Notes on Nursing Part 13

25,466 were returned, at the census of 1851, as nurses by profession, 39,139 nurses in domestic service,[40] and 2,822 midwives. The numbers of different ages are shown in table A, and in table B their distribution over Great Britain.

To increase the efficiency of this cla.s.s, and to make as many of them as possible the disciples of the true doctrines of health, would be a great national work.

For there the material exists, and will be used for nursing, whether the real "conclusion of the matter" be to nurse or to poison the sick. A man, who stands perhaps at the head of our medical profession, once said to me, I send a nurse into a private family to nurse the sick, but I know that it is only to do them harm.

Now a nurse means any person in charge of the personal health of another. And, in the preceding notes, the term _nurse_ is used indiscriminately for amateur and professional nurses. For, besides nurses of the sick and nurses of children, the numbers of whom are here given, there are friends or relations who take temporary charge of a sick person, there are mothers of families. It appears as if these unprofessional nurses were just as much in want of knowledge of the laws of health as professional ones.

Then there are the school-mistresses of all national and other schools throughout the kingdom. How many of children's epidemics originate in these! Then the proportion of girls in these schools, who become mothers or members among the 64,600 nurses recorded above, or schoolmistresses in their turn. If the laws of health, as far as regards fresh air, cleanliness, light, &c., were taught to these, would this not prevent some children being killed, some evil being perpetuated? On women we must depend, first and last, for personal and household hygiene--for preventing the race from degenerating in as far as these things are concerned. Would not the true way of infusing the art of preserving its own health into the human race be to teach the female part of it in schools and hospitals, both by practical teaching and by simple experiments, in as far as these ill.u.s.trate what may be called the theory of it?

FOOTNOTES

[1]

[Sidenote: Curious deductions from an excessive death rate.]

Upon this fact the most wonderful deductions have been strung. For a long time an announcement something like the following has been going the round of the papers:--"More than 25,000 children die every year in London under 10 years of age; therefore we want a Children's Hospital."

This spring there was a prospectus issued, and divers other means taken to this effect:--"There is a great want of sanitary knowledge in women; therefore we want a Women's Hospital." Now, both the above facts are too sadly true. But what is the deduction? The causes of the enormous child mortality are perfectly well known; they are chiefly want of cleanliness, want of ventilation, want of white-washing; in one word, defective _household_ hygiene. The remedies are just as well known; and among them is certainly not the establishment of a Child's Hospital.

This may be a want; just as there may be a want of hospital room for adults. But the Registrar-General would certainly never think of giving us as a cause for the high rate of child mortality in (say) Liverpool that there was not sufficient hospital room for children; nor would he urge upon us, as a remedy, to found a hospital for them.

Again, women, and the best women, are wofully deficient in sanitary knowledge; although it is to women that we must look, first and last, for its application, as far as _household_ hygiene is concerned. But who would ever think of citing the inst.i.tution of a Women's Hospital as the way to cure this want?

We have it, indeed, upon very high authority that there is some fear lest hospitals, as they have been _hitherto_, may not have generally increased, rather than diminished, the rate of mortality--especially of child mortality.

[2]

[Sidenote: Why are uninhabited rooms shut up?]

The common idea as to uninhabited rooms is, that they may safely be left with doors, windows, shutters, and chimney board, all closed--hermetically sealed if possible--to keep out the dust, it is said; and that no harm will happen if the room is but opened a short hour before the inmates are put in. I have often been asked the question for uninhabited rooms--But when ought the windows to be opened? The answer is--When ought they to be shut?

[3] It is very desirable that the windows in a sick room should be such as that the patient shall, if he can move about, be able to open and shut them easily himself. In fact the sick room is very seldom kept aired if this is not the case--so very few people have any perception of what is a healthy atmosphere for the sick. The sick man often says, "This room where I spend 22 hours out of the 24 is fresher than the other where I only spend 2. Because here I can manage the windows myself." And [Transcriber's Note: Word, possibly "it" missing in original.] is true.

[4]

[Sidenote: An air-test of essential consequence.]

Dr. Angus Smith's air test, if it could be made of simpler application, would be invaluable to use in every sleeping and sick room. Just as without the use of a thermometer no nurse should ever put a patient into a bath, so should no nurse, or mother, or superintendent be without the air test in any ward, nursery, or sleeping-room. If the main function of a nurse is to maintain the air within the room as fresh as the air without, without lowering the temperature, then she should always be provided with a thermometer which indicates the temperature, with an air test which indicates the organic matter of the air. But to be used, the latter must be made as simple a little instrument as the former, and both should be self-registering. The senses of nurses and mothers become so dulled to foul air that they are perfectly unconscious of what an atmosphere they have let their children, patients, or charges, sleep in.

But if the tell-tale air-test were to exhibit in the morning, both to nurses and patients and to the superior officer going round, what the atmosphere has been during the night, I question if any greater security could be afforded against a recurrence of the misdemeanour.

And oh; the crowded national school! where so many children's epidemics have their origin, what a tale its air-test would tell! We should have parents saying, and saying rightly, "I will not send my child to that school, the air-test stands at 'Horrid.'" And the dormitories of our great boarding schools! Scarlet fever would be no more ascribed to contagion, but to its right cause, the air-test standing at "Foul."

We should hear no longer of "Mysterious Dispensations," and of "Plague and Pestilence," being "in G.o.d's hands," when, so far as we know, He has put them into our own. The little air-test would both betray the cause of these "mysterious pestilences," and call upon us to remedy it.

[5] With private sick, I think, but certainly with hospital sick, the nurse should never be satisfied as to the freshness of their atmosphere, unless she can feel the air gently moving over her face, when still.

But it is often observed that nurses who make the greatest outcry against open windows are those who take the least pains to prevent dangerous draughts. The door of the patients' room or ward _must_ sometimes stand open to allow of persons pa.s.sing in and out, or heavy things being carried in and out. The careful nurse will keep the door shut while she shuts the windows, and then, and not before, set the door open, so that a patient may not be left sitting up in bed, perhaps in a profuse perspiration, directly in the draught between the open door and window. Neither, of course, should a patient, while being washed or in any way exposed, remain in the draught of an open window or door.

[6]

[Sidenote: Don't make your sick-room into a sewer.]

But never, never should the possession of this indispensable lid confirm you in the abominable practice of letting the chamber utensil remain in a patient's room unemptied, except once in the 24 hours, i.e., when the bed is made. Yes, impossible as it may appear, I have known the best and most attentive nurses guilty of this; aye, and have known, too, a patient afflicted with severe diarrhoea for ten days, and the nurse (a very good one) not know of it, because the chamber utensil (one with a lid) was emptied only once in the 24 hours, and that by the housemaid who came in and made the patient's bed every evening. As well might you have a sewer under the room, or think that in a water closet the plug need be pulled up but once a day. Also take care that your _lid_, as well as your utensil, be always thoroughly rinsed.

If a nurse declines to do these kinds of things for her patient, "because it is not her business," I should say that nursing was not her calling. I have seen surgical "sisters," women whose hands were worth to them two or three guineas a-week, down upon their knees scouring a room or hut, because they thought it otherwise not fit for their patients to go into. I am far from wishing nurses to scour. It is a waste of power.

But I do say that these women had the true nurse-calling--the good of their sick first, and second only the consideration what it was their "place" to do--and that women who wait for the housemaid to do this, or for the charwoman to do that, when their patients are suffering, have not the _making_ of a nurse in them.

[7]

[Sidenote: Health of carriages.]

The health of carriages, especially close carriages, is not of sufficient universal importance to mention here, otherwise than cursorily. Children, who are always the most delicate test of sanitary conditions, generally cannot enter a close carriage without being sick--and very lucky for them that it is so. A close carriage, with the horse-hair cushions and linings always saturated with organic matter, if to this be added the windows up, is one of the most unhealthy of human receptacles. The idea of taking an _airing_ in it is something preposterous. Dr. Angus Smith has shown that a crowded railway carriage, which goes at the rate of 30 miles an hour, is as unwholesome as the strong smell of a sewer, or as a back yard in one of the most unhealthy courts off one of the most unhealthy streets in Manchester.

[8] G.o.d lays down certain physical laws. Upon His carrying out such laws depends our responsibility (that much abused word), for how could we have any responsibility for actions, the results of which we could not foresee--which would be the case if the carrying out of His laws were _not_ certain. Yet we seem to be continually expecting that He will work a miracle--i.e. break His own laws expressly to relieve us of responsibility.

[9]

[Sidenote: Servants' rooms.]

I must say a word about servants' bed-rooms. From the way they are built, but oftener from the way they are kept, and from no intelligent inspection whatever being exercised over them, they are almost invariably dens of foul air, and the "servants' health" suffers in an "unaccountable" (?) way, even in the country. For I am by no means speaking only of London houses, where too often servants are put to live under the ground and over the roof. But in a country "_mansion_," which was really a "mansion," (not after the fashion of advertis.e.m.e.nts), I have known three maids who slept in the same room ill of scarlet fever.

"How catching it is," was of course the remark. One look at the room, one smell of the room, was quite enough. It was no longer "unaccountable." The room was not a small one; it was up stairs, and it had two large windows--but nearly every one of the neglects enumerated above was there.

[10]

[Sidenote: Diseases are not individuals arranged in cla.s.ses, like cats and dogs, but conditions growing out of one another.]

Is it not living in a continual mistake to look upon diseases, as we do now, as separate ent.i.ties, which _must_ exist, like cats and dogs?

instead of looking upon them as conditions, like a dirty and a clean condition, and just as much under our own control; or rather as the reactions of kindly nature, against the conditions in which we have placed ourselves.

I was brought up, both by scientific men and ignorant women, distinctly to believe that small-pox, for instance, was a thing of which there was once a first specimen in the world, which went on propagating itself, in a perpetual chain of descent, just as much as that there was a first dog, (or a first pair of dogs), and that small-pox would not begin itself any more than a new dog would begin without there having been a parent dog.

Since then I have seen with my eyes and smelt with my nose small-pox growing up in first specimens, either in close rooms or in overcrowded wards, where it could not by any possibility have been "caught," but must have begun.

Nay, more, I have seen diseases begin, grow up, and pa.s.s into one another. Now, dogs do not pa.s.s into cats.

I have seen, for instance, with a little overcrowding, continued fever grow up; and with a little more, typhoid fever; and with a little more, typhus, and all in the same ward or hut.

Would it not be far better, truer, and more practical, if we looked upon disease in this light?

For diseases, as all experience shows, are adjectives, not noun substantives.

[11]

[Sidenote: Lingering smell of paint a want of care.]

That excellent paper, the _Builder_, mentions the lingering of the smell of paint for a month about a house as a proof of want of ventilation.

Certainly--and, where there are ample windows to open, and these are never opened to get rid of the smell of paint, it is a proof of want of management in using the means of ventilation. Of course the smell will then remain for months. Why should it go?