[Sidenote: Disease a reparative process.]
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 accompanied with suffering: 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 being then, while the antecedent process was going on,
determined?
If we accept this as a general principle we shall be immediately 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 would be
immediately raised,--Will the top of Mont Blanc ever be made habitable?
Our answer would be, it will be many thousands of years before we have
reached the bottom of Mont Blanc in making the earth healthy. Wait till
we have reached the bottom before we discuss the top.
[Sidenote: Of the sufferings of disease, disease not always the cause.]
In watching disease, 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
incident to the disease are very often not symptoms of the disease at
all, but of something quite different--of the want of fresh air, or of
light, or of warmth, or of quiet, or of cleanliness, or of punctuality
and care in the administration of diet, of each or of all of these. And
this quite as much in private as in hospital nursing.
The reparative process which Nature has instituted and 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.
[Sidenote: What nursing ought to do.]
I use the word nursing for want of a better. It 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, cleanliness, quiet, and the proper selection and
administration of diet--all at the least expense of vital power to the
patient.
[Sidenote: Nursing the sick little understood.]
It has been said and written 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 arrangements often make it
impossible to nurse. But the art of nursing ought to include such
arrangements as alone make what I understand by nursing, possible.
The art of nursing, as now practised, seems to be expressly constituted
to unmake what God had made disease to be, viz., a reparative process.
[Sidenote: Nursing ought to assist the reparative process.]
To recur to the first objection. If we are asked, Is such or such a
disease a reparative process? Can such an illness 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 success of Nature'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 everything; to give air, warmth, cleanliness, &c.,
is to do nothing. The reply is, that in these and many other similar
diseases the exact value of particular remedies and modes of treatment
is by no means ascertained, while there is universal experience as to
the extreme importance of careful nursing in determining the issue of
the disease.
[Sidenote: Nursing the well.]
II. The very elements of what constitutes good nursing are as little
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 breaking of them produces only a less violent
consequence among the former than among the latter,--and this sometimes,
not always.
It is constantly objected,--"But how can I obtain this medical
knowledge? I am not a doctor. I must leave this to doctors."
[Sidenote: Little understood.]
Oh, 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?[1] "The life duration of tender babies" (as some Saturn,
turned analytical chemist, says) "is the most delicate test" of sanitary
conditions. Is all this premature suffering and death necessary? Or did
Nature intend mothers to be always accompanied by doctors? Or 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 extraordinary that, whereas the laws
of the motions of the heavenly bodies, far removed as they are from us,
are perfectly well understood, the laws of the human mind, which are
under our observation all day and every day, are no better understood
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 families of any class,
nor school-mistresses of any class, nor nurses of children, nor nurses
of hospitals, are taught anything 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 which make these bodies, into which
He has put our minds, healthy or unhealthy organs of those minds, are
all but unlearnt. Not but that these laws--the laws of life--are in a
certain measure understood, but not even mothers 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 control. 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, exposed to the east wind, but the young lady
who is worn out with the want of exposure to 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.