[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 pyaemia, 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
ages.
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
nurse.
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.