_WISDOM FROM THE QUEEN OF NURSES_
Literary Activity--_Notes on Hospitals_--_Notes on Nursing_--Hints
for the Amateur Nurse--Interest in the Army in India--Writings on
Indian Reforms.
This noble ensample to his sheep he gaf,
That first he wroughte and afterward he taught.
CHAUCER.
In the years succeeding her return from the Crimea Miss Nightingale, in
addition to the important labours recorded in the foregoing chapter,
was actively engaged with her pen. Her writings dealt with the subjects
so near her heart of hospital reform, sick nursing and household
sanitation. If the soldier needed hygienic reforms in barracks and
camps, so did the great mass of the people in their own homes. Miss
Nightingale’s interest in army reform did not absorb her attention to
the neglect of civil matters.
Her writings are distinguished not only by expert and technical
knowledge, but by much homely practical wisdom. There is nothing of the
blue-stocking about Florence Nightingale. She puts aside formulas, and
with tender human feeling, enlivened by witty epigram and racy humour,
goes right to the heart of her subject, particularly in regard to the
needs and management of the sick.
Her first published work after her return home was a statistical
account of her distribution of the “Voluntary Contributions,” placed at
her disposal for the sick soldiers, which has already been dealt with.
In the following year (1858) she issued her _Notes on Matters affecting
the Health, Efficiency, and Hospital Administration of the British
Army_, which was of great value to the Commission on the War, then
sitting, and led to the institution of many reforms.
In 1859 Miss Nightingale published her _Notes on Hospitals_, the basis
of which was a paper she prepared for the Social Science Association.
“It may seem a strange principle,” she writes with grim humour, “to
enunciate as the very first requirement in a hospital that it should do
the sick no harm. It is quite necessary, nevertheless, to lay down such
a principle, because the actual mortality _in_ hospitals, especially in
those of large crowded cities, is very much higher than any calculation
founded on the mortality of the same class of diseases among patients
treated _out of_ hospital would lead us to expect.”
It was the knowledge of this unsatisfactory fact which led Miss
Nightingale to thoroughly investigate the influence which hospital
construction exercised on the death-rate of patients received into the
wards. The result was her _Notes on Hospitals_, which in the enlarged
edition, published in 1863, became a standard work on the subject.
It is technical in character, and, in addition to recommendations on
the conduct and arrangements of hospitals, gives plans for hospital
construction. It covers the whole field from floors and walls to
hospital furniture.
In the following year of 1860 came that ever popular book, _Notes
on Nursing: What it Is, and What it is Not_, of which more than one
hundred thousand copies have been sold. In it Miss Nightingale gives
such homely advice as can be put into practice by every girl and woman
in the land. The subject is always topical, and I cannot do better than
cull some of the words of wisdom from the Queen of Nurses.
The _Notes_, she explains, are not intended as a manual for nurses but
simply to give hints for thought to women who have personal charge
of the health of others, and almost every woman in England has some
time or other the charge of the health of another. “Every woman is a
nurse.” Then she proceeds with piquant saying and homely illustration
to give simple rules for the amateur nurse. “No need to discuss,”
she says, “whether the top of Mont Blanc will ever be inhabited--it
will be thousands of years before we have reached the bottom of Mont
Blanc in making the earth healthy. Nursing has been limited to signify
little more than the administration of medicines and the application
of poultices. It ought to signify the proper use of fresh air, light,
warmth, quiet, and proper selection and administration of diet.”
She goes on to refer to the “coxcombries” of education, by which the
elements of astronomy are taught to every schoolgirl while the future
wives and mothers are not instructed in those laws which God has
assigned to the relations of our bodies with the world in which He has
put them. It is no use to blame the climate, which we cannot control,
for sickness. “What can we do with the east wind?” people ask.
“Who is it who knows when the wind is in the east?” returns Miss
Nightingale. “Not the Highland drover, certainly exposed to the east
wind, but the young lady who is worn out with the want of exposure to
fresh air, to sunlight. Put the latter under as good sanitary condition
as the former, and she too will not know when the wind is in the east.”
Miss Nightingale groups young ladies and soldiers together as the most
frequent victims of consumption, owing to foul air and exposure to
chills. “Young ladies, like soldiers, go out in all weathers, the one
to parties, the other to sentry duty; both enter foul air, the one in
ball-rooms, the other in guard-rooms; both go home in damp night air
after skin and lungs are oppressed in their functions by overcrowding.”
She implores young ladies to open their windows and bedcurtains at
night, and not be afraid of spoiling their complexions. This was
written, it must be remembered, more than forty years ago, when girls
were more afraid of fresh air than they are to-day, now that cycling,
hockey, and golf have inured them even to east winds.
After dealing with household hygiene in chapters on “Ventilating and
Warming,” and “Health of Houses,” she proceeds to consider the bad
results of “Petty Management,” under which heading the want of relays
of nurses is dealt with both in institutions and in private homes. A
tired, jaded nurse is almost worse than no nurse at all. The nurse must
have needed rest; still, the patient should not be left alone. “I once
heard a neglectful official rebuked,” says Miss Nightingale, “in the
words, ‘Patients, sir, will not stop dying while we are in church.’”
The subject of “Noise” gives Miss Nightingale the occasion to speak
plainly on the dress of the amateur nurse. She wrote in the days of
crinolines, but her strictures would equally apply to the woman who
in modern times gets her long skirts entangled in the furniture, and
creates as much noise and upset in the sick chamber as did the nurse
of the olden days with her crinoline. Miss Nightingale endorses Lord
Melbourne’s sentiments when he said: “I would rather have men about me
when I am ill. I think it requires very strong health to put up with
women.” It was “the fidget of silk and crinoline, the crackling of
starched petticoats, the creaking of stays and shoes,” which led Lord
Melbourne to make this ungallant observation.
Miss Nightingale advises the private woman called upon to nurse in her
own family to copy the neat, trim style of dressing adopted by the
professional nurse. Her manner should be as motionless as possible.
“Never gesticulate when speaking to the sick,” cultivate conciseness
and calmness, and avoid an irresolute manner.
The chapter on “Variety” deals in a beautiful and sympathetic spirit
with the effect of colour and variety of objects on the sick person.
“The effect in sickness,” she writes, “of beautiful objects, of variety
of objects, and especially of brilliancy of colour, is hardly at all
appreciated. Such cravings are not fancies.... Variety of form and
brilliancy of colour in the objects presented to patients are actual
means of recovery,” and she recalls her own case, already quoted,
when a nosegay of wild-flowers brought to her hut on the heights of
Balaclava, where she lay with fever, seemed to put new life into her.
“Form and colour,” she says, “will free your patient from his painful
ideas better than any argument.” People say it is the effect on the
patient’s mind. It is no such thing; the effect is on the body too.
While variety in objects is necessary, “it must be a _slow_ variety;
don’t show a patient ten or twelve engravings successively.” One fresh
picture a day hung on his wall or brought to his bedside will be more
appreciated.
The Queen of Nurses combats the frequently accepted idea that cut
flowers and growing plants are unhealthy in a sick-room, even at night.
“The carbonic acid they give off at nights,” she writes, “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.” The nurse should observe what colours are most pleasing to
her patient. “Some sick persons feel stimulus from looking at scarlet
flowers, others exhaustion from looking at deep blue.”
This reminds me of an incident which occurred while the present writer
was going over Netley Hospital when it was filled with wounded from
the battlefields of South Africa. The convalescent soldiers were doing
fancy woolwork, and a sister came into a ward bearing a parcel of wool
sent by a benevolent lady. When opened, the wool was found to be all
in khaki colour. The men turned their heads in disgust. “Didn’t we see
enough of khaki in South Africa, sister?” they exclaimed. “Why don’t
these kind ladies send us bright colours which will drive the thought
of khaki out of our minds.” A moment’s intelligent reflection on the
colours most likely to please the brave fellows at Netley would have
prevented such a foolish mistake. Miss Nightingale’s words of wisdom,
written forty years ago, are not obsolete yet.
The subject of “Taking Food” is next dealt with, and Miss Nightingale
vigorously attacks the accepted traditions. It is a common error “that
beef tea is the most nutritious of all articles. Now just try and boil
down a pound of beef into beef tea, evaporate your beef tea, and see
what is left of your beef--barely a tablespoonful of solid nourishment
to half a pint of water in beef tea.” Still, Miss Nightingale admits
that there is a certain reparative quality in beef tea, as in ordinary
tea. She denounces that favourite article with the friends of the sick,
jelly, which usually contains no nourishment at all.
Miss Nightingale is constantly called the “soldier’s friend” and one
may add that she is above all the patient’s friend. “Attend,” she
writes, “to the intelligent cravings of the sick. Patients crave
for things laid down in no sick dietary. It often happens that the
patient’s stomach is right and the book wrong. You can’t diet a patient
from a book.”
How many weary invalids will thank the Queen of Nurses for granting
them the too often condemned cup of tea. “A great deal too much against
tea is said by wise people,” she writes. “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. 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. It is 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, that they could do it best upon an
occasional cup of tea--and nothing else. Let experience, not theory,
decide upon this as upon all other things.” Cocoa increases fat, but
has no restorative power, and it is “pure mockery to offer it as a
substitute for tea--you might,” adds Miss Nightingale, “as well offer
patients chestnuts instead of tea.” She gives the warning, however,
that too much tea is given to the sick by foolish people, and that as
a rule neither tea nor coffee should be given to invalids after five
o’clock.
The remarks on “Beds and Bedding” are not as relevant now as when
they were written in the days of the much be-curtained four-post
bedstead and luxurious feather beds. Most people now acknowledge
the superiority of the iron bedstead with spring mattress. The bed
coverings should be light as well as warm and “a true nurse,” says Miss
Nightingale, “always makes her patient’s bed and does not leave it to
the housemaid.” She recommends that the bed should always be in the
lightest place in the room, and the patient able to see out of window.
“A fashionable physician,” she writes, “has been saying that he turns
his patients’ faces from the light. Yes, but Nature is stronger than
fashionable physicians, and depend upon it, she turns the faces back
and _towards_ such light as she can get.” Observation of the sick shows
that patients do not turn their faces to the wall.
Miss Nightingale, in illustration of the craving of the sick to see out
of window, relates a beautiful story of a nurse’s self-sacrifice. A
poor man in one of the hospitals was suffering from spinal accident and
expressed an intense longing just to have one look out of the window.
The nurse, moved with compassion for the poor fellow’s craving, raised
him on her back so that he might take his coveted look at the outside
world once again. His joy was great, but the effort cost the nurse a
long and serious illness.
Under the heading of “Chattering Hopes and Advices,” Miss Nightingale
evidently speaks out of the fulness of her own experience. “‘Chattering
Hopes,’” she says, “may seem an odd heading. But I really believe
there is scarcely a greater worry which invalids have to endure than
the incurable hopes of their friends. There is no one practice against
which I can speak more strongly from actual 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 probabilities of recovery.... The fact is that the patient is
not ‘cheered’ at all by these well-meaning, most tiresome friends.”
The advice or opinion of the experienced does not of course come under
the head of “Chattering Hopes,” but it is the advice of “inexperience
to bitter experience” which Miss Nightingale condemns, and which
amounts to nothing more than this, “that you think I shall recover
from consumption, because somebody knows somebody, somewhere, who
has recovered from fever.” Nurses should protect their patients from
visitors of the class indicated.
The “Observation of the Sick” is a quality which needs cultivation.
“The most important practical lesson that can be given to nurses is
to teach them what to observe,” writes Miss Nightingale, also “how
to observe,” and to accurately state the result of observation. It
is a more difficult thing to speak the truth than people commonly
imagine. “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 do that.
She quotes a little incident to illustrate the point. “I know I fibs
dreadful; but believe me, miss, I never finds out I have fibbed until
they tells me so,” was a remark once made to her, which is, as she
says, “one of more extended application than most people have the least
idea of.”
Needless to say, unintentional “fibbing,” or in other words lack of
observation, which leads a nurse to wrongly inform the doctor regarding
the patient, often leads to disastrous results. “I knew,” says Miss
Nightingale, “a very clever physician of large dispensary and hospital
practice, who invariably began his examination of a patient with ‘Put
your finger where you _be_ bad.’ That man would never waste his time
with collecting inaccurate information from nurse or patient.” Nothing
leads to inaccurate information more than putting “leading questions”
to sick people. “How do you sleep?” “How is your appetite?” A tactful
and observant nurse will be better able to answer such questions than
the patient himself.
Miss Nightingale thinks that Englishwomen are not naturally good
observers, though capable of attaining to it by training. The French
or Irish woman is much quicker. She records a homely little example of
want of observation. “I remember when a child,” she writes, “hearing
the story of an accident related by some one who sent two nieces to
fetch a ‘bottle of sal-volatile from her room.’ ‘Mary could not stir,’
she said; ‘Fanny ran and fetched a bottle that was not sal-volatile,
and that was not in my room.’ If Fanny had observed the bottle of
sal-volatile in the aunt’s room every day she was there, she would
have found it when it was suddenly wanted. This habit of inattention
generally pursues a person 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.”
In contrast to this type of careless person, Miss Nightingale
instances the trained observations of a famous actress. “I was once
taken,” she writes, “to see a great actress in Lady Macbeth. To me it
appeared the mere transference upon the stage of a death-bed, such as I
had often witnessed. So, just before death, have I seen a patient get
out of bed and feebly re-enact some scene of long ago, exactly as if
walking in sleep.” The actress played her part so well because she had
actually observed life.
[Illustration: PARTHENOPE, LADY VERNEY.
(_From the painting at Claydon by Sir William Richmond, R.A._)
[_To face p. 283._
]
“The very alphabet of a nurse,” says Miss Nightingale, “is to observe
so well that she is able to interpret every change which comes over
a patient’s countenance, without causing him the exertion of saying
what he feels.... A patient is not merely a piece of furniture, to be
kept clean and arranged against the wall, and saved from injury or
breakage--though to judge from what many a nurse does and does not
do, you would say he was.” Then comes a caution that all sick people
dislike being watched, and the nurse must observe without appearing to
do so. Miss Nightingale relates that the best observer she ever knew
was a distinguished doctor for lunacy. “He leans back in his chair,
with half-shut eyes,” she relates, “and, meanwhile, he sees everything,
observes everything, and you feel he knows you better than many who
have lived with you twenty years. I believe it is this singular
capacity of observation and of understanding what observed appearances
imply which gives him his singular influence over lunatics.”
In a concluding chapter, Miss Nightingale refers to the dangers of
“reckless physicking by amateur females,” and tells of the lady who,
having procured a prescription for a blue pill which suited her during
one indisposition, proceeded to dose not only herself but her family
too, “for all complaints upon all occasions.” Then there are the women
who have no ideas beyond calomel and aperients, and the Lady Bountifuls
who dose their poorer neighbours with a favourite prescription when it
would be doing more good if they persuaded the people 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 their cottages.”
She has some last words to say on nursing as a profession, and gives
a humorous little thrust at “the 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
school-master because he was ‘past keeping the pigs.’”
Miss Nightingale sums up the matter with some condensed wisdom on the
question as to whether women are fitted for the medical and other
professions. She urges them to keep clear of “the jargon” which impels
a woman on the one hand to do things simply to imitate men, and on the
other to refrain from doing what she has the power to accomplish simply
because it has hitherto been considered man’s work. “Surely woman,” she
writes, “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, but listening to the ‘what people will say’ opinion, to the
voices from without? No one has ever done anything great or useful by
listening to the voices from without. You want to do the thing that is
good, whether people call it ‘suitable for a woman’ or not. Oh, leave
these jargons, and go your way straight to God’s work, in simplicity
and singleness of heart.”
A year after the publication of _Notes on Nursing_, Miss Nightingale
issued (1861) a modified edition of the work, under the title of
_Notes on Nursing for the Labouring Classes_, adding a chapter on
“Minding Baby,” which is specially addressed to young girls in working
families, who have a great deal to do with minding mother’s baby. It
is delightfully written and reveals how conversant the author was
with the homes of the poor. It would do more good than many tracts if
distributed by the district visitor, and would be a useful addition to
the textbooks of our elementary schools. With her usual quick insight
the Queen of Nurses recognises the importance of the working-girl
nurse. “One-half of all the nurses in service,” she writes, “are girls
of from five to twenty years old. You see you are very important little
people. Then there are all the girls who are nursing mother’s baby at
home; and in all these cases it seems pretty nearly to come to this,
that baby’s health for its whole life depends upon you, girls, more
than upon anything else.” Simple rules such as a girl of six could
understand are given for the feeding, washing, dressing, nursing, and
even amusement of that important person, “baby.”
“The healthiest, happiest, liveliest, most beautiful baby I ever saw
was the only child of a busy laundress,” writes Miss Nightingale;
“she washed all day in a room with the door open upon a larger room,
where she put the child. It sat or crawled upon the floor all day with
no other play-fellow than a kitten, which it used to hug. Its mother
kept it beautifully clean, and fed it with perfect regularity. The
child was never frightened at anything. The room where it sat was the
house-place; and it always gave notice to its mother when anybody came
in, not by a cry, but by a crow. I lived for many months within hearing
of that child, and never heard it cry day or night. I think there is a
great deal too much of amusing children now; and not enough of letting
them amuse themselves.”
The versatility of Miss Nightingale’s pen is shown by her next
publication, _The Sanitary State of the Army in India_, which came out
in 1863. The hand which could write with such tender womanly concern
about baby could deal vigorous blows at the insanitary condition of the
soldiers in India. She had been keenly interested in Lord Herbert’s
scheme for uniting the Indian with the Home army, and followed it up
by a thorough investigation of the causes affecting the health of the
army in India. An elaborate series of written evidence procured from
all the principal stations of India by the Royal Commission appointed
for the purpose, was laid before Miss Nightingale in 1861, and at the
request of the Commission she wrote a valuable paper of comments on
the reports. Lord Stanley succeeded Lord Herbert as President of the
Commission, and to him Miss Nightingale addressed her observations,
which form a book of some hundred pages. She points out in her usual
concise style the evils arising from the defective sanitation of the
camps, the bad water, lack of drainage, and the imperfections of
the hospitals, and deals with the preventable causes which lead to
drunkenness and a low tone of morality amongst the Indian troops.
The state of the army in India continued to be a matter of great
concern to Miss Nightingale, and at the request of the National Social
Science Congress she prepared a paper on the subject, to which she gave
the arresting title “How People may Live and not Die in India.” This
was read at the Edinburgh meeting in 1863, and published in pamphlet
form the following year. In a prefatory note Miss Nightingale refers
with pleasure to the improvement in the condition of the soldiers
which had taken place in many respects. The introduction of soldiers’
gardens, trades, and workshops enabled the men to realise that it was
better to work than to sleep and to drink, even during hot weather.
She gives an interesting instance of how these reforms had worked. “One
regiment marching into a station,” she writes, “where cholera had been
raging for two years, were ‘chaffed’ by the regiments marching out, and
told they would never come out of it alive.
“The men of the entering battalion answered, They would see; we _won’t_
have cholera. And they made gardens with such good effect that they
had the pleasure not only of eating their own vegetables, but of being
paid for them too by the commissariat. And this in a soil which no
regiment had been able to cultivate before. And not a man had cholera.
These good soldiers fought against disease, too, by workshops and
gymnasia, and at a few hill stations the men have covered the whole
hill-sides with their gardens.”
She goes on to tell of the good results taking place from the
introduction of gymnastics for the men and cricket and other outdoor
sports. “In short,” she adds in a pithy sentence, “work and all
kinds of exercise cause sickly men to flourish.” Soldiers’ libraries
were being established by Government, better cook-houses built, and
the soldiers taught to cook. And so far she is glad to record that
the soldiers’ habits had improved. “But the main causes of diseases
in India--want of drainage, want of water supply for stations and
towns--remain as before,” she ironically remarks, “in all their
primitive perfection.” The death-rate of troops serving in India was
the alarming one of sixty-nine per thousand per annum. “It takes
something more than climate to account for this,” she writes. “All that
the climate requires is that men shall adapt their social habits and
customs to it, as, indeed, they must do to the requirements of every
other climate under heaven. There is not a shadow of proof that India
was created to be the grave of the British race.”
Miss Nightingale then enumerates the simple rules for dress, diet,
and exercise to be observed by soldiers serving in India. But though
a man can regulate his personal habits, “he cannot,” she adds, “drain
and sewer his own city, nor lay a water supply on to his own station,
nor build his own barracks,” and she proceeds to urge that sanitary
reform in India is still one of the most pressing questions for the
Government. By wise measures the enormous death-rate of sixty-nine per
thousand might be reduced to ten per thousand. “What a work, what a
noble task for a Government--no ‘inglorious period of our dominion’
that,” she writes, “but a most glorious one!”
Ten years later Miss Nightingale again returned to the “charge” and
prepared a paper on “Life or Death in India,” which was read at the
meeting of the National Association for the promotion of Social Science
at Norwich in 1873, and afterwards published as a pamphlet with an
appendix on “Life or Death by Irrigation.”
In this paper Miss Nightingale pointed out the cheering fact that
during the past ten years in which sanitary reforms had been
progressing the death-rate of the army in India had been reduced from
sixty-nine per thousand to eighteen per thousand--that is, eighteen
men died where sixty-nine had died before. Still, she considered
that this only sufficed to show the work that yet remained to be
done, especially with regard to the drainage, water supply, and the
irrigation of the country for commercial purposes, on account not only
of the soldier, but to promote the health of the teeming millions of
our fellow-subjects in India and their general prosperity.
Miss Nightingale disposes of the “caste” difficulty with an amusing
incident. When the Government’s new water supply “was first
introduced into Calcutta, the high-caste Hindoos still desired their
water-carriers to bring them their _sacred_ water from the _river_;
but these functionaries, finding it much easier to take the water from
the new taps, just rubbed in a little (vulgar not sacred) mud, and
presented it as Ganges water.
“When at last the filthy fraud was discovered, public opinion, founded
on experience, had already gone too far to return to dirty water.
And the new water supply was, at public meetings, adjudged to be
_theologically_ as well as physically safe.”
Miss Nightingale urges that irrigation schemes should be set on foot by
the Government as a preventive against the ever-recurring famines which
afflict our fellow Indian subjects so severely. “Is not the Government
of India,” she asks, “too much like a dispensary, which does all that
man can do to cure when too late to do anything to prevent?”
While Miss Nightingale’s pen was pleading so eloquently and practically
during this period for the good of the great Empire in the East, she
was not unmindful of the people at home. Her writings and work in
connection with the sick poor must form the subject of a separate
chapter.