhere else.

I have known two cases, the one of a man who intentionally and
repeatedly displaced a dislocation, 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 doctors, saved the
one case from persevering in a fraud, the other from being discharged
when actually in a dying state.

I will even go further and say, that in diseases which have their origin
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 day, 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
diseases 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 become quick,
perhaps 130, and so thready it is not like a pulse at all, but like a
string vibrating 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 cannot. 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? 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 income 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" either "so much better" 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 them. 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


[Sidenote: Sanitary nursing as essential in surgical as in medical
cases, but not to supersede surgical nursing.]

The whole of the preceding remarks apply even more to children and to
puerperal woman than to patients in general. They also apply to the
nursing of surgical, quite as much as to that of medical cases. Indeed,
if it be possible, 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 pyoemia, or purulent
discharge of some kind may else supervene. Has she a case of compound
fracture, of amputation, or of erysipelas, it may depend very much on
how she looks upon the things enumerated in these notes, whether 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 suppuration and discharge, she may see a vigorous patient in the
prime of life gradually sink and die where, according to all human
probability, he ought to have recovered. 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.

Nevertheless 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., who have this
surgical nursing to perfection, the converse is comparatively rare.

[Sidenote: Children: their greater susceptibility to the same things.]

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 when up,
by want of the spirit of management 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 children,
of attending to these things.

That which, however, above all, is known to injure children seriously is
foul air, and most seriously at night. Keeping the rooms where they
sleep tight shut up, is destruction to them. And, if the child's
breathing be disordered 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.

The following passages, taken out of an excellent "Lecture on Sudden
Death in Infancy and Childhood," just published, show the vital
importance of careful nursing of children. "In the great majority of
instances, when death suddenly befalls the infant or young child, it is
an _accident_; it is not a necessary result of any disease from which it
is suffering."

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 "sudden;" (for _sudden_ death is comparatively
rare in middle age;) and the sentence is almost equally true for all

The following causes of "accidental" death in sick children 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 overfull meal"--"any
sudden impression on the nervous system--any hasty alteration of
posture--in short, any cause whatever by which the respiratory process
may be disturbed."

It may again be added, that, with very weak adult patients, these causes
are also (not often "suddenly fatal," it is true, but) very much oftener
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 frequent 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 against any confusion of ideas
between cold and fresh air. You may chill a patient fatally 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

In cases of long recurring faintnesses from disease, for instance,
especially disease which affects the organs of breathing, fresh air to
the lungs, warmth to the surface, 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 this;
shutting up every cranny through which fresh air can enter, and leaving
the body cold, or perhaps throwing a greater weight of clothes upon it,
when already it is generating too little heat.

"Breathing carefully, anxiously, as though respiration were a function
which 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 accomplishment of the
respiratory function, some sudden demand for its complete exercise,
issues in the sudden standstill of the whole machinery," is given as one
process:--"life goes out for want of nervous power to keep the vital
functions in activity," 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.

[Sidenote: Summary.]

To sum up:--the answer to two of the commonest objections 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.

[Sidenote: Reckless amateur physicking by women. Real knowledge of the
laws of health alone can check this.]

(1.) It is often said by men, that it is unwise to teach women anything
about these laws of health, because they will 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 calomel and aperients. This is undeniably too
often the case. There is nothing ever seen in any professional practice
like the reckless physicking by amateur females.[1] But this is just
what the really experienced and observing 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 doctor's work--but no one really
believes that doctors wish that there should be more illness, in order
to have more work.

[Sidenote: What pathology teaches. What observation alone teaches. What
medicine does. What nature alone does.]

(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 such thing; medicine is the
surgery of functions, as surgery proper is that of limbs and organs.
Neither can do anything but remove obstructions; neither can cure;
nature 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 non_, the
panacea. 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 received idea among men and even among women
themselves that it requires nothing but a disappointment in love, the
want of an object, a general disgust, or incapacity for other things, to
turn a woman 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.

Yet popular novelists of recent days have invented ladies disappointed
in love or fresh out of the drawing-room turning into the war-hospitals
to find their wounded lovers, and when found, forthwith abandoning their
sick-ward for their lover, as might be expected. Yet in the estimation
of the authors, these ladies were none the worse for that, but on the
contrary were heroines of nursing.

What cruel mistakes are sometimes made by benevolent men and women in
matters of business about which they can know nothing and think they
know a great deal.

The everyday management of a large ward, let alone of a hospital--the
knowing what are the laws of life and death for men, and what the laws
of health for wards--(and wards are healthy or unhealthy, mainly
according to the knowledge or ignorance of the nurse)--are not these
matters of sufficient importance and difficulty to require learning by
experience and careful inquiry, just as much as any other art? They do
not come by inspiration to the lady disappointed in love, nor to the
poor workhouse drudge hard up for a livelihood.

And terrible is the injury which has followed to the sick from such wild

In this respect (and why is it so?), in Roman Catholic countries, both
writers and workers are, in theory at least, far before ours. They would
never think of such a beginning for a good working Superior or Sister of
Charity. And many a Superior has refused to admit a _Postulant_ who
appeared to have no better "vocation" or reasons for offering herself
than these.

It is true _we_ make "no vows." But is a "vow" necessary to convince us
that the true spirit for learning any art, most especially an art of
charity, aright, is not a disgust to everything or something else? Do we
really place the love of our kind (and of nursing, as one branch of it)
so low as this? What would the Mere Angelique of Port Royal, what would
our own Mrs. Fry have said to this?

NOTE.--I would earnestly ask my sisters to keep clear of both the
jargons now current every where (for they _are_ equally jargons); of the
jargon, namely, about the "rights" of women, which urges women to do all
that men do, including the medical and other professions, merely because
men do it, and without regard to whether this _is_ the best that women,
can do; and of the jargon which urges women to do nothing that men do,
merely because they are women, and should be "recalled to a sense of
their duty as women," and because "this is women's work," and "that is
men's," and "these are things which women should not do," which is all
assertion, and nothing more. Surely woman should bring the best she has,
_whatever_ that is, to the work of God's world, without attending to
either of these cries. For what are they, both of them, the one _just_
as much as the other, but listening to the "what people will say," to
opinion, to the "voices from without?" 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 wonderful for
a _woman_!" 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.


[Sidenote: Danger of physicking by amateur females.]

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--with what effect may be supposed. 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.g._, colocynth with colchicum. This _is_
playing with sharp-edged tools "with a vengeance."

There are excellent women who will write to London to their physician
that there is much sickness in their neighbourhood in the country, and
ask for some prescription from him, which they used to like themselves,
and then give it to all their friends and to all their poorer neighbours
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 neighbours 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 lime-wash 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 practice 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 acceptable. 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 conclusion of

This is a doctor's subject, and I will not enter more into 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 very 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.


[Transcriber's note: These tables have been transposed to fit the page

The figures in the left hand column, Table B: Nurse (not Domestic
Servant) do not add up. There is probably a typographical error in this
column since it cannot be accounted for by errors in transcription.]




NURSES. Nurse (not Domestic Nurse (Domestic
Servant) Servant)
All Ages. 25,466 39,139
Under 5 years ... ...
5- ... 508
10- ... 7,259
15- ... 10,355
20- 624 6,537
25- 817 4,174
30- 1,118 2,495
35- 1,359 1,681
40- 2,223 1,468
45- 2,748 1,206
50- 3,982 1,196
55- 3,456 833
60- 3,825 712
65- 2,542 369
70- 1,568 204
75- 746 101
80- 311 25
85 and upwards 147 16



NURSES. Nurse (not Domestic Nurse (Domestic
Servant) Servant)
Great Britain and 25,466 21,017
Islands in the
British Seas.
England and Wales. 23,751 18,945
Scotland. 1,543 1,922
Islands in the
British Seas. 172 150
1st Division.
London. 7,807 5,061
2nd Division.
South Eastern. 2,878 2,514
3rd Division.
South Midland. 2,286 1,252
4th Division.
Eastern Counties. 2,408 959
5th Division.
South Western
Counties. 3,055 1,737
6th Division.
West Midland
Counties. 1,225 2,283
7th Division.
North Midland
Counties. 1,003 957
8th Division.
North Western
Counties. 970 2,135
9th Division.
Yorkshire. 1,074 1,023
10th Division.
Counties. 462 410
11th Division.
and Wales. 343 614


25,466 were returned, at the census of 1851, as nurses by profession,
39,139 nurses in domestic service,[1] and 2,822 midwives. The numbers of
different ages are shown in table A, and in table B their distribution
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 to 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 it 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
indiscriminately for amateur and professional nurses. For, besides
nurses of the sick and nurses of children, the numbers of whom are here
given, there are friends or relations who take temporary charge of a
sick person, there are mothers of families. It appears as if these
unprofessional 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. How many of children's epidemics originate in
these! Then the proportion of girls in these schools, who become
mothers or members among the 64,600 nurses recorded above, or
schoolmistresses in their turn. If the laws of health, as far as regards
fresh air, cleanliness, 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 preventing the race from degenerating in as far as these
things are concerned. 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 experiments, in as far as these illustrate what may be called the
theory of it?

[1] A curious fact will be shown by Table A, viz., that 18,122 out of
39,139, or nearly one-half of all the nurses, in domestic service, are
between 5 and 20 years of age.


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