[1]
[Sidenote: Curious deductions from an excessive death rate.]
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 knowledge in women;
therefore we want a Women's Hospital." Now, both the above facts are too
sadly true. But what is the deduction? The causes of the enormous child
mortality are perfectly well known; they are chiefly want of
cleanliness, want of ventilation, want of white-washing; in one word,
defective _household_ hygiene. 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 for
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 in 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 think of citing the institution of a Women's Hospital as the
way to cure this want?
We have it, indeed, upon very high authority that there is some fear
lest hospitals, as they have been _hitherto_, may not have generally
increased, rather than diminished, the rate of mortality--especially of
child mortality.
[2]
[Sidenote: Why are uninhabited rooms shut up?]
The common idea as to uninhabited rooms is, that they may safely be left
with doors, windows, shutters, and chimney board, all
closed--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
hour 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?
[3] It is very desirable that the windows in a sick room should be such
as 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 the windows
myself." And [Transcriber's Note: Word, possibly "it" missing in
original.] is true.
[4]
[Sidenote: An air-test of essential consequence.]
Dr. Angus Smith's air test, if it could be made of simpler application,
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 instrument as the former, and
both should be self-registering. The senses of nurses and mothers become
so dulled to foul air that they are perfectly unconscious of what an
atmosphere they have let their children, patients, or charges, sleep in.
But if the tell-tale air-test were to exhibit in the morning, both to
nurses and patients and to the superior officer going round, what the
atmosphere has been during the night, I question if any greater security
could be afforded against a recurrence of the misdemeanour.
And oh; 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 would 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 our own. The little air-test would both betray the cause
of these "mysterious pestilences," and call upon us to remedy it.
[5] With 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, when still.
But it is often observed that nurses who 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 ward _must_
sometimes stand open to allow of persons passing in and out, or heavy
things being carried in and out. The careful nurse will keep the door
shut while she shuts the windows, and then, 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.
[6]
[Sidenote: Don't make your sick-room into a sewer.]
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; aye, 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 the 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.
If a nurse declines to do these kinds of things for her patient,
"because 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 consideration 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.
[7]
[Sidenote: Health of carriages.]
The health of carriages, especially close carriages, is not of
sufficient universal importance to mention here, otherwise than
cursorily. Children, who are always the most delicate test of sanitary
conditions, 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
preposterous. 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 unhealthy
courts off one of the most unhealthy streets in Manchester.
[8] 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 responsibility 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.
[9]
[Sidenote: Servants' rooms.]
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 almost
invariably dens of foul air, and the "servants' health" suffers in an
"unaccountable" (?) way, even in the country. For I am by no means
speaking only of London houses, where too often servants are put to live
under the ground and over the roof. But in a country "_mansion_," which
was really a "mansion," (not after the fashion of advertisements), I
have known three maids who slept in the same room ill of scarlet fever.
"How 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 was not a small one; it was up stairs, and it
had two large windows--but nearly every one of the neglects enumerated
above was there.
[10]
[Sidenote: Diseases are not individuals arranged in classes, like cats
and dogs, but conditions growing out of one another.]
Is it not living in a continual mistake to look upon diseases, as we do
now, as separate entities, which _must_ exist, like cats and dogs?
instead of looking upon them as conditions, like a dirty and a clean
condition, 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, distinctly
to believe that small-pox, for instance, was a thing of which there was
once a first specimen in the world, which went on propagating 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 having been a
parent dog.
Since then I have seen with my eyes and smelt with my nose small-pox
growing up in first specimens, either in close rooms or in overcrowded
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
substantives.
[11]
[Sidenote: Lingering smell of paint a want of care.]
That excellent paper, the _Builder_, mentions the lingering of the smell
of paint for a month about a house as a proof of want of ventilation.
Certainly--and, where there are ample windows 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 remain for months. Why should it go?
[12]
[Sidenote: Why let your patient ever be surprised?]
Why should you let your 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. Why 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 _not_ "let in," and such a
parcel had been wrongly delivered or lost because A and not B had opened
the door!
[13] There are many physical operations where _coeteris paribus_ the
danger is in a direct ratio to the time the operation lasts; and
_coeteris paribus_ 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; _coeteris paribus_ their capability of
bearing such operations depends directly on the quickness, _without
hurry_, with which they can be got through.
[14]
[Sidenote: Petty management better understood in institutions than in
private houses.]
So true is this that I could mention two cases of women of very high
position, both of whom died in the same way of the consequences of a
surgical operation. And in both cases, I was told by the highest
authority that the fatal result would not have happened in a London
hospital.
[Sidenote: What institutions are the exception?]
But, as far as regards the art of petty management in hospitals, all the
military hospitals I know must be excluded. Upon my own experience I
stand, and I solemnly declare that I have seen or know of fatal
accidents, such as suicides in _delirium 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 medical officers
should 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
_delirium tremens_? 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 office clerk, but as head nurse, (and head nurse the best
hospital serjeant, 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 _woman_ in charge of
the ward, or set of wards, the thing would not, in all certainty, 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.
[Sidenote: Nursing in Regimental Hospitals.]
It is often said that, in regimental hospitals, patients ought to "nurse
each other," because the number of sick altogether being, say, but
thirty, and out of these one only perhaps being seriously ill, and the
other twenty-nine having little the matter with 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 nursing. I have seen these "kind" fellows (and how kind
they are no one knows so well 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 could be
introduced in regimental hospitals. It would be most undesirable, even
were it not impossible. But the head nurseship of a hospital serjeant is
the more essential, the more 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 own 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 genius, however "kind" and
willing they may be.
[15]
[Sidenote: Burning of the crinolines.]
Fortunate it is if her skirts do not catch fire--and if the nurse does
not give herself up a sacrifice together with her patient, to be burnt
in her own petticoats. I wish the Registrar-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.
[Sidenote: Indecency of the crinolines.]
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 unpleasant truth.
[16]
[Sidenote: Never speak to a patient in the act of moving.]
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 accidents
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 if 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, which the act of moving is to any
feeble patient.
[17]
[Sidenote: Careless observation of the results of careless visits.]
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 them "better," thought they "only wanted a little
amusement," and who came again, saying, "I hope you were not the worse
for my visit," 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,
there is most danger to the patient. Unperceived 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
patient will often not even mention what has done him most harm.
[18]
[Sidenote: The sick would rather be told a thing than have it read to
them.]
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.
[19]
[Sidenote: Sick suffer to excess from mental as well as bodily pain.]
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 far 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
diseases, especially in convalescence from fever, that wall will appear
to make all sorts of faces at him; now flowers never do this. Form,
colour, will free your patient from his painful ideas better than any
argument.
[20]
[Sidenote: Desperate desire in the sick to "see out of window."]
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 desperate to "see once more out 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 serious 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
for food in the starving stomach, and tempts the famishing creature in
either case to steal for its satisfaction. No other word will express it
but "desperation." 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 with a "view" of some kind, as if they did not
provide the hospital with a kitchen.
[21]
[Sidenote: Physical effect of colour.]
No one who has watched the sick can doubt the fact, that some feel
stimulus from looking at scarlet flowers, exhaustion from looking at
deep blue, &c.
[22]
[Sidenote: Nurse must have some rule of time about the patient's diet.]
Why, because the nurse has not got some food to-day which the patient
takes, can the patient wait four hours for food to-day, who could not
wait two 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 _has_ got it, is equally fatal. If 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.
[23]
[Sidenote: Intelligent cravings of particular sick for particular
articles of diet.]
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. These are fruit,
pickles, jams, gingerbread, fat of ham or of bacon, suet, cheese,
butter, 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 was wrong.
The articles craved for, in these cases, might have been principally
arranged under the two heads of fat and vegetable acids.
There is often a marked difference between men and women in this matter
of sick feeding. Women's digestion is generally slower.
[24] 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
substituting a piece of bread for a cup of tea or coffee or beef tea as
a refresher. They would find it a very poor comfort. When soldiers have
to set out fasting on fatiguing duty, when nurses have to go fasting 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 circumstances.
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 upon all other things.
[25] In making coffee, it is absolutely necessary to buy it in the berry
and grind it at home. Otherwise you may reckon upon its containing a
certain amount of chicory, _at least_. This is not a question of the
taste or of the wholesomeness of chicory. It is that chicory 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 unite a good deal of hard manual
labour with the head-work necessary for arranging the day's business, so
that none of it shall tread upon the heels 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 contains the restorative they
want; which is not to be found in sloe-leaf tea.
The mistresses of houses, who cannot even go over their own house once a
day, are incapable 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.
[26]
[Sidenote: Nurses often do not think the sick room any business of
theirs, but only the sick.]
I once told a "very good nurse" that the way in which her patient's room
was kept was quite enough to account for his sleeplessness; and she
answered quite good-humouredly she was not at all surprised 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 called a "nurse?"
[27] For the same reason if, after washing a patient, you 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 minutes. The fire
will dry and at the same time air it. This is much more important than
with clean things.
[28]
[Sidenote: How a room is _dusted_.]
If you like to clean your furniture by laying out your clean clothes
upon your 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, sofas, 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 flaps every
thing, 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."
[29]
[Sidenote: Atmosphere in painted and papered rooms quite
distinguishable.]
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, _coeteris paribus_. The latter will always be musty, even
with all the windows open.
[30]
[Sidenote: How to keep your wall clean at the expense of your clothes.]
If 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!
[31]
[Sidenote: Absurd statistical comparisons made in common conversation by
the most sensible people for the benefit of the sick.]
There are, of course cases, as in first confinements, when an assurance
from the doctor or experienced nurse to the frightened suffering 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 advice 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 consumption,
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 with which
such comparisons require to be made, (and are made), in order to be of
any value whatever, 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 comparison
between old men with dropsies and young women with consumptions. Yet the
cleverest men and the cleverest women are often heard making such
comparisons, ignoring entirely sex, age, disease, place--in fact, _all_
the conditions essential to the question. It is the merest _gossip_.
[32] 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 ought always to be encouraged
to do so.
[33] 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
forgotten.
Courts of justice seem to think that any body 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 a fourteenth,
who had never left his bed, went to a distant chapel every morning 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 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.
[34] 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?
[35]
[Sidenote: More important to spare the patient thought than physical
exertion.]
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.
[36]
[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 Englishwomen) 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 Englishwomen 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 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.
[37]
[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
_recognized_ 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
recognized livery, as I have said--_de rigueur_ in novels, but nowhere
else.
[38] 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 becomes
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
reporter.
[39]
[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
experience.
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.
[40] 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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