Chapter 11

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, assists 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 Mère Angélique 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 every where (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 assertion, and nothing more. Surely woman should bring the best she has, _whatever_ that is, to the work of God'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 God's work, in simplicity and singleness of heart.

FOOTNOTES:

[1] [Sidenote: Danger of physicking by amateur females.]

I have known many ladies who, having once obtained a "blue pill" prescription from a physician, gave and took it as a common aperient two or three times a week--with what effect may be supposed. In one case I happened to be the person to inform the physician of it, who substituted for the prescription a comparatively harmless aperient pill. The lady came to me and complained that it "did not suit her half so well."

If women will take or give physic, by far the safest plan is to send for "the doctor" every time--for I have known ladies who both gave and took physic, who would not take the pains to learn the names of the commonest medicines, and confounded, _e.g._, colocynth with colchicum. This _is_ playing with sharp-edged tools "with a vengeance."

There are excellent women who will write to London to their physician that there is much sickness in their neighbourhood in the country, and ask for some prescription from him, which they used to like themselves, and then give it to all their friends and to all their poorer neighbours who will take it. Now, instead of giving medicine, of which you cannot possibly know the exact and proper application, nor all its consequences, would it not be better if you were to persuade and help your poorer neighbours to remove the dung-hill from before the door, to put in a window which opens, or an Arnott's ventilator, or to cleanse and lime-wash the cottages? Of these things the benefits are sure. The benefits of the inexperienced administration of medicines are by no means so sure.

Homoeopathy has introduced one essential amelioration in the practice of physic by amateur females; for its rules are excellent, its physicking comparatively harmless--the "globule" is the one grain of folly which appears to be necessary to make any good thing acceptable. Let then women, if they will give medicine, give homoeopathic medicine. It won't do any harm.

An almost universal error among women is the supposition that everybody _must_ have the bowels opened once in every twenty-four hours, or must fly immediately to aperients. The reverse is the conclusion of experience.

This is a doctor's subject, and I will not enter more into it; but will simply repeat, do not go on taking or giving to your children your abominable "courses of aperients," without calling in the doctor.

It is very seldom indeed, that by choosing your diet, you cannot regulate your own bowels; and every woman may watch herself to know what kind of diet will do this; I have known deficiency of meat produce constipation, quite as often as deficiency of vegetables; baker's bread much oftener than either. Home made brown bread will oftener cure it than anything else.

APPENDIX.

[Transcriber's note: These tables have been transposed to fit the page width.

The figures in the left hand column, Table B: Nurse (not Domestic Servant) do not add up. There is probably a typographical error in this column since it cannot be accounted for by errors in transcription.]

TABLE A.

GREAT BRITAIN.

AGES.

NURSES. Nurse (not Domestic Nurse (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, AND UPWARDS.

NURSES. Nurse (not Domestic Nurse (Domestic Servant) Servant) Great Britain and 25,466 21,017 Islands in the British Seas. 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 2,283 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. 462 410 11th Division. Monmouth and Wales. 343 614

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

25,466 were returned, at the census of 1851, as nurses by profession, 39,139 nurses in domestic service,[1] 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 class, 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 schoolmistresses 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 illustrate what may be called the theory of it?

[1] A curious fact will be shown by Table A, viz., that 18,122 out of 39,139, or nearly one-half of all the nurses, in domestic service, are between 5 and 20 years of age.

End of Project Gutenberg's Notes on Nursing, by Florence Nightingale