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About Google Book Search Google's mission is to organize the world's information and to make it universally accessible and useful. Google Book Search helps readers discover the world's books while helping authors and publishers reach new audiences. You can search through the full text of this book on the web at |http : //books . google . com/ Darvarb College Xibrari? BOUGHT WITH MONEY RECEIVED FROM THE SALE OF DUPLICATES Botes ON NmJsWI ^^^lE LABODKlNn (tus ^M » ■ FLORENCE NIQMTtNOALE. 1 ^^^H ^H ^pARIM|' — ^MALI,, J '•^^, ^^j ^^^^^^^^P^H^^^^v<* V i><-^TMl^^^^Hp^^H ^^^^Hf, «'- ^1 -'.^ Mf r^Uit.lr vrritfcoi /fTv^Vr-l^Mv^B ^^^^^^^^Ht ^^^H ^^^^^^^^^^K| 1 ]:£■ ^^^^^^B ] Is. 1 ^^^^^^^K '' iW. J ^^^^^^Bki 111 z li u 1} . I ^1 I i^^inofl ^^^^^^■i IU& Ye^, tot Cflngrogati^ ^^^^^^K ' r CoQgregaUcQiil Dk6, Hannomsefl an Ijcafl ^^^^^^^MJ^^UI^li^ OTES ON NURSING, roB THE LABOURING CLASSES. FLORENCE JllGHTiNGALE. -LONDON: AERISON, 59, PALL MALL, |00itselUr to i\t (^mm, 1 3G I. following notes are by no meaiiB intended aa a rule <> Dught by wliieh nnrses can teacb tliemsches to nurse B^till less as a manual to teacli nurseis to nurse. They w pant simply to give hints for thought to womea who i sonal charge of the health of others. Every woma least almost every woman, in England has, at one aaother of her life, charge of the personal heaM" aebody, whether child or invalid, — in other words, ever; aan is a nurse. Every day sanitary knowledge, or th lowledge of nursing, or in other words, of how to pu^J institution in such a state as that it will have no disf I that it can recover from disease, takes a higher pti is recogubed as the knowledge which every one oqgh have — distinct from medical knowledge, which only ttfession can have. : then, every woman must, at some time or other , become a nurse, i.e., have charge of somebody's he immense aod how valuable would be the produ united experience if every woman would think how ti aajH ever; ir th 1 pmS i>qgh wnly J I do not pretend to teach her how, I nfik her to elf, and for this purpose I venture to give her somi CO^B^TS. ■^^^ 1^ « ASP >V*»^° } ■« ot flooaia lU. B»"^ ,«, m.p«"^'' ..:; ::::.., jY^ Kois* •■■• *""'* ' """ y YasJJK^ • ^;. tAcs** ■^'^" ^IL^HatTooi. YlU. W» ^'" ^•^^rc^-- ::"• ^acB.r^\^;;,3.s.oK si«. o»-«'^«°'' " ^•^'-'7:^^ : XV. ^^^ ^ ^" svi- '*:^«^^*' " - '■^" NOTES ON NURSING: YraAT IT IS AND WHAT IT IS NOT. k iratcluiig disease, both in priyaie houses and in public MpitalSy the thing which strikes the experienced obserror ■QSt forcibly is this, that the symptoms or the sufferings gene- BiD^ considered to be unavoidable and peculiar to the disease ■s very often not symptoms of the disease at all, but of some- iiiig auite different— of the want of fresh air, or of light, or of •nnu, or of quiet, or of cleanliness, or of punctuality and care I the administration of diet, of each or of all of these. And lii quite as much in private houses and cottages as in hospitals. (The process of repairing the body which Nature has instituted, \d, which we call disease, has been hindered by some want of lowledge or attention, in one or in all of these things, and pain, iering, or interruption of the whole process sets in. If a patient is cold, if a patient is feverish, if a patient is faint, he 18 sick after talong food, if he has a bed-sore, it is generally t fiuilt not of the disease, but of the nursing. I use the word nursing for want of a better. It has been ■ited to signify little more than the administration of medicines li tiie appucation of poultices. It ought to signi^ the proper i of fresh air, li^ht, warmth, cleanliness, quiet, and the proper Boobig and giving of diet — all at the least expense of vital pver to the patient. fiU has been said and written scores of times, that every Ban makes a good nurse. I believe, on the contrary, that ▼erv elements of nursing are all but unknown. }f this I do not mean that the nurse is alwavs to blame. Bad ction of rooms and houses, and other Dad arrangements make it impossible to nurse. But the art of nursing ought mdude such arrangements as alone make what I understand BTsing possible. [Hwe are asked. Is such or such a disease a restorative process ? ^ such an illness be unaccompanied with suffering? Will care prevent such a patient from suffering this or that Y---I ilj say, I do not know. But when you have done away with ftat pain and suffering, which in patients are the symptoms ' tf their disease, but of the absence of one or all of the above- Loned essentials to the success of Nature's restorative pro- ^ we shall then know what are the symptoms of and the Ufamgs inseparable from the disease. Another and the commonest exclamation which will be instantly Hide is — Would you do nothing, theu^ in. Ci\tf^\a ^^^ "^^ 6 NOTES ON NUBSIira. cine is to be doing something, or rather everything ; to give ai warmth, cleanliness, &c., is to do nothing, ^e reply id, that i these and many other similar diseases uie exact value of pari cular remedies and modes of treatment is by no means ascertaine while there is universal experience as to the extreme importani of careful nursinff in determining the issue of the disease. n. The very elements of what constitutes good nursing ana i little understood for the well as for the sick. The same lai of health or of nursing, for they are in reality the same, obtai among the well as among the sick. The breaking of them m duces only a less violent consequence among the former tlu among the latter, — and this sometimes, not always. It is constantly objected, — '^ But how can I obtain this medifl knowledge ? I am not a doctor. I must leave this to dootonL" Oh, mothers of &milies ! You who say this, do you know tii one in every seven in&nts in this civilized land of Sng^ perishes before it is one year old ? That, in London, two in eves five die before they are hve years old ? And, in the other gra cities of England^ nearly one out of two ? Upon thifl fact the most wonderful deductions have been atron For a long time an announcement something like the foUowii has been going the round of the papers : — ** More than 26y0( children die every year in London under 10 years of age ; then fore we want a Children's Hospital." Last spring there was paper issued, and divers other means taken to this effect h '' There is a great want of knowledge about health in womeo therefore we want a Women's Hospital." Now, both the aboi facts are too sadly true. But what is the consequence ? Tl causes of the enormous child mortality are perfidotlv well known they are chiefly want of cleanliness, want of ventilation, carela dietiug and clothing, want of white-washing ; in one word, wn of household care of health. The remedies are just as m known ; and among them is certainly not the establishment ( a Child's Hospital This may be a want ; just as there may be want of hospital room for adults. But the Begistrar-Genen would certainly never think of giving us, as a cause for the hig rate of chUd mortality in (say) Liverpool, that there was lu sufficient hospital room for children ; nor would he urge upon o as a remedy, to found a hospital for them. AgaJD^ women, and the best women, are wofiilly deficient i YESrUiATlOVt AND WABMUfO. aldP rs to be always accompanied by doctors ? Or ia it bett^tf ^any thing rather than to learn the laws which arei er mothers of families of any olasf, iK>r 8chf>ol- i uiij elasg, nor nuraes of children, nor nnrBed pHals, are taught anything about those laws which God »'^ to the relations of our bodies with the world in wli ut them. In other wordfi, the lawn which make thd tito which He has put our rnindji, healthy or nnheaM _ >thosQ minds, are aU but unlearnt. Not but that these ) laws of life— are io a certain measure understoi>d, but L mothers think it worth their while to stttdy them — ^to r how to give their children healthy existencee. They o aU [ical or physiological knowledge, fit only for doctors. ^" ain, we are constantly told,—*' But the fcironmstances wh 1 o J r I Ml 's healths are lieyond our control. What i -ttii . ? There is the east wind. Most people efore they get up in the morning whether the wiimI ' I this one can answer with more certainty than to the fa\ Sections. Who is it who knows when the wind is in the east ? |the Highland drover, certainly, exposed to the east he '■young lady" who is worn out with the want of ^ to fresh air, to sunlight, &c. Put the latter under ^altby circumstances as the former, and she too will not know [ the wind is in the east. ^_ wi^ of 9 derW atS I,— TENTILATION AKD WARMING. ! very first rule of nursing, the first and the last thing upon . nurse- g attention must be fixed, the first essential to the j_without which all the rest yon can do for him is^aa^ 1th which I had almost said you may leave aU the is : To KEEP TBi3 ATR HB BA£ATHE3 AS PUBH A8 All AIR, WtTHOlTT OH[LLIA*0 HIM, Yet what 19 80 Utfcl attended to ? Even where it is thought of at all, there are the nost extraordinary misconceptions about it. Even in admitting iir into the patient's room or ward, few people ever think where ;hat air oomea from. It may come from a passage, always Xnaired, always full of the fumes of gas, dinner, of vanoug kinds >f muBtiness ; from an undergron'i' 1-^-1.^ ^•»»>v ,v«^^-h'>n ^atep*closet, dung-heap, or even, ; B, from open sewer? 1* ;i . . v,^... _.u. t's room or ward is liirl, ;is it is civlJ iher be sai^i Ahv:iv 11 irom tho : too, through those win'^ _ stt. From a closed court , : waj, air may come as aiagnibnt aa icQia auy uisitk pii**aag^ 8 KOTM ON NUA812«K Again, a thing I have often seen in the sleeping rooms < priyate houses and oottagos. The fire-place is carerally fastenf up with a hoard ; the windows are rarely or never opened; pe haps itiej are not made to open, or thejr open only at the bottom perhaps some kind of stores are kei>t in the room ; no breath < fresh air can by possibility enter into that room. The air as stagnant, musty, and cormpt as it can by possibility be mad It is quite ripe to breed small-pox, scarlet fever, diptheria, < anything dse you please. xet people, or worse still, children will sleep in that rooi without any previous airing. And the door will be left opea i day in order to make the acyoining sitting-room or ^'hons place," as foul as possible too, for ten to one the window of tl sitting-room is kept closed. The common idea as to rooms is that they may safeW be k with window and chimney-board both clc«ed — sealed up Csible —to keep out the dust, it is sometimes said ; and ihi^ i m will happen when inmates are put in. The question often asked — But when ought the windows to be opened ? Tl answer is — ^When ought they to be shut ? A ^ort time sm a man walked into a back-kitchen in Queen square, and cut the throat of a poor consumptive creature sittii by the fire. The murderer did not denv the act^ but simply sai " It's all right.'' Of course he was mad. But in our case, the extraordinary thing is that the victi says, '^ It's all right," and that we are not mad. Tet^ althou( we *' nose " the murderers in the musty, unaired, unsunn< room, the scarlet fever which is behind the door, or the fev and hospital gangrene which are stalking among the crowd beds of a hospital ward, we say, '* It's all right." With a proper supply of windows, and a proper supply of fu in open fire-places, fresh air is comparatively easy to secure wb your patient or patients are in bed. Never be afraid of ojp windows then. People don't catch cold in bed. This is popular fallacy. With proper bed-clothes and hot bottles, necessary, you can always keep a patient warm in bed, and w< ventilate him at the same time. But a careless nurse, be her rank and education what it ms will stop up every cranuj, and keep a hot-house heat when b patient h m bed, — and^ if he ia able to get up, leave him coi TKJfTlI*^TI05l AXJJ WABMINO* J t*a- [ whicb gball not chill the patient. Otherwise the l&t wers have then risen often finds the room as close and opprea- [ve OS he found it cold in the morning. Yet the nurse mil " plrified if a window is opened. It is very desirable that the windows in a sick room should fxch as that the patient shall, if he can move about, be able to open End shut them easily himself.* In fact, the sick room is very pldom kept aired if this is not the case — so very few people have «iy perception of what is a healthy atmosphere for the sick. The ^ck man often says, ^' This room, where I spend twenty-two hours [lit of the twenty-four, is fi'esher than the other where I only end two. Because here I can manage the windows mjrself.'^ lit 16 true. , little book on nursing, published a short time ago, we are that " with proper care it is very seldom that the windows bt be opened for a few minutes twice in the day to adi] " ' %ir from without,*' I should think not ; nor twice in either. It only shows how little the subject has been con? iered* all methods of keeping patients warm the very worst cer* is to depend for heat on the breath and bodies of tho X have known many a nurse keep her invalid's windows B closed, thus exposing the invalid to all the dangers of an. ed atmosphere, because she was afraid that, by admitting lair, the t'emperature would be too much lowered. This is n Bcdve fallacy* ^ attempt to keep a room warm at the expense of making the » repeatedly breathe their own hot, damp, putrid atmosphere^ mi trtain way to delay recovery or to destroy life, ^H Pyou ever go into the bed-rooms of any persons of any cl _ ier they contain one, two, or twenty people, whether they L sick or well, at night, or before the windows are opened in the 'ng, and ever find the air anything but un wholesomely and foul 9 And why should it be so ? And of how much ance is it that it should not be so 7 During sleep, the ,. body, even when in health, is far more injured by the tice 01 foul air than when awake. Why can't you keep the h all night, then, as pure as the air without in the rooms you Wep in 1 But for this, you must have sufficient outlet for tl Actors. — DeUrioufl fever CMca, wberc there ia any danger of the patient jumping « HHrNr, me of course, c> ' i>9oluteIy neceisury that tucb co»efl thoa ^^TOcml «£(! wcl^afred Le, with taut gimleti, to tave ftlk nakj HHb, hy mereTf prevci . iioth upper and lower, from Iieius5)^ I I JB NOTES ON IfUBSXira. unpnteftiryottinake yonraelftogoout ; sufBoient iuletl pure air from without to come in. Yoti must have opi neya, open windows, or ventilators j no cloee curtains roi beds ; no ehutters or curtains to your windows, none of triTances by which you undermine your own health ott the chances of recovery of your sick. Open the window above, not below. If your windowi open above, the sooner they are made to do so the liet inch or two will be enough for two people in a moderat bed-room in winter. In a children*a nursery or bed-roo will be required, according to the number. The worst admit air^ either into a sick room or hospital ward, ia a1 tlie level of the floor. I like cageraent windows better ti windows, for this reason^ that you ca7inot open a casoi French window aa I see all women doin^— an inch and a the lower sash— ju6t on purpose Twi to air the room and- you the rheumatism by the dt'aiight^ Air admitted in th tion cools the floor aud the lower strata of air ; and if thi 13 able to step out of bed, the cold air may give him a di chill. Daring mild weather and summer time your wind< be wide open. In this, as in other things, common sew be used. Ventilation of a bed-room or a sick room does n throwing the window up to the top, or drawing it d(»wn 9 it will corao ; still less does it mean opening th© win intervals and keeping them shut between times, thereby ing the patient to the risk of fretjuent and violent altej of temperature. It means simply keeping the air fresh. The true criterion of ventilation is to step out of thei room, bedroom, or sick room, in the morning, into the a| If^ on returning to it, you feci the least sensation of cloi ventilation has not been enough, and that room lias bi for either sick or well to sleep in. It is very odd how much more regard gardeners have 1 plants than women have for their children or patients, were a gardener^ you would know, that if you admitted your green- houses, as almost all women do into their n by a chink at the bottom of the window, the plants oppoi chink would die from the cutting air, and the plants ab^ chink would die for tmrU of air. The air throughout never changed by a dnmght in the lower part of the ro* it i^ changed by an opeu window in the upper part* I have observed fifty times the death of poor unH plants transferred to rooms aired after this fiashioa hyf of stupid women. What must it then be for their 0] 1 patients ? m It is a curious fact, which you may any day observe foi ^thMi tJje air admitted from a chink at the top of yma ^ffill oircnhte throughoni the room — 'm^ "k«^v ^^ ^"^ 1 I mT li'i L 'l wider ohmk near the 11 I [ rue trfnibiG to open the window from the top, liut III 7 mess which prevents your doing 80. Add to : gviieraliy TiT>^-- n ^nid chimney smoke by the chink j by the <- vL^ tmay any ii«, ^...v.rve for yourself how gmells drift, ornerin your room where there is no window, or . vnon the window, especi^iy if it be at the end of J iiell from any mesa or dirt, from anything * il be stronger there than at the spot, or at < ' spot in the room. Nay, it will even remain tnere long i I dirt Ib removed, and the smell gone from the spot. Yet-^ orner as this is the one generally chosen for a sick bed to You can easily satisfy yourself by actual experiment < Wi> I say. It is true even with regard to the scent of flowers. \ this which makes it so dangerous to leave the bedroom door ' into a passage. You are quite sure to have the smell of any < img, of any gas or candle, of any water closet or sink, drift* ' ' |the place you sleep in, or worse where your siok person ^ , places, public or private schools, where a number o! [ or young pci-sons sleep in the same dormitory, require '^^ tV • ^hne&s to bo constantly applied. If it be hazardous io sleep together in an unventilated bedroom, it ,,.; auultly BO to have four, and much more than trebly ft,vc six under the same circamstaiiceg. People rarely this ; yet, if parents were as solicitous about the air of edrooms as they are about the food the children are to the kind of education they are to receive, at school, pon it due attention would bo bestowed on this vitally ftjEiatter, and they would cease to have their children " lier ill, or because scarlet fever or some other ** ctir- _ (>n*' had broken out in the «chooL' There are school* Qition is paid to those things, and where ^' children^ ^ are unknown. iioh sickuGss, death, and misery arc produced by the ate of many factories, warehousea, workfihops, and work- 'V smakers, tailurSt letter-press v? to work for their living, iij 31, wld. A hot bottle should oever be hotter than il ably touched with the naked hand* It should not keep warm loiiger than eight hours. Tin foot hot aud too cold. Stone bottles are the beet, or Id But careless Jiurees make sad havoc with the latter, bj water too hot, or by letting the screw get out of ordi I patient be deluged in his bed. All these things require common sense aud care. "! in no one single thing is so Httle common beDse sh ranks, as in nursing. The art of nursing, aa now practised, seems to 1i I couetituted to unmake what God had made disease ta restorative process. The e:straordinarj confu^on between cold aud'vei] the miuds of even well-educated people^ illustrates tliij a room cold is by no means necessarily to ventilate it at all necessary, in order to ventilate a room, to chill a nurse finda a room close, she will let out the fire, ther it closer, or she will open the door into a cold roon fire, or an open window in it, by way of improving the ,iEhe safest atmosphere of aJl for a patient is a goodtj j(ppen window, excepting in extremes of temperature nurse can ever be made to understand this.) To small room without draughts of course requires moi to veutilate a large one* < But it is often observed that nurses who make i outcry against open windows are those who take the to prevent dangerous draughts. The door of the pa^ 7?r ** ^'7^j; tv ;' s stand open to allow of persi»n8 passiun; ' ; being carried in and out. The carefu k^^.^ u.u u^ij. cihut while she shuts the wtudows, and not before, set the door open, so that a patient may ] sifctinfi up in bed, perbape in a profuse perspiration, diij draugnt between the open door and window* Neithei should a patieutj while being washed or in any \^| remain in the draught of an open window or door* i It is truly provoking to see stupid women bring intj ,the life^spring of the patient, via,, fresh air, by theii Chest aud throat attacks may undoubtedly be broughii ^Aurae lettiug her sick run about without slippers^ flami iag-gowns, in a room where she has left the wintry wi in upon them, v i ■ uking any precaution if they aj their beds. Ctr tue sometimes pointed out, i Jielplesa way, a - ' 1 to bronchitis, becji '^draught irouj itould there be a d the door? If tl ay ^iv^Ad the draught fall g Is there no sue: a ticreeu to bo had : or if t be in a draught r^a^^^'^x vauuot be pitv^nUid, wbyud ve:stii*ation and waei:i>'g» ^15 cateksB woman will come into tlid edok room ao r open tili ^he goes out again, for no reaaon that an cover but her owu blindness. At>'1 ^^h" ^^^}\^ i nve ih over her patient who is wash! and then eay, "He has token ljLi ii^ii. .iiL- op He has takea cold from your own thoughtlegsnei ^ing doors open nor drawing down windows over yo^ itXL the sui'faoe Ib exposed is ventilation. It is Bimi]' I extraot'dbiaty fallacy is the dread of sight air. [breathe at night but night air I The ohoice is betwet air from without^ and foul night air from within. Mo ier the latter. An uiiacoountable ohoice. What will thu proved to be true that fully one half of all the diaea rem is occasioned by pt'r>ple sleeping with their windon irindow open at the top most nights in the year < i any one. In great towns night air is oft^en the I t air to be had in the twenty-four hours. I cou IftTgtand shutting the windows during the day in tow^ jr 1^} " T'^'^htj for the sake of the sick. Theabis* I A tend to making night the best time for ,L..^ .^ ill London is never so good as after tea * f time when it can he. unsafe to open the window at nig^ c air is mure [ it than within. This may i close hack cou , i open privies and middens tea^ J ch ought not to be permitted to exist f 11 there is a sudden fall of temperature, r roo{n> then, from the outaide airj if po&sibli e to open; doors are made to shut — a trad ;r6mely difficult of apprehension. I have seenej _ her patient's room through the door near i wo gaelights, (each of wliich conaumee as much ; uen,) a kitchen, a close passage, the atmoapheie of gas, paint, foul air, never €haD^e j :e care that your lid^ aa well as your utensil, be always] irotighly rinsed. r ■fa nurse declines to do these kinds of things for her pattejit, Bcause it is not her business/' I should say that nursing wr<} I , her calling, I have seen surgical *^ 8iBtei*s," women whoael ids were worth to them two or three guineas a-week, down f m their knees scouring a room or hut, because they thoughtl otherwise not fit for their patients to go into, I am far frouiJ ihing nurses to scour. It is a waste of power. But I do sayl ,t these women had the ti-uc nurse-calling — the good of their I t firsts and second only the consideration what it was their 1 lace*' to do—and that women who wait for anybody else to dai at their patients want» when their patients are suffering, have J : the inaking of a nurse in them. Earthenware, or if there is any wood, highly polished and ulshed wood, are the only materials fit for patients' utensils,^ e very lid of the old abominable close-stool is enough to breed] . It becomes saturated with offensive matter, which/ only wanted to bring out. I prefer an earthenware! aa Ijcing always cleaner* But there are various good iiew-4 bioned arrangements, A slop-pail should never be brought into a sick room, mid be a rule invariable, rather more important in thi? private tise than elsewhere, that the utensil should be carried directlyl the water-closet, emptied there, rinsed there, and brought T 3k. Tliere should always be water and a cock in every water- aet for rinaing. But even if there is not, you must carry wat*n»{ ire to rinse with, I have actually seen, iu the sick room, the ' fnsiU emptied into the foot-pan, and put back, unrinsed under I bed, I can hardly say which is tnoet abominable, whether ttf, this or to rinse the utensil in the gick room. In the besfcj Kit is now a rule that no slop-pail shall ever be broughl wards, bat that the utenrils 6\\«tVV\ife cwcTviiA^\t«sJw ^> ' i jrOTSS ON KUftSUfG. it Wi^^^l afectatrtSj^^i ptiod and rinsed at the proper pla^e, I would jrj house ! Let no one ever depend upon fumigations, " disinfectants/ the like, for purifying the air: The offensive thing, not i^ elL, must be removed. I wiah all diBinfectitig fluids inventc de such an " abominable sinell " that they forced yott_j u the windows and to admit fresh air, That won useful invention. H.— HEALTH OF HOUSES. 5, liff 3. Efficient i 4. Oleauliuess, And it will be 1 tal TsEEE ore ^ve esBential points in securing ho uses : — ^ft 1. Pure air. ^B 2. Pure water, ^M 5, light. ^Btthout these no house can be healthy, jttst in proportion as they are not. 1. To have pure air, your house must be so built as ih outer air shall fiud its way with ease to every corner of it, builders hardly ever consider this. The object in build I is to obtain the largest interest for the money, not i otor^s bills to the tenants. But, if tenants should ever 1 I wiBe as to refuse to occupy unhealthily built houses, bu would speedily be brought to their senses* As it is, thej I i pays best. And there are always people foolish enoB ffciake the houses they build. And if m the course of tin lies die off» asis so often the case, nobody ever thinks of bli ky but Providence for the result. Ill-informed people up the delusion, by laying the blame on " curreaK onsJ* Bad houses do for the healthy what bad hospiti p the sick. Onoe insure that the air in a house is sta I sickness is certain to follow. I Ko one thinks how much disease might be prevented] > the country, by simply attending to providing the ih fresh air. fl know whole districts in the south of England where,r] lien the windows are sashed, the sa&hes are never made to kthe top. ^I know whole diBtrlcta in the north of England where^^ \ quite new cottages, the bedroom windov/s are not en at all, excepting a singlo pane, geuerally placed low do window. Kow, if this open pane were iti the upper the upper sash, it would be all very well. Yery tolerable tioik is procured by this means. But if it is in the lowi r is^llwerrbad. It does nothing but produce a di gwganis^ aotuAlly driving the iowl ait u^aiie of perforated glass in a passage or stair- wind^ir. lace, under which three or four people 0^ lit] cottages of the south of England and in tior-houses — is an immense benefit to the an* of the "* it ha« disappeared in all new buildings ! ^ut never stop up your chimney. Of whatever size it is, imoat every night of the year, pull your wind^ fop. Remember, at the top. fintn^ district* visitors, and landlords may be pple to carry out these improvements. They are ofte to do so than you arc to help. You will thna d re good than by supporting hospitals and dispeusaric Ken they are ill of foul air. Why not prevent th fhich comes of foul air ? ftain olTJection of working-people to fresh air is the the air introduced into cottagerooms by pas^iil ne fire-clay contrivance behind tht^ I'mtr- i>nd hi -the air to be admitted ^3 tV beside, and entering the lOom \l ^ r economise half the fuel by som^ pi been remedied. But, in many parts of the country, well-watar a very impure kind is used for domestic purposes. And wb epidemic disease shows itself persons using such water are almc sure to suffer. Never use water that is not perfectly coknulc and without taste or smell. And never keep water in an op tub or pail in a sitting-room or bedroom. Water absorbs foul a and becomes foul and unwholesome in consequence, and it dan the air in the room, making it also unwholesome. 3. It would be curious to ascertain by inspection, how mai houses said to be drained are really well drained. Many pepi would say, surely all or most of them. But many people have no id in what good drainage consists. They think that a sewer in t street, and a pipe leading to it from the house is good drain^ All the while the sewer may be nothing but a place from iHn sickness and ill health are being poured into the house. ] house with any untrapped unventuated drain pipe commiu eating immediately with an unventilated sewer, whether it from water-closet, sink, or gully-grate, can ever be healthy. J untrapped sink may at »;ay time spread fevers and other doseaf among the inmates of a palace. Country cottages suffer from bad drainage quite as much j if not more than, town houses. The best that can be said abo their floors is that they are on the level of the ground, instei of being a foot or more above it, as they ought to be, with i air playing freely below the boards. Most frequently, howev( the floors are not boarded, but are merely made of earth or porous brick, which absorbs a large quantity of moisture, ai keeps damp cold air always about the feet. Perhaps mi frequently of all, the floor has been worn away several indt below the level of the ground, and of course after every wet d the floor is wet and sloppy. One would think this bad enou( but it is not the worst. Sometimes a dung hill or a pig sty kept so close to the door that the foul water from it, after lai may be seen flowing over the house floor. It frequently liuppeiis when cottages arc built on hill-sides ^ the cottage wall is built against the damp earth, instead of bei RBALTH or HOUSElg. I [ hesJtli. Is thei-e nobody iu the parish who would ^ttei*s up, and go from house to house to examine into them I commot) sense, sl little labour, which in nine oa«efl out C M be found by the people themselves, a few shillingfl i I &i the outside, and no costly machinery of any kinc put the whole thing to rights, and save health, life^ an oo d m 1 )id you ever observe on looking over an extensive laudscap er sunset that there were certain groups of houses over whioi I first fog settled sooner than over others ? The fog is nature' of showing that the houses and their neighbourhoo " ated with moisture from the neglects above specified. point out where the fever or cholera will come. remedy this state of things, the ground requires to la ined or trenched, the earth cut away, the floors raised abov f level of the ground, and dunghills and pig-sties removed a as possible from the houses. These things can always h ced m such a way as that the natural drainage removes al ; is oflensivc about them, at least away from the house, aother not uncommon cause of sickness among villnge peopi puddle of foul water or an offensive ditch. The foiiner cai ays be filled up with earth, or drained away by a little spad our. As regards the latter^ there is nothing in which mor ' could be done than by laying a drain pipe iu the bottom c ^Ive ditch and filling the earth in over it to a sufficient distano on either side the houses. People often put up with nuisances from dunghills and pig-stie« account of the value of the matter itself Value there i inly. But the question is whether the nuisance is necessary [ whether, in preventing nuisance, money would not be saved *All foul sraell indicates disease, and loss of money," sayi . Chadwick. Never live in a house which smells. Eithe! »*t take it, or examine where the smell cornea from, and put s » to it : but never think of living in it until there is no smell iouse which smells! is a hot bed of disease, lut though such smells always indicate danger, says the sanw fiority, it does not always follow that there is no danger whei \ is no smell. The danger is often greater, when the smel jives warning is gone. Therefore remove the thing itsel I only the smell. ' of the most common causes of disease in toAvns is havin| i and cesspools, ashpits or midiUmteath close to the houses are great atid rich cities and towns which justly prid< Ives on their drainage, their water-supply^ their paving, anc tl .irtAine, and yet have more death in their dwellingi 1 - where no such works have been carried out Itl M, the domestic ftlt\i ol \\vei ^^rc^^o^"^ ^Ssfi^ss^' ]imahkte mn ^ -]-—f^ mndows, in order that as much of th ' air as pos lit ha conducted into and retained i t bed-rooras, Iiio >> -.iderful! Another great evil in house construction is caiTying drain ierneath the house. Such drains are never safe. All bona una should begin and end outside the walls. Many peopl ' readily say, how important are these things. But how fe\ i there irho trace disease in their hou^holds to such caufles ^t not a fact, that when scai'let fever, measles, or small po: Bir : lO children, the very first thought which occurs i tkevi- liltlreu can have " caught*'' the disease ? And fcb '^pnrcnts iiuaiediately run over in their minds all the families wit) whom they may have been. They never think of looking i botne for the source of the mischief. If a neighbour's child i [ with small-pox, the first question which occurs is, whethe L been vaccinated. No one would underviUue vaccination \ it becomes of doubtful benefit when it leads people to lool oad for the source of evils which exist at home, 4, Without cleanliness, withuY and without your house, ventila Ki is comparatively useless. In certain foul districts pooi pie used to object to open their windows and doors because o foul smells that came in. Rich people like to have theii stables and dunghill near their houses. But does it ever occur t< that with many arrangements of this kind it would bt to keep the windows shut than open 1 You cannot havi ' ' of the house ptire with dung heaps under the windowt are common everywhere. Aiid yet people are surprisec their children, brought up in "^^ country air," suffer Idren'a distaaes- If they studied nature's laws in the, i ^lildren's health, they would not be so surprised, here are other ways of having filth inside a hou=e bes J dirt in heaps. Old papered walls of years' standing, dirt) ts, dirty walls and ceilings, uncleaned furniture, poDute thi as much as if there were a dung heap in the baseroeat are so unaccustomed to consider how to make a home Yj that they either never think of it at all, and take everj as a matter of course, to be " resigned to" when it comcj I the hand of Providence ;" or if they ever entertain the ' preserving the health of their houseliold as a duty, i i very apt to commit all kinds of " negligences and ignoraa ^^^erforming it. ^Hbveii in the p<:.orest houses, washing tK^ ^^3ia 'mA c:.e^JSsa^ ^Bi qmck-lime wash twice a year, ^^otolV^ ^x^sx^viX. T£i5ytre ; it ig indeed t<^ be feai'ed that weakness of dig ptd health is becoming *' hereditary " in many wom€ *' predisposes" to ♦ : ; ion, and which, more thf be, tends to the dc: f a family or race. We jestion depends upun nahit: ily and directj l^of fresh air ; beooudarily aj« ly upon idleu^ fehy work or excitement, uii\\ijLuciujriti food, abu£e [ and aperients, and other exhausting habits, ^n oft^n stated that iiil-"^"M'>7»iTire, maiTylng coush ' source of himily weal 1 want of health ; ered that other habiL l -.,i,iiiig from parents eh, for iustance, us intemperance, breathing frM < [loomy unhealthy lociilitka ikvul tW \^v>, i^^ In healtliy " registration" districts, the mortaUt tinual proportion of birtlis is also low, but in ur' lie mortality rises, while at the same time the prop ttcreases, showing that in snch districts the circuij ^ortened. Now as to these childi'eu ushered into existence in 1 ttoh excessive mortality ! ' Has not every one had the opportunity of compar; ealthy development of a child bom in a healthy q ict with the thin, ill-fed, undeveloped or ilhdevelopi be child born in an unhealthy town ? And is not the irresistible that the unhealthy town child belongs ! fetnily type than the healthy country child l A proca '. deterioration has been going ou notwithstanding tl : births • and of these two claases of children about a) ountry children die before they reach the age of five J " the town children a half die before that period, j "proportion of those who survive their fifth year are i people, whose early deaths go to swell the local inortiu These are momentous facts, if people would only p< and act on the lessons they are teaching. ; With regard to the health of houses where there il son, it often happens that the sick room is made a shaft for the rest of the houte* For while the housl close, unaired, and dirty as usual, the window of the f Icept a httle open always, and the door occasioni tiere are certain sacrifices which a house with one sic . does make to that aick person. Why can't iti horoughly dean and unusually well aired, out of ri jjkck person 1 \ We must not forget what, in ordinary language, is oal lion ;'* — a thing of which people are generally so afral aently follow the very practice in regard to it ^ _ bt to avoid. Nothing used to be considered so ij ontagious as small-pox ; and people, not vei7 long q| Dver up patients with heavy bed-clothes, while th fires and shut the windows. Small-pox, of ed [lis management, was very *' infectious " People art * er now in their management of tliis disease. Thej ared to cover the patients lightly and to keep the win ^and we hear much less of the " infection'' of small-f used to do. But do people in our days act with mord the subject of *^ infection'* in fevers— scarlet fever, mej than their forefathers did with small-pox ? Poes not I 'deaof *' infection" involve that people should take ^ i' themselves than of the patient ? That, for instano '^ too much with the patient. ^mA True nursbg knows nothing of infection, except to prevent i — ^ — \BB and fresh air .from open windows, with unremittin to the patient, are the only defence a true nurse eithc or needs. Wise and humane management of the patient is the best safe lild against infection. Ib it not living in a continual mistake to look upon diseases, a do now, as separate things, which must exist, like cats an 1 instead of looking upon them as conditions, like a dirty an —i condition, and just as much under our own control ; c aa the reactions of a kindly nature, against the condition Ik whudi we have placed ourselves. ' I was brought up, both by scientific men and ignorant womei ^Atinctly to believe that small pox, for instance, was a thing < :^«liialL there was once a first specimen in the world, which wei en nropagating itself, in a perpetual chain of descent, just f ''mua as that there was a first aog, (or a first pair of dogs), an Unt small pox would not b^in itself any more than a new do would begin without there having been a parent dog. Smce then I have seen with my eyes and smelt with my nos miall pox growing up in first specimens, either in close rooms c in overcrowded wards, where it could not by any possibility ha-v bem " caught," but must have hegon. Nay, more, I have seen diseases b^n, grow up, and pass iut (me another. Now, dogs do not pass into cats. I have seen, for instance, with a little overcrowding, continue krm grow up ; and with a little more, typhoid fever ; and wit a little more, typhus, and all in the same ward or hut. Would it not be £Eur better, truer, and more practical if ^ looked upon disease in this lignt 1 There are not a few popular opinions, in regard to which it : ttseful at times to ask a question or two. For example, it : oommonly thought that children must have what are common] eaUed ^children's epidemics," '^current contagions," &o,; i other words, that they are bom to have measles, hooping-cougl perhaps even scarlet fever, just as they are bom to cut the teeth, if they Uve. Now, do tell us, why must a child have measles ? Oh, because, you say, we cannot keep it from infection— othc children have measles— and it must tsuce them— and it is safii that it should. Bat why must other children have measles 1 And if the have^ why must yours have them too ? If Tou believed in, and observed the laws for, preserving tl health of houses yrhioh inculcate cleanliness, fresh air, whiti wasfainff, and other means* and which, by the way, are laws^ t imphdSjr as yon belieye in the popnlax o^\\noTi>^QxV(*S&T^«J^ more than an opinion, that your cnild mxx!^ \v«^^ <3K\^^«i^ ^Bdcmics, don't ycm think tbat, upon the whole, your chil< ^bbe more likely to e8cai>e altogether ? KOTES ON KUESOrO. IIL— PETTY M^VNAGEMENT. 3 it A » All the results of good nurmng may be spoiled or ^ negatived by one defect, viz. ; in petty management, or, words, by not knowing how to manage, that what you do i» you are there shall be done when you are not there. The I devoted friend or nurse cannot be always there. Nor is it ^ .ble that she should. And she nsay give up her health, other duties, and yet, for want of a little management^ ©ne-half &o efficient as another who is not one-half so (* l>ut who has thiB art of multiplying herself— that is to { jatient of the first wiH not really be so well cared^fotf patient of the second. It is a9 impoMiMe in a book to teach a person in chaif flick how to mmiatfi, as it i3 to teach her how to nurse. CiW stances must vary with each different case. But it is poA to press upon her to think for herself. Now, what does hai] during my absence ? I am obliged to be away on Tueflday; freah air, or punctuality, is not less important to my patifu Tuesday than it was on Monday. Or : At 10 p.m. I am with my patient ; bat quiet ia of no less consequence to ' 10 than it was at 5 minutes to 10. Cujrioufl as it may seem, this very obvious conRideratio comparatively to few, or if it does oocur, it is only to < devoted friend or nurse to be absent fewer hours or fewer i fi'om her patient — not to arrange bo as that no minute'^ hour shall be for her patient without the essentials nursing* A very few in«tauoc9 wUi be suflicientj not as preceptsl iUustratiouB, A stranger will burst in by mistake to the patient *8 siok-iH after he has fallen into his first doze, giving him a shock, effeota of which are irremediable, though he himself laugl the cause, and probably never even mentions it. The m who is, and is quite right to be, at her supper, has not pro? that the stranger ahoU not lose his way and go into the ifl room. The patient's room may always have the window open. the passage outside the patient's room may never have one o Because it is not understood that the charge of the siok-i lextends to the charge of the passage. And thus, \\s often bar nurse makes it her business to turn th<^ j.'.^\c^Tyk\^ iiig Bhaf^ for the foul air of the wli JUffteofpt/ room, a newly painted toouL, ^\ . . . J ''boArdf maf often become a reseTTOit oi imS w ^ PSTTY KAHAOEXEirT. 31 use, beoAUBe the person in cliarge never thinks of arranging at these plaoes wall be^wavB aired, always cleaned; she ael7 opens the window herself " when she goes in.'' in. exoedlent paper, the BuUder^ mentions the lingering of the eil of paint for a month about a house as a proof of want of itilation. Certainly— and, where there are windows to open, i these are never opened to get rid of the smell of paint, it is iroof of want of management in using the means of ventilation. course the smell will then remain for months. Why should pol ku agitating letter or messa^ may be delivered, or an impor- it letter or message 910/ dehvered ; a visitor whom it was of isequenoe to see, may be refused, or one whom it was of still re oonsequenoe TWt to see, may be admitted — ^because the son in charge has never asked herself this question. What is le when I am not there ? W\kj should you let your patient ever be surprised, except by BTOS ? I do not know, tn England, people do not come down r ohimnej, or through the window, unless they are thieves. sy come in by the door, and somebody must open the door to m. Lt all events, one may safely say, a nurse cannot be with the lent, open the door, eat her mc^, take a message, all at one L the same time. Nevertheless the person in charge never ms to look the impossibility in the fieu^. iidd to this that the attempiinff this impossibility does more to rease the poor patient's hurry and nervousness than anything L t is never thought that the patient remembers these things if I do not. He has not only to think whether the visit or letter J arrive, but whether you will be in the way at the particular ' and hour when it may arrive. So that your partial measures *' being in the way" yourself, only increase the necessity for thought. Whereas, if you could but arrange that the thing old {dways be done whether you are there or not, he need er think at all about it. 'or the above reasons, whatever a patient can do for himself, I better, ^. e, less anxiety, for him to do for himself^ unless the )on in charge has the spirit of management. iways tell a patient and tell him beforehand when you are \g out and when you will be back, whether it is for a day, lOur, or ten minutes. Tou fiEincy perhaps that it is better for if ho does not find out your going at all, better for him if do not make yourself '^ of too much importance " to him ; or you cannot bear to give him the pain or the anxiety of the porary 6e|Muration. o such thing. You ouffht to go, Vf ^ -vtBI «a^Y*^» ^^cSiSs^^st. requires it. Then say so to ttve ^^\,\«n!t o^\^l • ^ ^^>v^ ■if] ^OTES OX STTESntQ, 1 Ilia k, he ithout Lis knowiBg it, and he finds it out, ho never ' ure again that the things which (J^peiid upon you will ] when yon are away, and in nine c:ise3 out of ten he will h If you go out without telling him when you will be hack, he take no measures nor precautions as to the things whioh < you both, or which you do for him. If you look into the reports of trials or accidents, and < ^ ,^ of suicides, or into the medical history of fatal cases, it ia~a£ii incredible how often the whole thing tarns upon aometli which has happened because *' he," or still oftener ** she," mot there." But it is still more incredible how often, how \ Always this is accepted as a sufficient reason, a justification " le very fact of the thing having happened is the proof oj *ng a justification. The person in charge was (^nite rj to be " tht^re,^* he was called away for quite sufficient i he was away for a daily recurring and unavoidable cause j provision was made to supply his absence. The fault wat his ** being away," but in there being no management to I ment his *' being away,** When the sun is under a total ecK or during his nightly absence, we light candles. But it wfl seem a£ if it did not occur to us that we must also supplen the person in charge of sick or of children, whether ua " ^ OGcasional eclipse, or during a regular absence. In institutions where many lives would be lost, and th of such want of management would be terrible and paten perform it. r be ^' in charge ** is certainly not only to cnrry out the propc snres yourself but to see that every one elae does so too ; U 1 no ono either wilfully or igriorantly thwarts or prevent [ measures. Tliis is the mQaning which must be attached t* ^ word by (above all) those '* in charge *' of sick and of children ether of numbers or of individuals, and indeed I tliink it i I the latter that it is least understood. ^s the jury seems to have thouglit the tap was in charge \ ship's safety^ so mistresses now seem to think the house is i] irge of itself. They neither know how to give orders, nor ho^ [ t^ach children or servants to obey orders — i> e. to obey inte! ently, which is the real meaning of all discipline. "lider children are often the most efficient assistants a mothe i school-mistress can have in carrying out her " charge.'* A public schools this is so well understood that the highes I often keep order better than the master himselfj who taugh * Ow. It is less well understood in families, where many k»ild would have been «aved if the mother had understocn put the elder boy or girl in clmrge when she wa ing. But I have seen in a careful family l\v^ ^VsJJSt ^ L ^ve years old exercising this c\mTg|a ^\ci 'a.\iXX\fii q^\&< f Much iK'tter tliAii a grov/a \i\v womxk^iv ^ookSj accc hut themselves. It seems to me that the pi*ide is rath Qg on a system, in keeping stores, closets, hooks, ac |»that anybody can uuderBtand and cany them on— so th f of absence or illness^ one can deliver everjrthiug up toe I know that all will go on as usual, and one shall aev Bed, IV.— NOISE. ^U^TNECESSAEY noisc, or noise that creates an e3q>eotation i ' ud, is that which hurts a patient. It is rarely the lou i noise, the effect upon the organ of the ear itself, ^ to affect the sick. How well a patient will ^h(ji>, the putting up of a Bcaffohiing close to the hooseil \ cannot bear the tidking, stiU less the whispering, esp it be of a familiai' voice, outside his door. ^ There ai'o certain patients, no doubt, especially where th jht coiicuasiou or other disturbance of the brain, wh^ footed by mere noise. But intermittent noise, or Budd arp noise, in these, as in all t>ther cases, affects far mon ^jatinuous noise — noise with jar far more than noise wilj " one thing you may be certain, that anything which Btient suddenly out of his sleep will invariably put him ate of greater excitement, do him more serious, aye, and I "schief, than any continuous noise, however loud, k Never to allow a patient to be waked, intentionally or ac ly, is a m.'tie qua no?i of all good nursiDg. If he is roused. I i first iileep, lie ia ahiiopt certain to have no more eleep, iouB but (juite intelligible fact that, if a patient is wake a few honi^s* instead of a few minutes* sleep, he is much likely to sleep again. Because pain, like irritability of I prpetuates and intensifies itself. If you have gained a i ^ either in sleep, you have gained more than the mere : Dth the probability of recurrence and of the same inteE 1 diminished, whereas both will be terribly increased by ep. This is the reason why sleeji i^ so all-important. reason why a patient, waked in the early part of hia e», not only hiB ©leep* bn^ ^^^ - • or to sleep. A i-- ^^^ - bo allows himself to si the day will J But it is exact!) • . ,i.r?e with the n^ ^ ,^^. I more they sleep the l>ctter will they be ablo bo sleep. iiinsij rviii jLuuly hot buttlt'S to the feet, or n iir by hour, without d , ^ lent, I ha^ft se^i\ ^ ^»sv^tsSS^ ^^^s^ "Ss^ }rvea on edffe. Advice, such ^ -^^vbA. \ Vwi^ \iwscL ^bw«^^ re harm than Kood, if it o\iVr mv down,— shut the windoWj sure that she woul< leave the door open— hide everything they were likely to want (not because they had no right to have it, but because she woulf inadvertently put it out of their reach). A good nurse will always make sure that no door or window ti dr patient's room ahall rattle or creak ; that no blind or curtail ' " J by any change of wind through the open window, be madi flap — especially will she be careful of all this before ghe leavci ■ patients for the night. If you wait tdl your patients tell you jreraind you of these things, where is the use of their having j \ l There are more shy than exactiug patients in all classse^ I many a patient passes a bad night, time after time, rathe remind his nurse every night of all the things she ha gotten. If there are blinds to your windows always take care to hav< them well up, when they are not l>eiug used. A little piec< piug down, and flapping with every draught, will disti'act £ ent il hurry or bustle is peculiarly f ainful to the &ick. And whei atient has compulsory occupations to engage him, instead o; ing simply to amuse himself, it becomes doubly injuiious ^e friend who remains standing and fidgeting about while i fttient is talking business to him, or the friend who sits aUC " Q8j the one from an idea of not letting the patient talk, the othei an idea of amusing him, — each is equally inconsiderate Irays sit doivn when a sick person is talking business to you no signs of huiTy, give complete attention and full considei*^ bn jf your advice is wanted^ and go away the moment tlw gect IB ended, Iways sit within the patient's view, so that when you speali kiin be has not painfully to tuni his head round iu order tc at you* Everybody involuntarily looks at the persoi ting. If you make this act a wearisome one on the^part o I patient you are doing him harm. So also if by continuing U pd you make him continuously raise Km eyes to see you. Bi outionless as possiblCj and never gesticulate in speaking tc ieick. lever make a patient repeat a message or request, eepeciallj ' , bo some time after. Occupied patients are often aeGus^ling between lite and death, Jf the doctor betrayed of decision, if the nurse lost any portion of her caUimeBa ision, it just turned the scale in favour of death, ition is what all patients most dread. Rather than in others, they will collect all their data, and make up Ls for themselves. A change of mind in others, whether ding an operation, or re- writing a letter, always Le patient more than the being called upon to make d to the most dreaded or difficult decision. Farther in very many cases, the imagination in disease is far fe and lively than it is in health. If you proposed to ,t change of air to one place one hour, and to another the ias, in each case, immediately constituted himself in lu the tenant of the pUice, gone over the whole I idea, and you have tired him as much by displacing ation, as if you had actually carried him over both l\ leave the sick room quickly and come into it quickly. Illy, not with a rush. But don't let the patient be YLiting for when you will be out of the room or when B in it. Coacisouess and decision in your movement.*, your words, are necessary iu the sick room, as necessary of hurry and bustle. To possess yourself entirely will from either failing— either loitering or harrying, lent has to see, not only to hia own but also to his ictuality, or perseverance, or readiness, or calmness, to of these things, ho is far better without that nurse her — ^however valuable and haudy her services ma}' e to him, and however incapable he may be uf render- ) himself. gard to reading aloud in iho sick room, my experience len the sick ai'c too ill to read to themselves.^ tlvi^ c^^v to be read to. Children, eye-^l\«ii\;e*.^\v:«v^^s^<:ra^ NOTES ojsf iruasiTfG. I reading. People nlio like to be read to, 'hwim feal ^uch the matter witli theni ; while in fevers, or where th pMch irritability of braiB^ the eifort of list emu g to rea^ \ often brought on delirium. I speak with ^reat ( catiae it ia an almost universal belief that it is j^ ck to read aloud to them. But two things are certain :- (1.) If there is some matter which mmC be read to erson, do it slowly. People often think that the way to I rer with least fatigue to him is to get it over in least! They gabble; they plunge and gallop through the rea fhere never was a greater mistake. Houdin, the conjuror,! at tfie way to mate a story seem short is to tell it slowly. ; is with reading to the sick* 1 have often hoard a patient I to such a mistaken reader, " Don't read it to me ; tell it na^'l Sick children, if not too shy to speak, will always express l^^ wish. They invariably prefer a story to ho told to t]\r than read to them. Unconsciously they are aware that regulate the plunging, the reading with unequal paces, &I14 over one part, instead of leaving it out altogether, if it is portant, and mumbling another. If the reader lets Mai attention wander, and then stops to read np to himself, or| ^^ has read the wrong bit, then it is all over with iht^ ^B^tient's chance of not suffering. Very few people kuoK ^K read to the sick ; very fiew read aloud as pleasantly e? Hpcy speak. In reading they sing, they hesitate, they Stan ^^ley hurry, they mumble ; when in speaking they do 110 these things, ileading aloud to the sick ought always tol rather slow, and exceedingly distinct, but not mouthing — a '^ monotonous, but not sing song — rather loud, but not noisy ^^ove all, not too long. Be very sure of what your patieq ^V (2.) The extraordinary habit of reading to one's self in j room, and reading aloud to the patient any bits which will 1 him or more often the reader.^ is unaccountably thoughtless.] I you think the patieut is thinking of during 3'our gaps 1 ading ? Do you think that be amuses him eel f upon wh^ ^ve read for precisely the time it pleases you to go on i > yourself, and that his attention is ready for somethin ; precisely the time it pleases you to begin reading again f| » One thing more : — From the flimsy manner in which ^odem houses are built, where every step on the stairs, andL| floors, is felt all over the house ; the higher the stor eater the vibration. It is inconceivable bow much thd suffer by having anybody overhead. In the solidly bail ■ Duses, which, fortunately, most hospitals are, tlie no\m^ aking is comparatively trifling. But it is a serioua oaujid.' "^ering^ in lightly built houses, and'wltb t\\e \rtvt*biLity ue digoases. Better far put svicVi ^^t\eu^ aA. Vtet^ Vs^ VABIETT. 4*6 ren with the additional fatigue of stairs if you cannot e room above them being untenanted ; you may other- g on a state of restlessness which no opium will subdue, leglect the warning, when a patient tells you that he Bry step above him to cross his heart." Remember that »i8e a patient cannot see partakes of the character of s to mm ; and I am persuaded that patients with these Y irritable nerves, are positively less injured by having D the same room with them than overhead, or separated . thin compartment. Any sacrifice to secure silence for les is worth while, because no air, however good, no 3e, however careful, will do anytMng for such cases juiet. v.— VARIETY. ' but an old nurse, or an old invalid, the degree would inconceivable to which the nerves of the sick suffer from e same walls, the same ceiling, the same surroundings long confinement to one or two rooms, s suffering severe paroxysms of pain are much more than persons suffering from nervous weakness. This been remarked upon, and attributed to the enjoyment ►rmer of their intervals of respite. I incline to think majority of cheerful cases is to be found among those who are not confined to one room, whatever their , and that the minority of depressed cases will be seen lose subjected to a long monotony of olyects about them, ervous frame really suffers as ^uch from this as the from long monotony of diet, as e,ff, the soldier from his ne years' *' boiled beef." feet in sickness of beautiful objects, of variety of objects, eially of brilliancy of colour, is hardly at all appreciated, cravings are usually called the ^^ fancies " of patients, a, doubtless, patients have ^'fancies," as, e.^, when they contradictions. But much more often, their (so-called) " are most valuable signs of what is necessary for their And it would be well if nurses would watch these I) " fancies " closely, seen, in fevers (and felt, when I was a fever-patient my- 1 most acute suffering produced from the patient (in a being able to see out of window, and the knots in the ng the only view. I shall never forget the rapture of ients over a bunch of bright-coloured flowers. I remember wu case) a nosegay of wild flowers being sent me, and t moment recovery becoming more rapid. ! say the effect is only on ttiQ ixmidL. \\.Sa^u^ %wuciQ^ ^jJwwiS.'*^^^'* in which we ate affected by form, know this, that they have an actutil homily eflffect Variety of form and brilliancy of colour in the objects H to patient!?, are actual means of recovery. But it Tnuet be slow variety, e.g. if you Bhow a patiea twelve pictures successively, ten to one that he does ny< cold and faint, or feverish, or even si6k ; but hang one upi him, one on each successive day, or week, or moutli^ an^ delight in the variety. The folly and ignorance which are too often supreme ack room, cannot bo l>ettcr sho>m than by this. W3 nurse will leave the patient stewing in a corrupting atni she will deny him, on the plea of uiihealthiness, a glaa( flowers, or a growing plants Now» no one ever saw "ove ing" by plants in a room or ward. And the carbonic K <^ive off at nights w^ould not poison a fly. Nay, in over^ rooms, they actually absorb carbonic acid, and give off Cut-flowers also decompose Tvater, and produce oxygen ga true there are certain flowers, e,^g. lilies, the smell of 1 said to depress the nervous system. These are easily k the Braell, and can he avoided, ' A very great deal is now written and spoken as to the the mind upon the body. Much of it is true. But I wia more wae thought of the effect of the body on the mill ivho believe yourselves overwhelmed with cares, but d every day to walk up the street^ or out in the country^ your meals with others in other rooms, tt^c, itc, 50U litj how much your anxieties are thereby lightened ; you liij how intense they become to those who can have no chan e very walls of their sick rooms acera hung with thei how the ghosts of their troubles haunt their beds ; how in it is for them to escape from a pursuing tbotight witho help from variety. It is jTmatter of painful wonder to the sick themseli much more they think of painful things than of pleasai they reason with themselves^ they think themselves UDg it is all of no use. The fact is, that these painful ideiS better dismissed by amusing the invalidj or by showing h| thing pretty, than by arguing with him. I have mentis cruelty of letting hiin stare at a dead wall. In many i especially iti recovery from fever, that wall mil appear i all sorts of faces at him ; now flowers never do this. < A patient can just as much move his leg when it is bn I change his thoughts when no help from vai'iety is giv This iR, indeed, <>ne of the main Bufferings of sickness j the fixed pofeture is one of the main sufferings of the broki ft Is a coiisttant wonder to me to see p^opU^^Vio ^^Uil UFS^ acting thus, ^' VABIBTY, 4') loyments, many times a day; and while nursing (!) some ridden sufferer, they let him lie there with no view at all ;he flies on the ceiling ; without any change of object to enable to vary his thoughts ; and it never even occurs to them, at to move his bed so that he can look out of window. No, the bed be always left in the darkest, dullest, closest part of the room, remember a case in point. A man received an injury to the e, from an accident, which, after a long confinement, ended eath. He was a workman — he did not care about " nature," aid — but he was desperate to " see once more out of window." nurse, who was the woman of the house where he lodged, ally got him on her back, and managed to perch him up at window for an instant, " to see out." The consequence to the • woman was a serious illness, which nearly proved fatal. The . never knew it ; but a great many other people did. Yet ' none of them thought, so far as I know, that the craving for ety in the starving eye is just as desperate as that for food in starving stomach, and tempts the famishing creature, in either , to steal for its satisfaction. No other word will express it "desperation." And it is lust as stupid not to provide the bed with a ** view," or witn variety of some kind, as if you not provide the house with a kitchen. nd in no case does the considerate person meet with the same less as he does with the sick. People write poetry about the arms of nature." I question whether the intensest pleasure ' ielt in nature is not that of the sick man raising a forest , six inches high, from an acorn or a horse-chestnut, in a don back-court. is a very common error among the well to think that, " with tie more self-control," the sick might, if they choose, " dis- \ painful thoughts,*' which "aggravate their disease," &c. eve me, almost a?iy sick person, who behaves decently well, cises more self-control every moment of his day than you will • know tiU you are sick yourself. Almost every fitep that ses his room is painful to him ; almost every thought that ses his brain is painful to him ; and if he can speak without g savage, and look without being unpleasant, he is exercising control. ippose you have been up all night, and instead of being Ned to have your cup of tea, you were to be told that you it to " exercise self-control," what should you say 1 Now, nerves of the sick are always in the state that yours are in r you have been up all night. '^e will suppose the diet of the sick to be cared for. Then, state of nerves is most frequently to be relieved by care in rding them a pleasant view, a variety of flowers, and pretty igs. Light by itself will often reVie^^ V^. '^\^'fe ^^-r ;w^'' J^^ ily tbin^ wiich wotdd do va laxj fswi?* hswS^^'ei cnwiwis^. ^xi \a"(5Mt ^'ara^w something to make tw Bleep," teirikmg for wiiiit of food; bytlie simple questiou put to hei' doctor, *' But is there no hour when you feel 3^ou could ea ' Oh, j'cs/' she said, "I could always take souietljiug at — o'd and — o'clock.** The thing was tried aud suoceeded. Path I very eeldom, however, can tell this ; it is for you to watch i b out. A patient ehould, if possible, not pee or smell either th^l others, or a greater amount of food than he himself can conS at one time, or even hear food talked about or see it in f Etate. I kuow of no exception to the above rule. The 1 of it always brings on more or less dislike to taking food. In hospital wards it is of course impossible to observe and in rooms, where a patient must be closely wat having its food or drink at one hour to-day, and to- it does not have it, because she has failed in getting it, he ffer. She must be always exercising her ingenuity to iefects, and tcyremedy accidents which will happen among b contrivers, but from which the patient does not suffer , " because they cannot be helped." , because the nurse has not got some food to-day which lent takes, can the patient wait four hours for it to-day iild not wait two hours yesterday 1 Yet this is the only one generally hears. On the other hand, the opposite viz., of the nurse giving the patient a thing because she it, is almost equalty baa. If she happens to have fresh • fresh fruit, she will frequently give it to the patient half- • after his dinner, or at his dinner, when he cannot pos- t that and the broth too— or, worse still, leave it by his 3 tin he is so sickened with the sight of it, that he cannot ball very small caution, — take care not to spill into your s saucer, — ^in other words, take care tho.t tha ^\s^^^«i^ rim of his cup is quite dry and <:^&^si\ Si^ ^-^^t^ >o3s>l^'^ cup to bia lips, he nas to caxry Vk<^ ^•axs.Qet ^VOa.S^^'^s^ ^ K0TE5 oif THimmm. op the food upon and to soil his sheet, or hia ff or, if he 18 sitting up, his dress, jon have no iu\,\j^ "^nsxi^x^,^*.^ Kj^^NSba'^'w^'*"^ lach WHM right ^ f^diaeea with wliich ** certain dasses of *^ patic^ diluted meat juice or beef tea repeatedly, when they refud other kiud.9 of food," Tliis is particularly remarkable in *' i of gastric fever, in which," he says, " little or nothing else bestdg beef tea or diluted meat juice *' Iuib been taken for weeks or j ^ months ; *' aiul yet a pint of beef tea contains scarcely { i Crthing but water/' L small quantity of beef tea added to other ai'ticles of] kea them more nonrishinff. The reason why beef tea should be nonriahing and jelly l to the sick, is a secret yet undisicovered, but it clearly shoi^ oorefal observation of the sick is the only clue to thsi dietary. Again, the nourishing power of milk and of the prep from milk, is very much undervalued ; there is nearly as nourishment in half a pint of milk as there ia in a quarter ( lb. of meat. But this is not the whole question or nearly tiw whole. The main question is, what the patient*3 stomach can derive nourishment from, and of this the patient's stomach is \' sole judge* Chemistry cannot tell this. The patient's sto must be its own cliemist. The diet which will keep the ho man healthy, will kill the sick one. Tlie same beef %vhioh most nutritive of aO meat, and which nourishes the healthy i is the lejist nourishing of all food to the sick man, whoso 1 dead stomach can assimilate no part of it, that is, make ng out of it. On a diet of beef tea healthy men on the othei* | speedily lose their strength. I have known patients live for many months without toe bread, because they could not eat baker's bread* These mostly country patients, but not aQ. Home-made bre brown bread is a most important arricle of diet for many pati The use of aperients may bo entirely superseded by it. Oat^ ^B^iother. ^^o watch for the opinions, then, which the patieut'3 1 gives, ratlier than to read books about ** foods," is the bus all those who have to settle ^vhat the patient ia to eat~pe (most important thing to be provided for him after the i o breathe* ^ow the medical man who sees the patient only once a, I even only once or twice a week, cannot possibly telXl hout the assistance of the patient himself, or of those I are in constant observation of the patient. The utraostj medical man can tell is, whether the patient is weaker or stro at this visit than he was at the last visit, I should therefore tlinl TTi comparably the most in^portant office of the nu iRken care of the paticnt*3 air, ia to take care tj ^r of his foody and report it to iW 4ri^ '^irkSG "^ WHAT VOOD ] 53 sat deal too much of tea is given to the sick by foolish people. n jou see the natural and almost universal craving in ish sick for their '' tea," you cannot but feel that nature 7B what she is about. But a little tea or coffee restores them i as much as a great deal, and a great deal of tea and espe- f of coffee impairs the little power of digestion they have, a nurse because she sees how one or two cups of tea or 8 restores her patient, thinks that three or four cups will do 3 as much. This is not the case at all ; it is however certain there is nothing yet discovered which is a substitute to the ish patient for his cup of tea ; he can take it when he can nothing else, and he often can't take anything else if he has t. I should be very glad if any of the abusers of tea would ; out what to give to an English patient after a sleepless b, instead of tea. If you give it at five or six o'clock in the ing, he may even sometimes fall asleep after it, and get ips his only two or three hours sleep during the twenty-four. 16 same time you never should give tea or coffee to the sick, rule, after five o'clock in the afternoon. Sleeplessness in iarly night is from excitement generally, and is increased by r coffee ; sleeplessness which continues to the early morning om exhaustion often, and is relieved by tea. The only Lsh patients I have ever known refuse tea, have been typhus , and the first sign of their getting better was their craving 1 for tea. In general, the dry and dirty tongue always rs tea to coffee, and will quite decline milk, unless with tea. e is a better restorative than tea, but a greater impairer of ligestion. Let the patient's taste decide. You will say that, ses of great thirst, the patient's craving decides that it will c a great deal of tea, and that you cannot help it. But in \ cases be sure that the patient requires diluents for quite : purposes than quenching the thiist ; he wants a great de^ me drink, not only of tea, and the doctor will order what he have, barley water or lemonade, or soda water and milk, aa ase may be. is often recommended to persons about to go through great ue, either from the kind of work or from their being not in te fit for it, to eat a piece of bread before they go. I wish ecommenders would themselves try the experiment of taking ce of bread instead of a cup of tea or coffee as a refresher, would find it a very poor comfort. When men have to set astiug on fatiguing duty, when nurses have to go fasting in eir patients, it is a hot restorative they want, and ought to , before they go, not a cold bit of bread. If they can take of bread wiah the hot cup of tea, so much the better, but not Tud, of it. The fact that there is more nourishment \sl \^^t. .ii X0TE3 OX XUKSIXG. Euglish men and women who have undergone great fJEiiigB^ such as taking a long journey without stopping, or sitting up It several nights in succession, almost always say that they cani it best upon a cup of tea. It is also the best re&eshment bdofl going out, to a long day's work. In making coffee for the sick, you should always buy it k the berry and ^rind it at home. Otherwise you may redwl upon its containing a certain amount of chicory, at leatt, Thisil not a question of the taste or of the wholesomeness of ohiood It is that chicory has nothing at all of the properties for ww{ you give coffee. And therefore you may as well not give it. Again, all laundresses, mistresses of dairy-farms, head nmM (I speak of the good old sort only — ^women who do both a gool deal of hard hand-labour, and also the head-work necessary fv arranging the day's business, so that none of it shall tread upM the heels of something else) set great value, I have observed, apo having a high-priced tea. This is called extravagant. But tM women are " extravagant " in nothing else. And they are ri|^ in this. Real tea-leaf tea alone contains the restorative th^ wsot which is not to be found in sloe-leaf tea. The mistresses of houses, who cannot even go over their on house once a-day, are incapable of judging for these women. Fo they are incapable themselves, to all appearance, of the spirit c arrangement (no small task) necessary for managing a large WM or dairy. Cocoa is often recommended to the sick instead of tea or co^ But independently of the fact that English sick very genenll dislike cocoa, it has quite a different effect from tea or coffee. 1 is an oily starchy nut, having no restorative power at all, In simply increasing fat. It is pure mockery of the sick, therefor to call it a substitute for tea. For any refreshment it is oi^ yo might just as well offer them chestnuts instead of tea. An almost universal error among nurses is in the bulk of tl food and especially the drinks they offer to their patients. Sn] pose a patient ordered four oz. brandy during the day, how is i to take this if you make it into four pints with diluting it ? Tl same with tea and beef tea, with an-owroot, milk, ^>Daa\i^^^^^ in," and one can oniy hope it ia uot iTM^ft* '^\:^\.\ S» ^^^"^ I I 'I 56 ^0TE8 out NfTASIXO. already saturated with Bomebodj else's damp before my comes to exhale into it Mb owu damp ] Has it not had ae ohance to be aired ? No, ijot one. " It has been slept night;* The best bedding, either for sick or well, is an iron (no vallance, of course), and hair mattress. Whenever you i haog up the whole of the bedding to air for a few hours. On no account whatever should a sick person's bed evw higher than a sofa. Otherwise the patient can get at nothiiij himself : he can move nothing for himself, A patient's bed sh never have its side against the wall. The nurse must be ab get easily to both sides of the l>ed, and to reach easily every of the patient without stretching ~a thing impossible if T be either too wide, or too high, or in a corner. When I Bee a patient in a room nine or teu feet highl bed between four and five feet highj with his head, when' sitting up in bed, actually within three or four feet of the cei I ask myself, is this to make him feel as if the walla and ce were closing in upon him ? If, over and above this, the wii stops short of the ceiling, then the patient's head may literal ahove the fresh air, even when the window ia open, l^he hea sleepers or of sick in ordinary bedrooms should never be hi than the throat of the chimney, which ensures their being current of best air. And we will not suppose it possible t have closed your chinmey with a chimiiey-board» If a bed is higher than a sofa, the fatigue of getting in i of bed will just make the difference, very often, to the pa (who can get in aud out of bed at all) of toeing able to U few minutes' exercise, either in the open air or in another ro A patient's bed should always be in the lightest spot u room ; and he should be able to see out of wiJidow. I need scarcely say that the old four-poat bed with curiai bad, whether for sick or well. I wish we might nevei another I Never use a feather bed, either for sick or well careful woman will air her whole bedding, at least once a f either by hanging it out in fine weather in the sun and air, < toasting it before a hot fire. This is especially iiecessar children's bedding ; especially necessary whei-e the whole fji lives in one room. Not a few cases of eorofula among children proceed froil habit of sleeping with the bead under the bed clothes, an breathing air ali*eady breathed, aud full of perspiration front skin. The same with sick. A good nurse wiU bo caroft attend to this. It is an important part, so to speak, of ventilai Consumptive patients often put their heads under the bed clo because it relieves a fit of cotigliiug, brought on by a chaoj I'nd or by damp. 0£ all places to takii v^'^jxwi ot \\cj\t\, ^s^ is ccrtmnly tho worst. And pei^xa^vB^ \1 \i\it%&^ ^^i < very len 1 ng ij BSD AND BEDDING. this practice, we need no longer wonder at the " rapid decline"* Borne consumptive patients. A folded silk handkerchief, light laid over the mouth, or merely breathing the steam from a bas of boiling water, will relieve the fit of coughing witliout sue danger. But this last must be carefully managed, so as not make the patient damp. It may be worth while to remark, that where there is ai danger of bed-sores a blanket should never bo placed uiider tl patient. It retains damp and acts like a poultice. Never use anything but light Witney blankets as bed coverii for the sick. The heavy cotton counterpane is bad, for the vei reason that it keeps in the perspiration from the sick perso wMle the blanket allows it to pass through. Weak patients a; always distressed by a great weight of bed-clothes, which ofte prevents their getting any sound sleep whatever. I once told a "very good nurse" that the way in which hi patient's room was kept was quite enough to account for his slee; lessness ; and she answered with perfect good-humour, that si was not at all surprised at it — as if the state of the room wer like the state of the weather, entirely out of her power. Now i what sense was this woman to be called a " nurse V A true nurse will always make her patient's bed carefully he self. Consider the importance of sleep to the sick, the necessH of a well-made bed to give them sleep. But a careless nun doubles the blankets over the patient's chest, instead of leavir tiie lightest weight there — she puts a thick blanket under him- she does not turn his mattress every way eveiy day; and tl patient would rather than not that his bed were made by ar body else. One word about pillows. Every weak patient, be his illne; what it may, suffers more or less, from difficulty in breathin (1.) To take the weight of the body off the poor chest, which hardly up to its work as it is, ought therefore to be the object < the nurse in arranging his pillows. Now what d^ies she do an what are the consequences ] She piles the pillows one a-top of tl other like a wall of bricks. The head is thrown upon the ches And the shoulders are pushed forward, so as not to allow the lun| room to expand. The pillows, in fact, lean upon the patient, n< tho patient upon the pillows. It is impossible to give a rule fc this, because it must vary with the figure of the patient. Bi the object is to support, with the pillows, the back helow tl; breathing apparatus, to allow the shoulders room to fall bad and to support the head, without throwing it forward. The su fering of dying patients is immensely increased by neglect < these points. And many an invalid, too weak to drag a£)ut h Sows himself slips his book or anything at hand behind th er j^axt of nia back to support it* ^€^ ^\iJ\\^\'sviw8» ^ much more than ehort oues, becau^^ oi >X\n a r X.-CLEA>aiKE8S OF ROOMS AKB WALLS. It camiot be nccessaTy to tell a niii'se tliat sbe sliuuld | r>r that she shoiLld keep her patient cleau, — ^seeing greater part of imnsiiig consists in preserving cleanline ventilation can freshen a room or honse where the most scri loua cleanliness is not oberved* Unless the wind l>e blo\ through the -vnndnws at the rate of twenty milea an hoJir^ d carpeS, dirty wainscots, n;u3ty curtains and furniture, always give off a close smell. 1 have lived iii a large Lor I house, where I had two very lofty rooma^ with opposite wind to myself, and yet, owing to the above-mentioned dirty ciro etances, no openiug^ of windows could ever keep those rooms from clofieness ; but the carpet and curtains having been tui out of the rooms altogether, they became as fresh as couk ■wished* It is pure nonsense to say that in London a cannot be kept clean. Many of our hospitals show reverse. But no particle of dust is ever or can ever he rev really got rid of by the present way of dusting. DusJ these days means nothinc^ but flapping the duat from one par Pa room on to another w4th doors and windows closed* lf\ you do it for, I cannot think. You had much better leave dust alone if you are not going to take it away altogethe from tiie time a room begins to be a I'oom, up to the tin it ceases to be one, no one atom of dust ever actually la Tidying a room means nothing now but removing a tbii^ one place, which it has kept clean for itself, on to another a dirtier one. Flajiping by way of cleaning is only admiB "" ^^ the case of pictures, or anything made of paper. The ob ^ ^■I know to remove dust, the plague of all lovers of fresh airj i ^^wipe everything with a damp cloth. And all furnitm-e oughl be BO made as that it may be wiped with a damp eloth witi injury to itself, and so polished as that it may be damped witi ^ISnjury to others. To " dust/' as it is now practised, really me ^Pto distri))ute dust more equally over a room. I Ifyouliketo clean your furnitui'e by laying out yourd clothes upon your dirty chairs or sofa, this is one way certaj of doing it. From the chairs, tables, or sofa, upon which "things* have lain during the night, and which are thev^ ^olean from dust or blacks, the " thinga'^ ha\ing " caught" it, then remove them to other chairs, tables, sofas, upon which ieould write your name vnth your finger in the dust or blacks. * '}iher eide of the *^ things'' is therefore now evenly dirtied or dus Che woman then Haps everything or some things, not out leach, with a tiling called a duster — the dust flies ivj hsettles 2nore eq uallj than it lay bijiovo, T1\ia^ \ft q^V^j^" ' room torlghtB.' CLEANLINSSS Of BOOMS AND WALLS. 6 As to floors, the only really clean floor I know is the old fiishioned polished oak floor, which is wet rubbed and dry rubbe( .every morning to remove the dust. For a sick room, a carpet is perhaps the worst invention whici eonld by any possibility have been made. If you must have s oarpet, the only safety is to take it up two or three times a year instead of once. A dSrty carpet literally infects the room. Anc if you consider the enormous quantity of dirt from the feet o people coming in, which must saturate it, this is by no mean; furprising. Washing floors of sick rooms is most objectionable, for thij xeason. In any school-room or ward, much inhabited, you ma} smell a smell, while the floor is being scoured, quite differeni from that of soap and wateri It is the exhalation from the animal matter which has soaked into the floor from the feet anci breath of the inhabitants. Dry dirt is comparatively safe dirt. "Wet dirt becomes dangerous, Uncleansed towns in dry climates have been made pestilential by having a water supply. Doctors have forbidden scrubbing in hospitals. And nurses have done it in the earliest morning, so as not to be detected. What is to be done ? In the sick room, the doctor should always be asked whether and at what hour he chooses the floor to be washed. If a patient can be moved, it will probably be best to wash the floor only when he can be taken into another room, and his own room dried by fire and opened windows before he returns. A dry day and not a damp one is, therefore, necessary. But a private sick room (where there is not the same going to and fro as in a hospital ward) has been kept perfectly clean by wiping the floor with a damp cloth, and drying it with a floor- brush. All the furniture was wiped in the same way with a cloth svrung out of hot water — thus freeing the room from dust. In more than one house the purpose has been answered by Dlaning the floors, saturating them with " drying" linseed oil, veil rubbed in, staining them (for the sake of appearance merely), md using beeswax and turpentine. The floor was cleaned by using a brush with a cloth tied over t. And if anything offensive was spilt, it was washed off* imme- liately with soap and water and the placed dried. I hope the day will come in England when other floors will jease to be ever used, whether in school-rooms, lunatic asylums, lospitals, or houses. As for walls, the worst is the papered wall ; the next worst is >la8ter. But the plaster can be made safe by freajjiftufe Uxsaa- vashing and occasional Bciapmg •, t\v^ ^^-^^t \^q^^'«» \:t^«5^«s jnewing. A glazed paper geta t\^ oi ^ ^^'^kOc ^^"^^ ^'^ ^^ w 6i irOTfis OK NirnsiNd, f 1 su and wiUJi i danger. But the ordinary bedroom paper 7iot to be. A person who bns accustomed her senses to c proper and improper, for the sick tmd for childi blindfold, the difrerence of tho air in old pai» papered rooms. The latter will always be muBty. tho windows open. The close connection between ventilation and shown in this. An ordinary light paper wiU^ longer if there is an Arnott*s yentilator in othei-wiae would. The best wall now extaat is oil paint, wash the animal matters.* These are what make a room musty. Air can be soiled just like water. If you blow will soil it with the animal matter from your br with air. Air is always soiled in a room where wi are saturated with aoiraal exlialations. Want of cleaulinesg, then, in rooms and wards, i to guard against, may arise in three ways. 1. Dirty air coming in from without, soiled by tions, tho evapoi*ation from dirty streets, smoke, b inel, bits of straw^ bits of horse dung» If people would but cover the outside walls of tb tiles, what an incalculable improvement would th( cleanliness, dryness, warmth, and consequently < play of a (ire-engiue would then effectually wash a house. This kind of walling would stand nes^ improving the health of towns, 2. Dirty air coming from within, from dust, w displace, but never remove. And this recalls wb a sine qua non. Have as few ledges in your roc possible. And under no pretence have any ledge of sight. Dust lies there, and will never be wiped certain way to soil the air. Besides this, the anh from your inmates saturate your furniture, km clean your furniture properly, how can your roon anything but musty ? Ventilate as you please, \ never be sweet. Besides this, there is a consta as it IS called, taking place from everything exc( glazed articlefl — E, 5., iii colounng certain green * T "' "'" Tfattgine wliy p^,,r'- — ^' ■"='" *' ---;•- r-" -. t,. - «h lc UiC Will li. If ^lQ^l lite lowipc yonr dirly door, ur mme portion of vomr d watf usual w»y, aud jrenerally the ouly wn^'ot c\c4nM\% «iiik CLEANLINBSS OF BOOMS AND WALLS G ' used. Now in the very dust even, which is lying about i: oms hung with this kind of green paper, arsenic has hecu die tij detected. You see your dust is anything but harmless \ you will let such dust he about your ledges for months, you ma for ever. Again, the fire fills the room with coal-dust. 3. Diity air coming from the carpet. Above all, take care c ' » carpets that the animal dirt left there by the feet of visitor not stay there. Floors, unless the grain is filled up an< hed, are just as bad. The smell, already mentioned, froi floor of a schoolroom or ward, when any moisture brine ^nt the organic matter by which it is saturated, might alone b enough to warn us of the mischief that is going on. The outer air, then, can only be kept clean by sanitar imiprovements, and by consuming smoke. The expense in soa] ^rhich this single improvement would save, is quite incalculable. ^ The inside au* can only be kept clean by excessive care in tfa "irays mentioned above, — to rid the walls, carpets, fumitun lecQies, &c., of the organic matter and dust — dust consistin greatly of this organic matter, — with which they become sati rated, ^d which is what really makes the room musty. Without cleaDliness, you cannot have all the effect of ventih * tion ; without ventilation, you can have no thorough deanlines Very few people, be they of what class they may, have an idea of the exquisite cleanliness required in the sick room. Fc much of what is here said applies less to the hospital than to tL private sick-room. The smoky chimney, the dusty furniture, th ntensils emptied but once a day, often keep the air of the sic constantly dirty in the best private houses. The well have a curious habit of forgetting that what is i them but a trifling inconvenience, to be patiently "put up" witl is to the sick a source of suffering, delaying recovery, if nc actually hastening death. The well are scarcely ever more tha eight hours, at most, in the same room. Some change they ca always make, if only for a few minutes. Even during thes eight hours, they can change their posture or their position i the room. But the sick man who never leaves his bed, wli cannot change by any movement of his own his air, or his ligh or bis warmth ; who cannot obtain quiet, or get out of the smok or the smell, or the dust ; he is really poisoned or depressed 1: what'is to you the merest trifle. " What can't be cured must be endured.'^ is the very won and most dangerous maxim for a nurse which ever was mad Pfttience and resignation in her are but other words for careles ness or indifference — contemptible, if in regard to herseli culpable, if in regard to her sick. XL-^PERSOS^AL CLEAlOJXEf^ Is almost all diseases, the cleanliness of the 5kiti ill aportant. Aud this is partictdarlx ^le case with children. he perspiration- whieh comes from the skin^ is left there, i emoved bj washing or bj the clothes. Every aurse should b( , constantly in mind. — for, if she allow her sick to nunl bed, or their clothing to remain on them after hat ated with perspiration or other excretion, she is interfeoj Hth the process of nealth just as effectually aa if she wen^: ive the patient a dose of slow poison by the mouth, Poisoni py the skin is no Iqss certain than poi^ulng by the mouth— «l " is slower in its operation* Country people are much more afraid of water th&u tm t>ple ; poor people than rich people^ Many a good, aoii> tleanly, country housewife has told me with pride that she I pcver had her children's feet washed in all their lives, nor of them ever touch himself with cold water. Mani oilier and labouring man still boasts that he has never wad Dytlung below his face, except his hands. In districts where 1 srater-cvire is established, in towns where baths and wash-hoa well known, these extraordinary prejudices are r^ ■* - - Jut there is still many a school where the greatest pund in getting the children to have their feet Wiii^u choola ought to have b:iths and washing-places at hem. ^ Even ia rcusote country villages, however, people arc g&^ iscr. An excellent old grandniutherj who had never was! ler own children, began, in her old age, to wash her delic ttttle orphan grandchiid all over every day, and found [ Up a stout boy. An old lady began to wash herself all 07 Did water, for tlie tirat time after eighty years of age^ ac tu good years afterwards. The amount of relief and comfort experienced by mc De tikiu has been carefully washed and dried, is one ' Onnnone^t observations made at a sick bed, But it mo 1 forgotten that the comfort aud rehef so obtained are i 'hoy are, in fact, nothing more than a sign that the p9j 8f life have been relieved by i-emoving something tha' " oppressing them. The nurse, therefore, must never Uttfudiiig to the personal cleanliness of her patient und plea that all that is to be gaiuad is a little relief, which j jUito as well given later. In all well-regulated hospitals this ought to be, and ge , attended to. But it is very generally neglected with , ome. ^w^usi as it ia necessary to renew the ms TO\md t, dck 1 ptCBtfy, to carry off sickly vapour% from iV^ \^Ka^ wi attacH ucuuiiiuiuug iree veuuuiuou, so is ic uecossaiy lo Keep tn » of the skin free from all obstructing excretions. Th ct, both of ventilation and of skin-cleanliness is pretty mud same, — to wit, removing hurtful matter from the body a Hy as possible. ire should be taken in all sponging, washing, and cleansing th , not to expose too great a surface at once, so as to check th piration, which would renew the evil in another form. le various ways of washing the sick need not here be spccifiec le less so as tne doctors ought to say which is to be used. here the skin is hard and harsh, the relief afforded b; ling with a great deal of soft soap is incalculable. In othe 3, sponging with tepid soap and water, then with tepid watei drying with a hot towel will be ordered. irery nurse ought to be careful to wash her hands ver lently during the day. If her face, too, so much th 3r. 16 word as to cleanliness merely as cleanliness. »mpare the dirtiness of the water in which you have washe( a it is cold without soap, cold with soap, hot with soap. Yoi find the first has hardly removed any dirt at all, the secon( tie more, the third a great deal more. But hold your han( a cup of hot water for a minute or two, and then, by merel; )ing with the finger, you will bring off flakes of dirt or dirt; . After a vapour bath you may peel your whole self clean ii way. What I mean is, that by simply washing or spongin] I water you do not really clean your skin. Take a roug] »I, dip one corner in very hot water, — if a little spirit b jd to it it will be more effectual, — and then rub as if yoi ) rubbing the towel into your skin with your finger. Th k flakes which will come off will convince you that you wer clean before, however much soap and water you have usee le flakes are what require removing. And you can reall; > yourself cleaner with a tumbler of hot water and a rougi j1 and rubbing, than with a whole apparatus of bath an« • and sponge, without rubbing. It is quite nonsense to sa; anybody need be dirty. Patients have been kept as cleai hese means on a long voyage, when a basin full of wate d not be afforded, and when they could not be moved out o r berths, as if all the appurtenances of home had beeii a i. '^ashing, however, with a large quantity of water has quit T effects than those of mere cleanliness. The skin absorb water and becomes softer and more perspirable. To was] I soap and soft water is, therefore, desirable from other point iew than that of cleanliness. ou ought to use fresh water as fred^ ^ot l\i^ ^V\xv 'i>ss^\«e^ "^-^ he lungs. But the water mw^^ \i^ ^^i^, ^^vs^^^^^^vi^^ tJO NOTES OK NUBSING. think of this. They think mainly of hard water as chamil their hands, not as being a promoter of drunkenness, undM Hness, indigestion. "Water-dressings," used to sores, hi absolutely the opposite effect, viz., poisoning the sore, when m with very hard water, to what they have, viz., cleanshiji; c heading the sore, when the water is soft. When water is hard is worth while to have distilled water for every water-dress For all washing of the sick, it is worth while to collect ram-ivsl or to condense steam from a boiler, or to boil water, which i often remove from one-half to three-fourths of the hardn Soap and hard water actually dirty your patient's skin. The in the soap, the perspiration from the skin, and the lime in water, unite to form a kind of varnish upon the skin, wl comes off in the above-mentioned black flakes when rubbed. The use of soft or filtered water for making tea or dri: boiling vegetables, or mixing medicines, is very important, careless nurse sometimes takes the water from the wadi-h stand for this last purpose. She had often as well not giTe medicine at all. XII.— CHATTERING HOPES AND ADVICES, The invalid to his advisers. " My advisers ! Their name is Legion. * * * Some or other, every man, woman, and child considers him, hei itseR, privileged especially to advise me. Why ? That is preci what I want to know." And this is what I have to say to tl I have been advised to go to every place in and out of Eng] — ^to take every kind of exercise by every kind of cart, carriaj yes, and even swing (!) and dumb-bell (!) in existence ; to d] every different kind of stimulus that ever has been invented. this when those best fitted to know, viz., medical men, had decl; any journey out of the question, had forbidden any kin( motion whatever, had closely laid down the diet and di What would my advisers say, were they the medical attends and I, the patient, left their advice, and took the casual advise But the singularity in Legion's mind is this : it never occur him that everybody else is doing the same thing, and that I patient micst say in self-defouco, " I could not do with all." *' Chattering Hopes" may seem an odd heading. But I re believe there is scarcely a greater worry which invalids hav( endure than the incurable hopes of their friends. Tliere i one practice against which I can speak more strongly from ac personal experience, wido and long, of its effects during sick observed both upon others and upon myself. I would ap most seriously to all friends, visitors, and .aUcv\v\w\\Vi q>^ ^^- to leave oiT this practice of attempUw^ to ^' c\\^^^'' V\ OHATTBSINa HOPES AND ADVICES. f$7 long light of their danger and by exaggerating their proba- .tids of recovery. fii more now than formerly does the medical attendant tell ^mth to the sick who are really desirous to hear it about their I state. tow intense is the folly, then, to say the least of it, of the nd, be he even a mediced man, who thinks that his opinion, m after a cursory observation, will weigh with the patient, inst the opinion of the medical attendant, given, perhaps after rs of observation, after using every help afforded by the stetho- »e, the examination of pulse, tongue, &;c. ; and certainly after ih more observation than the friend can possibly have had. ipposing the patient to be possessed of common sense, — ^how tne ^ favourable " opinion, if it is to be called an opinion at of the casual visitor "cheer" him, — when different from that ;he experienced attendants. Unquestionably the latter may often does, turn out to be wrong. But which is most likely e wrong? he £^t is, that the patient "^ is not " cheered " at all by these [•meaning, most tiresome friends. On the contrary, he is ressed and wearied. If^ on the one hand, he exerts himself to everybody one after the other, why he does not think as they —in what respect he is worse, — what symptoms exist that they w nothing o^— -he is fatigued instead of " cheered," and his tntion is fixed upon himselfl In general, patients who are ly ill do not want to talk about themselves. Would-be inva- de ; but again I say we are not on the subject of would-be ilids. ^ on the other hand, and which is much more frequently the J, the patient says nothing but " Oh !*' and " Ah !" in order to ipe from the conversation about himself the sooner, he is ressed by want of sympathy. He feels isolated in the midst of Ibere are, of ooune, cases, as in ih'st confinements, when an assurance from the >r or experienced nurse to the frightened suffering woman that there is nothing oal in her case, that she has nothing to fear hut a few hours' pjain, may cheer her effectually. This is advice of quite another order. It is the advice of experience to inexperience. But the advice we have been referring to is the advice of inexperience :ter experience ; and, in general, amounts to nothing more than this, that you think II recover from consumption, because somebody'knows somebody somewhere who has cred from fever. lave heard a doctor condemned whose patient did not, alaa ! recover, because another ir's patient of a different sex, of a different age, recovered from a different disease, in ereni place. Yes, this is really tarue. If people who make these comparisons did know (only they do not care to know) the care and preciseness with which such larisons require to be made (and are made), in order lo be of any value whatever, would spare their tongues. In comparing the deaths of one hospital with those of ler, any statistics are justly considered absolutely valueless which do not give tho the sexes, and the diseases of all the cases. It does not seem necessary to mention It does not seem necesMry to say that there can bo no comparison between old with dropsies and young women with consumptionB. Yet the cleverest men and leverest women are often heard making wimVi wsvo^ttMiRiVA^ \^g\'jKi\\^''^'vK^^^'^''' 7() NOTES UN HUHStJm, on win i loses I I do not say, don't tell him your anxieties — I helieve i good for him aud good for you too ; but if you tell him win anxious, surely you can remember to tell him what is plea ^ A sick person does bo ciijoy hearing good news : — for i of a love and courtship, wliile in progress to a good end _ you tell him only vvlieu the nmrriage takes place, he loses the pleasure, which God knows he has Httle enough of ; to one but you have told him of Bome love-making ^ ending. A sick person also intensely enjoys hearing of any 7m good, any positive or practical success of the right. He h much of books and hction, of principles, and precepts, theories ; do, instead of advising him with advice he has J at least iifty times before, teU him of one benevolent act 1 has reaUy aucaeeded practically,^t is like a day*a health to ^ You have no idea what the craving of sick with u 11 dim in power of thinking, but little power of doing, ia to hear of practical action, when they can no longer partake in it. Do observe these things, especially with invaUds, Do remc how their life is to them disappointed and incomplete. Yt them lying there witli miserable disappointments, from whicl: can have no escape but death, and you can't remember t< them of what would give them so much pleasure, or at lea hour's variety. They don't want you to be whining with them, they like y be fresh and active and interested^ but they cannot bear &b of mind, and they are ao tired of the advice and preaching receive from every body, no matter whom it is, they see. There is no better society than babies and sick people^ another. Of course you must manage this so that neith sutler from it, which is perfectly possible. If you think 1 of the sick room " bad for the baby, why it ia bad for the it too,, and, therefore, you will of course correct it for both fresnens up a sick person's whole mind to see **the baby/' . a very young child, if unspoiled, will generally adapt its derfully to the ways of a sick person, if the time thij together is not too long. If you knew how unreasonably sick people suffer fipou able causes of distress, you would take more pains about 1 things. An infant laid upon the sick bed will do the sick thus Bufferitig, more good than all your eloquence. A good news will do the same. It has been very justly said that sick and invalids • A «t«ii1! pft auitunl ia often nn tticellent: ccanpntsion Tr r the •irk. ftir ! Mtc^ ' -11 \ biril iu a curt; la BometljMCffl thi- for y, J!ie room. Il be mn fcod &iiii [ fl/irj.: >:nigtd and u&iikcd to d«j lo, ^u irainjf i^j i'i n'jrso aad a itwg, inliiiitely TjteEcrtta V\vj.\. -^a uw, a-yi '• d tiifl kthi he it both Lby/'n its4 ^4 mm CHATTHBINa HOPES AND ADVICES. 4L n in this, there is no proportion in events to them. Now ur business as their visitor to restore this right proportion n — ^to show them what the rest of the world is doing, sin they find it out otherwise ? You will find them £ur pen to conviction than children in this. And you will find eir unreasonable intensity of suffering from unkindness, ant of sympathy, &c., will disappear with their freshened b in the big world^s events. But then you must be able to em real interests, not gossip. oh 1 how much might be spared to the djdng ! If anxious would but not ask the dying man to ^^ give a sign ;" to them of his '^eternal salvation ;'' of his being ''happy;" ' fEurewell f' how much they would spare him ! b distress the dying father with, ''What will become of a you are gone 1" Nor the dying child with the mother's s to keep it. I have heard a child say, ''Oh, mother, wish so i I can't die easy while thou'rt wishing f so with making a will, family arrangements and the hun- her things which are often crowded into the few hours or mutes before death, when, too, the dying are weakened ise, confused by medicines, and either in a state of half )r unnatural excitement sooner you settle all the affairs of life, the better. The r you are when you are doing it, the better, and ^e more of recovery you give yourself when you are ill. the last straw that breaks the camel's back. ' a If^ chance of life has been lost by putting off business Eist moment ; most of all, the highest business of salvation. . so-caUed " miracle" has been worked by the mind, calm led from these anxieties, allowing the body to make the effort to live. is one of the commonest experiences of God's ways to bo have watched many death-oeds. All classes are nearly But small farmers and shopkeepers are perhaps most put off the business of life until death, physical difference of death-beds by different diseases, is )served. Patients who die of consumption very frequently , state of seraphic joy and peace ; the countenance almost es rapture, ratients who die of cholera, peritonitis, &c., contrary, often die in a state approaching despair. The lance expresses horror. ysentery, diarrhoea, or fever, the patient often dies in a * indifference. d, in some oases, even of consumption and peritonitis, re alternations admost of ecstasy, and of despondency. In es of the " Siaints," and in religious biographies, we often ch death-beds described tmly ci^w^gcL* "^xi^ '^ftssa.*^^^ and ftiends make unwise e^ex^AO^ia ^^^s^^nsss^^j^^"^ rapture, quite unawaio t\ia\. Vc xQa»i\^ w^ '^^'Sssj^^s ^^Tid if it doc 3 not return, both ma^ pcrkips c^^^^-'T- •■ tH ^ence is a token of si state oV- roprobation,' or " l ; . lends, IB all these caseaj are apt to judge mosL [jirituul state of the sick from the phys^ieii atatc. P XIIL— OBSERYATIOSr OF THE SICK. e most important practical icssou that can bo given ta iiureet teach tlictn what to observe — how to observe — what ayrop- iiidicate improvement — what the reverse — ^which rtance— which are of none— ivMcb are the evidence ol i of what kind of neglect, ! this is what ought to make part, and an essential |mrt, raining of every nur&g. At present how few there are, eit&(i^l fisionalor nnprofcBsional, who really know at all wbcttkr^ lick per^ou they may bo with is better or worse, an record but a very few specimena of the answers which I heard made by friends and nnrsea, and accepted by phyjiiciikus targeoni at the very bed-eidti of the patient j who could Imx^ adioted every word but did not — sometimes from audiibiiitj', from shyness, ofteiiest from languor ! low often have the bowels acted, iiurso I" ^ Once, lif.'* generally means that the utensil has beeu emptied ouoe^ ii }g been iised perhaps seven or eight times. >a vuu think the patient is rnticS weaker than lie was mt B ago f * Oh no, sir j yon know it is very long ^iiiCti he Kien up and dressed, and he can get across the room in^. " means th^tt the nurse has not observed that whereas $aX s !Jigo he tat up and occupied Iiimseif in bed, he iiow Um ioing nothing ; that, although he can *' get acrusa the room,'* nnot stund for five seconds. lother patient who is eating well, recovering steadily althougk y^ from fever, but cannot walk or stand, is represented i© octor as making no progress at all, IS a much mure dij^cult thing to epeak the truth than psoplft li Donly imagine. There is first the man who gives, in anawtr i < question asked about a thing that has been before his eya Iib' ipa for years, iuformation exceedingly imperfect or says, Ita jesnotknow^. He has never observed. And people iimply l|pp : him stupid. itl^ ill 0B8BBTATI0K OF TBI! SIOK. 73 trath and nothing but the truth," if he does but intend it. uires many faculties combined of observation and memory a^ ** the whole truth" and to say " nothing but the truth." knows I fibs dreadful : but believe me, Miss, I never finds have fibbed until they tells me so," was a remark actually It is also one of much more extended application than people have the least idea of. ive heard thirteen persons ^^ concur" in declaring that a enth who had never left his bed^ went to a distant chapel morning at seven o'clock. kve hea^ persons in perfect good £uth declare, that a man bo dine every day at the house where they lived, who had dined there once ; that a person had never taken the sacra- by whose side they had twice at least knelt at Communion ; ut one meal a day came out of a hospital kitchen, which : weeks they had seen provide from three to five and six a day. Such instances might be multiplied ad infinitum if ary. stions as asked now (but too generally) of, or about patients, obtain no information at all about them, even if the person of had every information to give. The question is generally ing question ; and it is singular that people never think must be the answer to this question before they ask it ; for ce, " Has he had a good night 1" Now, one patient will he has a bad night if he has not slept ten hours without g. Another does not think he has a bad night if he has ntervals of dozing occasionally. The same answer has ly been given as regarded two patients— one who had been ly sleepless for five times twenty-four hours, and died of it, Lother who had not slept the deep of a regular night, without g. Why cannot the question be asked. How many hours' las hadi and at what hours of the night ] This is tant, because on this depends what the remedy will be. sitient sleeps two or three hours early in the night, and loes not sleep again at all, ten to one it is not a sleeping le wants, but food or stimulus, or perhaps only warmth. I^ \ other hand, he is restless and awake all night, and is J in the morning, he probably wants sedatives, either coolness, or medicine, a lighter diet, or all four. Now )ctor should be told this, or how can he judge what to V few there are who, by five or six pointed questions, can the whole case and get accurately to know and to be able ort where the patient is. lew a very clever physician, of large dispensary and hos^jital oe, who invariably l)egan his examination of each ^tient "Put your Mger where you ht \mA2' ^^^ Tasss^. ^^2^^ waste hia time with coUectmg\Txaftwa».\fe vc&s^^^ I nurse or patient. Leading questions alwaja collect informatiou. At a receut celebrated trinL, the following leading que« put successively to nine diatiuguiphed medical men, *' attribute these B}TnptomB to ai^ything elae but poison out of the nine^ eight auswercd " No ! " without any qua! whatever, It appuared^ upon cross-examination: — ' none of them had ever seen a case of the kind of | Buppoged- ^. That none of them had ever seen a caa kind of disease to which the death, if not to poison, vi bu table. 3, That none of them were even aware of t fact of the disease and condition to whick the death m butable. Surely nothing stronger can be adduced to prove y leading questions are of, and what they lead to. I had rather not aay how many instanoes I have kno' owing to this system of leading questions, the patient and the attendants have been actually unaware of the feature of tlie case. It is useless to go through all the particulars, bedt which people have a peculiar talent for gleaning information. As to food, for instance, I often think tl common question, How is your appetite ? can only be pui the questioner believes the questioned has really not; matter with him, which is very often the case. But wher« is, the remark holds guod wliich lias been made about sleep mme answer wiU often be made as regards a patient who < take two ounces of solid food per diem, and a patient not enjoy five meals a day as much as usual Agaiw, the question, How is your appetite ? is often How is your digestion i is the question meant. No d< two things often depend on one another. But they different. Many a patient can eat, if you can only " appetite.'* The fault lies in your not having got him that he fancies. But many another patient does not carebi grapes and turnips, — everything is equally distasteful ti He would try to eat anytliing which would do him goo( everything '* makes him worse.'* The fault here general in the cooking. It is not his ^' appetite " which requU'e iug,*' it is his digestion which requires sparing. And cookery vdll save the digestion half its work. There may be four different causes, any one of w] prodtice the same result, viz., the patient slowly atarving'i Ixom want of nutrition. 1. Defect in cooking ; 2. Defect in choice of diet ; 3L Po/ect in choice of hours for ia\ai\^ d\el ; •it Jb^bot of appetite in patient. 1 these are generally comprehended in the one sweeping on that the patient has ''no appetite." ilj many lives might he saved by drawing a closer distinc- for the remedies are as diverse as the causes. The remedy ! first is, to cook better ; for the second, to choose other 3 of diet ; for the third, to watch for the hours when the b is in want of food ; for the fourth, to show him what he and sometimes unexpectedly. But no one of these reme- ill do for any other of the defects not corresponding jinot too often be repeated that patients are generally either igoid to observe these things, or too shy to speak about nor is it weU that they should be made to observe them, I their attention upon themselves, in, I say, what is the nurse or friend there for except to ote of these things, instead of the patient doing so 1 } commonly supposed that the nurse is there to spare the ; from making physical exertion for himself— I would say, that she ought to be there to spare him from taking it for himself. And I am quite sure, that if the patieut pared all thought for himself and vwt spared all physical m, he would be the gainer. The revei-se is generally the L the private house. In the hospital it is the relief from iety, afforded by the rules of a well-regulated institution, has often such a beneficial effect ^pon the patient, n I do anything for you?" says the thoughtless nurse — 16 imcivil patient invariably answers "no"-;— 4he civil b, " no thank you." The £ekct is, that a real patient wiU go without almost anything than make the exertion of Qg what the nurse has left undone. And surely it is for ot for him, to make this exertion. Such a question is, on itrt, a mere piece of laziness, under the guise of being :ing." She wishes to throw the trouble on the patient of g himself. in, the question is sometimes put, Is there diarrhoea ? And iswer will be the same, whether it is just merging into a, whether it is a trifling degree brought on by some r indiscretion, which will cease the moment the cause is 3d, or whether there is no diarrhoea at all, but simply 1 bowels. 3 useless to multiply instances of this kind. As long as ation is so little cultivated as it is now, 1 do believe that it er for the physician not to see the friends of the patient at ?hey will oftener mislead him than not. And as often by g the patient out worse as better than he really is. the case of infants, everything must depend upon the ,te observation of the nurse or Tuot^i^t ^"^^ \i36A\ft 's»^'^ 7W seldom ia this condition oi afiOKOtuc^ io^^^ I NOTES ON KUKamG. I I I It is the real teet of a ntirse whether she can ni infant* Of it she can never ask, ** Ciiu I do auythiag for A celebrated man, tliough celebrated oiily for foolf " has told us that oDe of his main objects in the cducatil son, was to give hira a ready liabit of Jiccurate obsen certainty of perception, and that for this purpose on means was a month's course as follows : — ho took the bo] past a toy-shop ; the father and kou then described ' other as many of the objects as they conld, which t seen in passing the windows, noting them down wils and paper, and returning afterwards to verify their cnracy. The boy always succeeded best, baa taken nothing all day," or A. his dinner as usual.** I have known several of our real old-fashioned hospital who could^ as accurately as a measuring glass, measure their patient's wine and medicine by the eye, and never ' 1 do not recommend this,— ^one must be very sure of 01 I do it. I only mention it, because if a nui'se can by pract 8uro medicine by the eye, surely she is no nurs^ who measure by the eye about how much food (in oz.) her pat taken. In hospitals those who cut up the diets give wi snSicient accuracj, to each patient, \ik \^ ox. ^ix ^\& 'ii fithvat weighing, Yut a uurae "wiiX olleu \w*q v^Hassb OBBEBVATION OP THE SICK. 79 5 all food aiid incapable of auy will to get well, ^ qq *i Oable over the contents of the plate or dip the spoou iu ir« ^ deoeive the nurse, and she will take it, away withe aing that there is just the same quantity of food as wi Ought it, and she will tell tlie doctor, too, that the patient has ben all his diets as usual, when all she ought to have meant is ^t she has taken away his diets as usual. 37ow what kind of a nurse is this ? nhere are two causes for mistakes of inadvertence. 1. A Kat of ready attention ; only part of a patient's request is heard all 2. A want of the habit of observation. fPo a nurse I would add, take care that you always put the me things in the same places ; you don't know how suddenly vxL may 1^ called on some day to iind something, and may not 6 able to remember in your haste where you yourself had put it, your memory is not in the habit of seeing the thing there ways. Good nursing consists simply in observing little things which re common to all sick, and those which are particular to each ek individual. Some people have a curious power over animals. They can >llect wild birds round them in a wood. This, once thought itchcraft, is now supposed to be some peculiar power, which we Lii't see into, like the calculating boy's. It is nothing at all but 16 minute observation of the habits and instincts of birds. So the " peculiar power" of one nurse, and the want of power ' another over her patient, is nothing at all but minute observa- on in the former of what affects him, and want of observation in le latter. In nothing is this more remarkable than in inducing patients » take food. A patient is sinking for want of it under one nurse ; >u put him under another, and he takes it directly. How is lis ) People say, oh ! she has a command over her patients. ; is no command. It is the way she feeds him, or the way she illows his head, so that he can swallow comfortably. Opening le window will enable one patient to take his food ; washing his bce and hands another ; merely passing a wet towel over the back f the neck, a third ; a fourth, who is a depressed suicide, requires little cheering to give him spirit to eat. The nurse amuses im with giving some variety to his ideas. I remember that, ^hen very ill, the way in which one nurse put the spoon into ly mouth enabled me to swallow, when I coiQd not if I was fed y any one else. It is just the observation of all these little things, no unintel- gible '' influence," which enables one woman to save life ; it is the 'ant of such observation which prevents another from finding ie means to do 80> Even delirium, which seems to '^VacQ Vk'ft ^^XKec^ Vi ^^^^ ^^"^ Hoi^s ON iTUBsrira. IV ... - Pftch of all himian relief, that he h shrieking and ^u, and you cannot make hira understand that yon are tin \m^ is often increased by an awkward noise or touch, i the nurse who does m never perceives it. ^K Again, few things pre^s so heavily on one suffering fi^Bl| ^Bid incurable illness, as the necessity of teUing bis nur ^TOne to time, who will not otherwise see, that he can not < or that, which he could do a mouth or a year ago* Wb nurse there for, if she cannot observe these tilings for he Yet I have known more accidents (fatal, slowly or rapidly) j from this want of observation among nurses than from anything else. Because a patietit could get out of a winn { alone a month ago— because a patient could walk as far i door, or call so as to be heard a week ago, the nurse con that he can do so now. She has never observed the change sd the patient is lost from being left in a helpless state of exhau till some one accidentally comes in. And this not fro unexpected apoplectic, paralytic, or fainting fit (though even 1 oould be expected far more, at leasts than they are now, i£i ^bt obs&ruc). No, from the expected, or to be expected*! ^Hible, calculable, uninterrupted increase of weakna ^ftie need fail to observe. ^VAgaiti, a patient not usually confined to bed, ^B attack of diarrhoea, vomiting, or other accident^ to 1 bed for a few days ; he gets up for the first time, and the \ lets him go into another room, without coining in, a few afterwards, to look after him. It never occurs to her that 1 C[uite certain to be faint, or cold, or to want something, , says, as her excuse, Oh, he does not like to be fidgeted Yes, he said so some weeks ago ; but he never said he did liltc to be'* fidgeted after," when he is in the state he I now : and if he did, you ought to make some excuse to him. More patients have been lost in this way than is ai i generally known, viz., from relapses brought on by beij for an hour or two, faint, or cold, or hungry, after for the first time. You do not know how small is the power of resistancoj weak patient — how he will succumb to habits of the nui^e, occasion him positive pain for the time, and total prostratiq the whole day, rather than remonstrate. A good nurse { ]ient into a good habit, such as washing and erent times so as to spare his strength. A bad nursei 1 the patient ttdopts her bad ways without a struggle, ^ ^ ^hat theif are ea^fteettd to fh. This is et^uaUy important \ ^embered, for good iis well as for bad, rh ^VixXiSx. «ili [en whose profession, like that of medical men, leads them serve only, or chieflj, palpable and permanent organic » are often just as wrons in their opinion of the result as ;rho do not observe at aU. For instance, there is a cancer .*oken 1^ ; the surgeon has only to look at it once to know ; not be different if he sees it in the morning to what it have been had he seen it in the evening. In whatever ions the broken leg is, or is likely to be, there will still l)e oken leg until it is united. The same with many organic iB. An experienced physician has but to feel the pulse ind he knows that there is aneurism which will kill some »r other. with the great majority of cases, there is nothing of the and the power of forming any correct opinion as to the must entirely depend upon an inquiry into all the conditions oh the patient lives. In a complicated state of society in towns, death, as every one of great experience knows, is B often produced by any one organic disease, than by some , after many other diseases, producing just the sum of stion necessary for death. re is nothing so absurd, nothing so misleading as the verdict • often hears : So-and-so has no organic disease, — there is son why he should not live to extreme old age ; sometimes ause is added, sometimes not : Provided he has quiet, good ;ood air, &c., &c., &c. ; the verdict is repeated by ignorant vithotU the latter clause ; or there is no possibility of the ions of the latter clause being obtained ; and this, the ssential part of the whole, is made of no effect, ve known two cases, the one of a man who intentionally peatedly displaced a dislocation, and was kept and petted the surgeons ; the other of one who was pronounced to have ig the matter with him, there being no organic change •tible, but who died within the week. In both these cases, the nurse who, by accurately pointing out what she had hteij observed, to the doctors, saved the one case from per- ig in a fraud, the other from being discharged when actually ^ng state. one may even go further and say, that in diseases which heir origin in the feeble or irregular action of some function, )t in organic change, it is quite an accident if the doctor sees the case only once a day, and generally at the ;ime, can form any but a negative idea of its real condition. middle of the day, when such a patient has been refreshed it and air, by his tea, his beef tea, and his brandy, by hot I to his feet, by being washed and by clean linen, you can ly believe that he is the same person as he lay \d.tlL ^ ^».^vi in^ pulse, with puffed eye-Uds, mVJa. ^wX. \fs«^5^^ ^s*^^ and unsteady handa, tViis moTtiVavt. '^Q^"«V^\'a»^'«^^^ I be bm to do in sucli a case ? Not cry, ** Lord bless yau^ sir, why^l Lave thought he were a dying aU night/* This may be tru it ia not the way to impress with the truth a doctor, mop of form lug a judgment from the fjictB, if he did hut kii than you are. What he wants is not your opinion, respectfully given, but your facts. In all diseases it ia import but in diseases which do not run a distinct and fixed Gours€| not only impurtantj it is essential, that the facts the nurse* can observe, should be accm-atel^ observed and aocttW reported to the doctor. The nurse's attention should be directed to the extreinyi tion there is not unfrequently hi the pulse of such patienlH the day. A very common case is this : Between 3 and 4h ■ pulse becomes quick, perhaps 130, and so thready it is not* pulse at all, but like a string vibrating just underneath the I After this the patient gets no more sleep. About mid*4ij pulse has come down to bO ; and though feeble and compreM is a very respectable pulse. At night, if the patient has l day of excitement, it is almost imperceptible. But, if the £ft has had a good day, it is stronger and steadier and tio|fl| than at mid-day. This is a common history of a oominc^| 1^ and others, equally varying during the day, might ^H ^H Kow^ in iutiammation, which may almost always lie de^H ^^ the pulse, in typhoid fever, which is accompanied b^TB pulse that nothiug will raise^ there is no such great vatil ■ And doctors and nurses become accustomed not to look f The doctor indeed cannot. But the variation is in itsd important feature. Cases like the above often ^* go off rather suddenly,' called, from some trifling ailment of a few days, which ju up the sum of exhaustion necessary to produce dead everybody cries, Who would have thought it? excepG serving nurse, if there is one, who had always expect? exhaustion to come, from which there would be no rally, be she know the patient had no capital in strength on whi draw, if he failed for a few days to make his Imi-eiy daily i^ I in sleep and nutrition. Really good nurses are often distressed, because tb ^ impress the doctor with the real danger of then' patii quite provoked because the patient ** will look,'' either '* better,'* or '' so much worse/* than he really is '* when i ia there/* The distress is very legitimate, but it gener from the nurse not having the power of laying clearly atij _ before the doctor the iacts from which she derives her opin from the doctor being hasty and inexperienced, and i]q| of eliciting them* A man who really cares for his pat^ sfjoa Jearu to ask for and apprecia.te lV\e \\vtti\m,vUftVL y generation after generation, in the conditions which make kupers. Death and disease are like the workhouse ; they take jm the same fiamily, the same house, or in other words, the me conditions. Why will we not observe what they are 1 The close observer may safely predict that such a family, lether its members marry or not, will become extinct ; that ch another will degenerate morally and physically. But who irns the lesson '? On the contrary, it may be well known tliat e children die in such a house at the rate of 8 out of 10 ; one >uld think that noticing more need be said ; for how could •ovidence speak more distinctly ? yet nobody listens, the family es on living there till it dies out, and then some other family kes it. Neither would they listen " if one rose from the dead." XIV.— CONVALESCENCE. Many, indeed most, of the hints given for sickness will not do f convalescence ; for instance, the patienCs fancies about diet e often valuable indications to follow — ^the convalescetU^e often e reverse. When convalescence has fairly setixi^^fe ^^HI\«^ -^'stj ^''^sk^ s loDgijigs, especially for aitiolca o£ ioo^,\N\v\<^^Vi ^si^'a»^^ss^'^^ I I unwl '»" J to (1 Lirse ! VL J 82 NOTES ON NURSIIfG. indulged, may lead to violent re-action, or even to~MEij medical attendant is, of course, the best judge of the ffl)^ regimen required ; but during convalescence he id not th« by day, very often not above once or twice a week ; and nurse, at one of the most important periods of her p. is left altuost to herself — she has to be doctor and nu i It has happened that a single well-meant but indulgence has ended in death. The nurse has often to deal not only with the patient^ tite, but with the officiotisness of his friends. Some unw? some, perhaps poisonous, delicacy is one of the fir&t generally made by them. On the other hand, it may be that the main difficult recovery is the patient's nmit of appetite, most likely to c where he has no change of air. In such cases the nurse exercise the same care in regard to diet and the times at ^ it is to be given, as is indicated for sickness at Chap. VL There are other indulgences besides those of the etoii require to be kept imdcr check, Home patients are exert themselves in various ways, to incur unnecessary er^ and fatigue, perhaps to 1>q followed by sitting in a dri Friends often carry on long and exhausting couversatioi] prolonged readings, at one time, which are followed by a 1^ power to the patient, requiring some time for its recovery. I in too much or too little clothing have also to be guarded agi but as a rule convalescenta require warm clothing. In all these things, a convalescent is, so to speak, like a neither mind nor body has recovered its proper tone, \ certain time differing in different diseases, the nurse has] him by her own experience. Change, a change of air, is of the very first import anc as the disease has "taken a turn.'* Every body m^ remarked how a person recovering remains sometimeB without making any progress, yet with apparently not matter with him. The change from a ground-floor to an * room will sometimes hasten a patient'^ recovery. The' move will give him a fillip. Change is essential- He im to another place, or even only to another room. Then be ' diately begins to " pick up/' This is every- day-experieiT^ with the poor "change of air*' is next to impossible, with the most careful nursing and every comfort tog^ country air would save many lives from being spent in the ' Workhouse, many from requiring poor law relief at all, man^ giving birth to unhefUtliy families, and many premature de There are those to whom this sulgect appears unimj Biich people say, when a sick man is convalescing, h©j woilt and there is an end of it, TYi^-j tx^n^t ci^jW^stTt raJmccuce has its degi-ees ami tla covvrBe ^^ ' She never will ho a nurse. ^4 jjoTKS 05 NXBsrs-a. " He hates to be matched,*' 13 the excuse ot every^ nurse- Very tme. All sick people and all children •* hi watched." But fiud a nurse who really knows and und her children and her patients, and sqq whether these that they have been ** watched.*' It is not the stark patient which teUs the really observant nurse the lit ahe ought to know* People often talk of a nurse who has been ten or i with the sick, aa being an *^ experienced nurse/' observation only which makes experience ; and a won does not observe might be fifty or sixty years with the I never be the wiser- Kay more, experience Boraetimea tells in the opposite < A farmer ** who practises the blunders of his predec often said to be ** a practical man ;" and she who per the *' blunders of her predecessors '* is often called an J nurse. The friends of a patient have l>een knov mend the lodging in which he fell ill, just for the" which made him ill. A nurse has alleged as her reason the things by which her predecessor ruined her own 1 patient's health, that her predecessor "had always don Peoples have taken a house because it had been emptied of ail its occupants. These are they whom no experid teach — viz,, those who cannot see or understand the i*esults of wliat they and others do. Now it is 710 reasoa did it for B to do it. It would be a reason if the re doing it had been proved to be good. What strikes one most witli many womeUj who call nurses, is that they have not learnt this ABC of j education* The A t>f a nurse ought to be to know whij human being is. The B to know how to T^ehave to a Bid being. The to know that her patient is a sick huraa , and not an animal. What 19 it to feel a calling for any tiling ? Is it not toj ' work i!i it to Hutisfy your own higli idea ol wluit is the s I I'e^iy and not becauBe you vn\[ l>e *' found out *' if you doul This is the ** enthusiasm '* whicli every one, from a shoeinl I a sculptor, must have, in order to follow his "calling'' proj Now tile nurse hris to do, not with shoos, or 'vrith chi marble, but witli hmnan beings ; and if she, for her ov friction, does not look after her patients, no ielUng will nK I capat*lc of doing so. A nurse who has such a '* calling " will, for her ov J faction and intereat in her patient, inforin herself as to 1 I of his pulsjte, which can Ik* quite well dona without dia \}ijm, ShQ ivill have observed the state of the secretions, 1 fb/rf ta do so or not. Nay, the very i\^pe?^T^TiVjAexNm^ «^^ r '^ has not boeM ^m^ii^ijii^^ 's^^^^ \T\o^.Vj'si^ WHAT is xmrs^f ^m 3Ji(3 will, in like inatiner, have observed the fetatc of the si tether there is dryness or perspiration — the eflfect of the diet [the medicines, the stimulauU. And it is remarkable ben' . the doctor is deceived Id pnvate practice by not being tol( ^t the patient has just bad his meal or his brand)^ She wil 6t carefully have watched atiy redness or soreness of the akin ays on her guard against bed sores. Any loss of flesh wil VQr take place nnknown to her. 2^or TviJl she over niistak* Hut* or swelling for gaining in flesh. She will bo well acquainte( L the different eruptions of fevers, measles, tfec., and premo pry symptoms. She will Itnow the shiver whicli betrays tha Iter is fonning — that which shows the nncouscious patient^! Ire to pasa water— that which precedes fever. She wil erve the changes of animal heat in her patient, and whethe; [fodical. and nut consider him as a piece of wood vt stone, ii ping him warm or cool. nurse who ha^ sucli a *^ calling " will look at all the mediciiK ties delivered to her for her patients, srnell each of tlicm, and aot satisfied, taste each. Kine hundred and ninety nine timci re will be no mistake, but the thousandth time there may b^ erious mistake detected by her meana. But if she does noi this for her own satisfaction, it is no use telling her, becau« may bo sure that Ehe will use neither smell nur taste tu auj ose, nurse who has 7K}t such a ** calling," will never be ah the sound of her patient*s bell from that of others. ?ije will, when called to fur hot brandy aud-water for Lc3 [iting patient, offer the weekly '* Punch" (fact). Or she i At to bring the cortlial till she brings his tea (fact). 7nder such a nurse, the patient never gets a hot drink, ars out his tea, then she makes a journey to the larder for th( |ter, then she remembers that &he has forgotten the toaati has another journey to the kitchen fire to make the she fills a hot water bottle, and last of all she takes \ i tea. Buch a nurse will never know whether her patient is awall ep. She will rouse him up to ask him " if ho wants \ ug/* and leave him un cared for when he Ik tip. Elbe ivill make the room like an oven when he is fevcrii |ht, and lot out the tire when he is cold in the morning, guch a mxvsc seems to have neither eyes, nor cars, nor haiii Bhc never touches anything without a crash or an upset. Bhe does not shut the door, but pulls it after her, so th [rays bursts open Ui^iin* •nnwii". villi ni rni f.inlirni':l.l".]r>n wif.liniH. riitilriiii"* : to auj abfl * be] I fmtb thQ other. Both ot coutwi coivva ^ ^' ^^\sS«' A iUH S6 mTM OU BfljBilKO. ^"^ carries m a tray in one hand, and a coal ecuttTo in i}m i Both of cDurB what he feels nor as to what he wants. But she does n e for granted, eithefr to herself or to others, that ehe kuoi he feels and wants, without the roost careful obser^t id testing of her own observations. ' ^| But why, for instance, should a nurse ask a patient ever^i fBhall I bring your coffee T' or'* your bruth ?'^ or whatever when she lias every day brought it to him at that hour. 0] uld think she did it for the sake of making the patient spea ..A,r,4. ^T , ' -^- nt most wants is, never to be called Ui ll .. .1 . _. v.c.T uurse fhonid b« on© who is to be dep in other words, capable of lieiug a " c<>nfidential " nurf ! does not know how soon she may find herself placed i I situation ; she must be no gosj^ip, no vain talker-, she ever answer guestions about her ^cVl ^i^^ie^^X. ^c»\)i\^'?A^Vvi> ^ht £q ask them ; she must, I nee^ noX* w^l,^:fe ^«tv:iby is sick after it.s food, you /(((re given it too much). Neiti u[M>.: it, lie imili^r fi'd, Ali.'fVe iill^ never lhyo it any uiiwholeso fu .li, nor atiydiinLT at all to make it sleep, unless the doc Here arc a few. 1. Baby, who is weaned, requires to be fed often, regularly, an* not too much at a time. I knew a mother whos^ baby was in great danger one day fron oonvulsions. It was about a year old. She said she had wishei to go to church ; and so, before going, had given it its thre meds in one. Wsls it any wonder that the poor little thing ha( convulsions i I have known (in Scotland) a little girl, not more than fiv years old, whose mother had to go great distances every day, an< Who was trusted to feed and take care of her little brother, unde a year old. And she always did it right. She always did wha mother told her. A stranger, coming into the hut one day (it wa no better than a hut), said, " You will burn baby's mouth." " 01 Qo," she said, " I always bum my own mouth first." 2. When I say, be careful of baby, I don't mean have it alway in your arms. If the baby is old enough, and the weather warn enough for it to have some heat in itseljf, it is much better for ; child to be crawling about than to be always in its little nurse' arms. And it is much better for it to amuse itself than to hav her always making noises to it. The healthiest, happiest, liveliest, most beautiful baby I eve saw was the only child of a busy laundress. She washed all da; in a room with the door open upon a larger room, where she pu the child. It sat or crawled upon the floor all day with no othc play-fellow than a kitten, which it used to hug. Its mother kep it beautifully clean, and fed it with perfect regularity. The chil( was never frightened at anything. The room where it sat was th house-place ; and it always gave notice to its mother when an; body came in, not by a cry, but by a crow. I lived for man; months within hearing of that child, and never heard it cry da; or night. I think there is a great deal too much of amusing childrei now ; and not enough of letting them amuse themselves. Never distract a child's attention. If it is looking at on thing, don't show it another ; and so on. 3. At the same time, dulness and especially want of light, i worse for children than it is for you. A child was once brought up quite alone in a dark room, b; persons who wished to conceal its being alive. It never saw an; one, except when it was fed; and though it was treated pcrfcctl; kindly, it grew up an idiot. This you will easily guess. Plenty of light, and sun-light particularly, is necessary to mak a child active, and merry, and clever. But, of all things, don' bum baby's brains out by letting the sun bake its head whei out, especially in its little cart, on a hot summer's day. iVcj^r leave a child in the dark •, aTid\e\. VXvaxviovsxSi^'^'s^xss.V: a^u>iaytfis oir iruEBurG. I fiervilri depe ■llof fhen the doctor tella you to darken the room, which L some chUdreti's illnesses, 4. Do you know that one-half of all the nurses in i girla of from five to twenty years old ? You see you are vc " nportant little people. Then there are till the girls who n araiug mother's baby at home ; and, in all these cases, it seel etty nearly to come to this, that baby's health for its wh^|i| depends upon you, girls, more than upon anything else, ^H I need hardly gay to you, What a charge 1 For I beliei^| '. of you, or nearly all, care aljout baby too much not to feel i rly as much as I do. You, all of you, want to make^ grow up well and happy, if you knew how, 80 I Bay again, — t5. The main want of baby is always to have fresh air. You can make baby ill by keeping the room where it ii jht shut up, even for a few hours. You can kill baby when it m ill by keeping it in a hot j th sevei'al people in it, and all the doors and windows sh The doctor who looks alter the Queen's children says so, ] This is the cuBe most particularly when the child has sob e matter with its lungs and its breathing, I found a poor child dying in a small room, tight shut vd a large fire, and four or five people round it to Bee it di| breathing was short and hurried : and it could not cou what was choking its lungs and throat — iimciis it is called ^^pctor^ who was a very clever man, came in, set open ^Hindow, turned everybody out but one, and stayed two lie ^^reep the room clear and fresh, ile gave the child no and it was cured simply by kiij fresh air. A few hours will do for baby, both in killing and hat days will not do for a gi-own-up person. ' Another doctor found a child (it was a rich one) djind ^cndid close room, nearly breathless from thraat-coiD| ! walked straight to the window and pulled it open ; " fog ^d, "when people can breathe very httle air, they want tha od/* The mother said ho would kill the child, But, intrary, the child recovered. ^But,— ^^5. Take you care not to let a draught blow* upon a ch nUy a sick child. ' Perhaps you will say to me, " I don't know what you have me do. You puzzle me so. You tell me, don't feed t] child too much, and don't feed it too little ; don't keep t) room shut up, and don*t let there bo a dratight ; don't let child l>e dull, and don't amuse it too much." Dear little yon must learn to mannfjti, Home people never do learn ini 2t / Aave luit all these d\fiio\xU\vi* uv^w^^S.*, v^xitV \qi }th&t it 18 not from rtadmg my \>\>q»V i\wis.v i^^u^fC^ m ■4 I "mustdinq baby." 91 miud baby well, but from practising yourself how best to manage to do what other good nurses (and my book, if you like it,) tell you. But about the draughts. It is all nonsense w£it some old nurses say, that you can't give baby fresh air without giving it a chill ; and, on the other hand, you may give baby a chUl which will kill it (by letting a draught blow upon it when it is being washed, for instance, and chilling its whole body, though only for a moment), without giving it fresh air at all ; and depend upon this, the less fi'esh air you give to its lungs, and the less water you give to its skin, the more liable it will be to colds and chills. If you can keep baby's air always fresh in doors and out oi doors, and never chill baby, you are a good nurse. A sick baby's skin is often cold, even when the room is quite dose. Then you must air the room, and put hot flannels or hot bottles (not too hot) next baby's body, and give it its warm food. But I have often seen nurse doing just the contrary ; namely, shutting up every chink and throwing a great weight of bed- clothes over the child, which makes it colder, as it has no heat in itself. You would just kill a feverish child by doing this. A children's doctor, very famous in London, says that when a sick child dies, it is just as often an accident as not ; that is, people kill it by some foolish act of this kind, just as much as if they threw it out of window. And he says, too, that when a sick child dies suddenly, it is almost always an accident. It might have been prevented. It was not that the child was ill, and so its death could not be helped, as people say. He tells us what brings on these sudden deaths in sick children : — Startling noises ; chilling the child's body ; wakening it suddenly; feeding it too much or too quickly; altering its posture suddenly, or shaking it roughly ; frighteiiinrr it. And to this you may add (more than anything else, too), keeping it in foul air, especially wlieii asleep, especially at ni(/ht. even for a few hours, and even when you don't feel it yourseli'. This is, most of all, what kills babies. Baby's breathing is so tender, so easily put out of order. Sometunes you see a sick baby who seems to be obliged to attend to every breath it draws, and to "breathe carefully," in order to breathe at all ; and if you disturb it rudely, it is all over with baby. Anything which calls upon it for breath may stop it altogether. 7. Bememher to keep hciby clean, I can remember when motliei-s boasted that their "children's feet had never been touched by water; no, nor any part of them but faces and handa;" that Boniel)ody'8 "child had had its ieet vi;vs\itii^/Oi.\\^V^\^'K^^^^'^^^'^ i^row up, ^^^'>» 94 NOTES ON NURSINQ. a windpw which opens, or an Amott's ventilator, or to < cleanse, and lime-wash their cottages ? Of these thisgi iKjnefits are sure. The benefits of the inexperienced admii tion of medicines are by no means so sure. An almost universal error amongst women is the suppo that everybody mv^t have the bowels opened once in every tB four hours, or must fly immediately to aperients. The revi the conclusion of experience. This is a doctor's subject, and I will not enter more ir but will simply repeat, do not go on taking or giving to children your abominable " courses of aperients," without c in the doctor. It is very seldom indeed, that by choosing your diet cannot regulate your own bowels ; and every woman may ^ herself to know what kind of diet will do this ; deficiency of produces constipation, quite as often as deficiency of v^eti baker's bread much oftener than either. Home-made 1 bread will oftener cure it than anything else. A really experienced and observing nurse neither p] herself nor others. And to cultivate in things pertainii health observation and experience in women who are mo governesses, or nurses, is just the way to do away with an physicking, and, if the doctors did but know it, to make the i obedient to them, — helps to them instead of hindrances, education in women would indeed diminish the doctor's w but no one really believes that doctors wish that there shoi more illness, in order to have more work. (2.) Nothing but observation and experience will teach i ways to maintain or to brinff back the state of health. It is thought that medicine is the curative process. It is no thiug ; medicine is the surgery of functions, as surgery pro that of limbs and orgaus. Neither can do anything but k obstructions ; neither can cure ; nature alone cures. Su roinoves the bullet out of the limb, which is an obstruction to but nature heals the wound. So it is with medicine ; the fiir of an organ becomes obstructed ; medicine, so far as we 1 assists nature to remove tlie ol)Struction, but duos notliing And what nursing has to do in cither case, is to put the p; in the best condition for nature to act upon him. (^cneralh the contrary is done. You tliink fresh air, and quiet and \ liness extra vai^ant, perhaps dangerous, luxuries, which shoi ftivon to tlie patient only when quite convenient, and me( the ])anacca. If I liave succcedtMl in any measure iu disp tliis illusion, and in showhig what true nursing is, and wha not, my object will have been answered. Now for the caution : O'^J It rovins a coniuionly xccwcvi VOlqw x\\w>yv« ycv'^w^vcwJ NOTE UPON EMPLOTMEKT OP WOMEN. mmong women themselves, that it requires nothing but a lovi: Tieart, the want of an object, a general disgust or incapacity i other things, to turn a woman into a good nurse. This reminds one of the parish where a stupid old man was i to be schoolmaster because he was " past keeping the pigs." Apply the above receipt for making a good nurse to making ood servant. And the receipt will be found to fail. What cruel mistakes are sometimes made by benevolent m and women in matters of business about which they can kn( nothing, and think they kuow a great deal. The everyday management of a sick room, let alone of a hou — the knowing what are the laws of life and death for mc and what the laws of health for houses— (and houses are healt! or unhealthy, mainly according to the knowledge or ignoran of the woman) — are not these matters of sufficient importan and difficulty to require learning by experience and carei inquiry, just as much as any other art ? They do not come inspiration to the loving heart, nor to the poor drudge hard-i for a livelihood. And terrible is the injury which has followed to the sick frc such wild notions. NOTE UPON EMPLOYMENT OF WOMEN. People have written of late years immensely upon the "non-mark( for "female labour/' the want of "demand," or of 'Afield," for t " industriar employment of " women." My experience is, that i " demand** is many times greater than the supply, that the market " female labour" is large, but the labourers are few. I limit mya to my own personal experience and particular field, and of course paid labour. I do not avail myself of information collected as to otl employments, such as that of teachers, both in families and in natioi schools, in which experience is the same as mine is in nursing. to nursing, then, I have had, during the last three years, seye hundreds of applications to recommend qualified matrons or sup intendents of institutions — qualified missionary or parish nun («.c., to nurse in a parish with a salary, derived not from Boards Guardians, but from proprietors in the parish) — qualified sick nun for private families, for hospitals, and workhouses. Now, in all tl the lack was of qualified nurses to fill the places, not of places for i nurses, had they existed, to fill. At a rough guess, I should say tl about* one-third of these applicants offered ample remuncratio another third fixed no rate, but were willing to enter into any agr ment suitable to the qualifications of the nurse ; and the remaini third (principally workhouses and provincial hospitals), offered a si which could not have obtained the qualifications they required any case. 1 can only re-echo, as to nurses, \r,r\ v.t. ^^^v.tv.Oi v.vi;.i, n;x I i czfhme Z:.z'-' v:.\'r". Zq., Inc. THE BORROWEH WILL iE CHARGED AN OVERDUE FEE IF THIS BOOK IS NOT RETURNED TO THE LIBRARY ON OR BEFORE THE LAST DATE STAMPED BELOW. NON-RECEIPT OF OVERDUE NOTICES DOES NOT EXEMPT THE BORROWER FROM OVEROUt FEES.