Notes on Nursing Part 12

To revert to children. They are much more susceptible than grown people to all noxious influences. They are affected by the same things, but much more quickly and seriously, viz., by want of fresh air, of proper warmth, want of cleanliness in house, clothes, bedding, or body, by startling noises, improper food, or want of punctuality, by dulness and by want of light, by too much or too little covering in bed, or when up, by want of the spirit of management generally in those in charge of them. One can, therefore, only press the importance, as being yet greater in the case of children, greatest in the case of sick children, of attending to these things.

That which, however, above all, is known to injure children seriously is foul air, and most seriously at night. Keeping the rooms where they sleep tight shut up, is destruction to them. And, if the child's breathing be disordered by disease, a few hours only of such foul air may endanger its life, even where no inconvenience is felt by grown-up persons in the same room.

The following pa.s.sages, taken out of an excellent "Lecture on Sudden Death in Infancy and Childhood," just published, show the vital importance of careful nursing of children. "In the great majority of instances, when death suddenly befalls the infant or young child, it is an _accident_; it is not a necessary, inevitable result of any disease from which it is suffering."

It may be here added, that it would be very desirable to know how often death is, with adults, "not a necessary, inevitable result of any disease." Omit the word "sudden;" (for _sudden_ death is comparatively rare in middle age;) and the sentence is almost equally true for all ages.

The following causes of "accidental" death in sick children are enumerated:--"Sudden noises, which startle--a rapid change of temperature, which chills the surface, though only for a moment--a rude awakening from sleep--or even an over-hasty, or an over-full meal"--"any sudden impression on the nervous system--any hasty alteration of posture--in short, any cause whatever by which the respiratory process may be disturbed."

It may again be added, that, with very weak adult patients, these causes are also (not often "suddenly fatal," it is true, but) very much oftener than is at all generally known, irreparable in their consequences.

Both for children and for adults, both for sick and for well (although more certainly in the case of sick children than in any others), I would here again repeat, the most frequent and most fatal cause of all is sleeping, for even a few hours, much more for weeks and months, in foul air, a condition which, more than any other condition, disturbs the respiratory process, and tends to produce "accidental" death in disease.

I need hardly here repeat the warning against any confusion of ideas between cold and fresh air. You may chill a patient fatally without giving him fresh air at all. And you can quite well, nay, much better, give him fresh air without chilling him. This is the test of a good nurse.

In cases of long recurring faintnesses from disease, for instance, especially disease which affects the organs of breathing, fresh air to the lungs, warmth to the surface, and often (as soon as the patient can swallow) hot drink, these are the right remedies and the only ones. Yet, oftener than not, you see the nurse or mother just reversing this; shutting up every cranny through which fresh air can enter, and leaving the body cold, or perhaps throwing a greater weight of clothes upon it, when already it is generating too little heat.

"Breathing carefully, anxiously, as though respiration were a function which required all the attention for its performance," is cited as a not unusual state in children, and as one calling for care in all the things enumerated above. That breathing becomes an almost voluntary act, even in grown up patients who are very weak, must often have been remarked.

"Disease having interfered with the perfect accomplishment of the respiratory function, some sudden demand for its complete exercise, issues in the sudden standstill of the whole machinery," is given as one process:--"life goes out for want of nervous power to keep the vital functions in activity," is given as another, by which "accidental" death is most often brought to pa.s.s in infancy.

Also in middle age, both these processes may be seen ending in death, although generally not suddenly. And I have seen, even in middle age, the "_sudden_ stand-still" here mentioned, and from the same causes.

[Sidenote: Summary.]

To sum up:--the answer to two of the commonest objections urged, one by women themselves, the other by men, against the desirableness of sanitary knowledge for women, _plus_ a caution, comprises the whole argument for the art of nursing.

[Sidenote: Reckless amateur physicking by women. Real knowledge of the laws of health alone can check this.]

(1.) It is often said by men, that it is unwise to teach women anything about these laws of health, because they will take to physicking,--that there is a great deal too much of amateur physicking as it is, which is indeed true. One eminent physician told me that he had known more calomel given, both at a pinch and for a continuance, by mothers, governesses, and nurses, to children than he had ever heard of a physician prescribing in all his experience. Another says, that women's only idea in medicine is calomel and aperients. This is undeniably too often the case. There is nothing ever seen in any professional practice like the reckless physicking by amateur females.[39] But this is just what the really experienced and observing nurse does _not_ do; she neither physics herself nor others. And to cultivate in things pertaining to health observation and experience in women who are mothers, governesses or nurses, is just the way to do away with amateur physicking, and if the doctors did but know it, to make the nurses obedient to them,--helps to them instead of hindrances. Such education in women would indeed diminish the doctor's work--but no one really believes that doctors wish that there should be more illness, in order to have more work.

[Sidenote: What pathology teaches. What observation alone teaches. What medicine does. What nature alone does.]

(2.) It is often said by women, that they cannot know anything of the laws of health, or what to do to preserve their children's health, because they can know nothing of "Pathology," or cannot "dissect,"--a confusion of ideas which it is hard to attempt to disentangle. Pathology teaches the harm that disease has done. But it teaches nothing more. We know nothing of the principle of health, the positive of which pathology is the negative, except from observation and experience. And nothing but observation and experience will teach us the ways to maintain or to bring back the state of health. It is often thought that medicine is the curative process. It is no such thing; medicine is the surgery of functions, as surgery proper is that of limbs and organs. Neither can do anything but remove obstructions; neither can cure; nature alone cures.

Surgery removes the bullet out of the limb, which is an obstruction to cure, but nature heals the wound. So it is with medicine; the function of an organ becomes obstructed; medicine, so far as we know, a.s.sists nature to remove the obstruction, but does nothing more. And what nursing has to do in either case, is to put the patient in the best condition for nature to act upon him. Generally, just the contrary is done. You think fresh air, and quiet and cleanliness extravagant, perhaps dangerous, luxuries, which should be given to the patient only when quite convenient, and medicine the _sine qua non_, the panacea. If I have succeeded in any measure in dispelling this illusion, and in showing what true nursing is, and what it is not, my object will have been answered.

Now for the caution:--

(3.) It seems a commonly received idea among men and even among women themselves that it requires nothing but a disappointment in love, the want of an object, a general disgust, or incapacity for other things, to turn a woman into a good nurse.

This reminds one of the parish where a stupid old man was set to be schoolmaster because he was "past keeping the pigs."

Apply the above receipt for making a good nurse to making a good servant. And the receipt will be found to fail.

Yet popular novelists of recent days have invented ladies disappointed in love or fresh out of the drawing-room turning into the war-hospitals to find their wounded lovers, and when found, forthwith abandoning their sick-ward for their lover, as might be expected. Yet in the estimation of the authors, these ladies were none the worse for that, but on the contrary were heroines of nursing.

What cruel mistakes are sometimes made by benevolent men and women in matters of business about which they can know nothing and think they know a great deal.

The everyday management of a large ward, let alone of a hospital--the knowing what are the laws of life and death for men, and what the laws of health for wards--(and wards are healthy or unhealthy, mainly according to the knowledge or ignorance of the nurse)--are not these matters of sufficient importance and difficulty to require learning by experience and careful inquiry, just as much as any other art? They do not come by inspiration to the lady disappointed in love, nor to the poor workhouse drudge hard up for a livelihood.

And terrible is the injury which has followed to the sick from such wild notions!

In this respect (and why is it so?), in Roman Catholic countries, both writers and workers are, in theory at least, far before ours. They would never think of such a beginning for a good working Superior or Sister of Charity. And many a Superior has refused to admit a _Postulant_ who appeared to have no better "vocation" or reasons for offering herself than these.

It is true _we_ make "no vows." But is a "vow" necessary to convince us that the true spirit for learning any art, most especially an art of charity, aright, is not a disgust to everything or something else? Do we really place the love of our kind (and of nursing, as one branch of it,) so low as this? What would the Mere Angelique of Port Royal, what would our own Mrs. Fry have said to this?

NOTE.--I would earnestly ask my sisters to keep clear of both the jargons now current everywhere (for they _are_ equally jargons); of the jargon, namely, about the "rights" of women, which urges women to do all that men do, including the medical and other professions, merely because men do it, and without regard to whether this _is_ the best that women can do; and of the jargon which urges women to do nothing that men do, merely because they are women, and should be "recalled to a sense of their duty as women," and because "this is women's work," and "that is men's," and "these are things which women should not do," which is all a.s.sertion and nothing more.

Surely woman should bring the best she has, _whatever_ that is, to the work of G.o.d's world, without attending to either of these cries.

For what are they, both of them, the one _just_ as much as the other, but listening to the "what people will say," to opinion, to the "voices from without?" And as a wise man has said, no one has ever done anything great or useful by listening to the voices from without.

You do not want the effect of your good things to be, "How wonderful for a _woman!_" nor would you be deterred from good things, by hearing it said, "Yes, but she ought not to have done this, because it is not suitable for a woman." But you want to do the thing that is good, whether it is "suitable for a woman" or not.

It does not make a thing good, that it is remarkable that a woman should have been able to do it. Neither does it make a thing bad, which would have been good had a man done it, that it has been done by a woman.

Oh, leave these jargons, and go your way straight to G.o.d's work, in simplicity and singleness of heart.

APPENDIX.

[Transcriber's Note: The tables below have been rotated through 90 for easier display.]

TABLE A.

GREAT BRITAIN.

AGES.

Nurse Nurse NURSES. (not Domestic (Domestic Servant) Servant) -------------------+---------------+-----------+ All Ages 25,466 39,139 Under 5 Years. ... ... 5- ... 508 10- ... 7,259 15- ... 10,355 20- 624 6,537 25- 817 4,174 30- 1,118 2,495 35- 1,359 1,681 40- 2,223 1,468 45- 2,748 1,206 50- 3,982 1,196 55- 3,456 833 60- 3,825 712 65- 2,542 369 70- 1,568 204 75- 746 101 80- 311 25 85 and Upwards 147 16 -------------------+---------------+-----------+

TABLE B.

AGED 20 YEARS OF AGE, AND UPWARDS.

Nurse Nurse (not Domestic (Domestic Servant) Servant) -----------------------------------------------+--------------+-----------+ Great Britain and Islands in the British Seas. 25,466 21,017 England and Wales. 23,751 18,945 Scotland. 1,543 1,922 Islands in the British Seas. 172 150 1st Division. London. 7,807 5,061 2nd Division. South Eastern. 2,878 2,514 3rd Division. South Midland. 2,286 1,252 4th Division. Eastern Counties. 2,408 959 5th Division. South Western Counties. 3,055 1,737 6th Division. West Midland Counties. 1,225 2,383 7th Division. North Midland Counties. 1,003 957 8th Division. North Western Counties. 970 2,135 9th Division. Yorkshire. 1,074 1,023 10th Division. Northern Counties. 402 410 11th Division. Monmouth and Wales. 343 614 -----------------------------------------------+--------------+-----------+

NOTE AS TO THE NUMBER OF WOMEN EMPLOYED AS NURSES IN GREAT BRITAIN.