Identify one classic article

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Assigned Reading
You should read the following for this module …
Readings:
Hood: Chapters 2 & 6
Handout: Notes on Nursing by Nightingale
Video – nursing metaparadigm

APA resources
Instructions
For this assignment you will need to find specific types of resources and then provide a citation and synopsis, for each one. This assignment is worth 10% of your course grade. These resources may be eventually used for course papers such as your upcoming theory paper. You should write these as an annotated bibliography including one to two paragraphs describing each article, chapter or book.
This is a two-page assignment, the first page should identify and explain the journals/books and the second is the reference page based on APA 7th edition. You should select 2-3 articles/chapters or texts.
In this guide you will find information about the following:
1. Find 2-3 articles/texts with at least one peer-reviewed article.
2. Identify one classic article – Classic works are ones that have had a major impact in a field of study. They are also called seminal works.
3. One primary source- a primary source is an article or book written by the original author.
Create a Reference page in APA format
As you go through your program, you will become familiar with classic works because they will be mentioned frequently in textbooks, research articles, and other resources.
It is more difficult to identify classic articles as a new student.
Here are some hallmarks of classic works:
Frequently cited by other authors
Written by major theorists or researchers
They are often called influential, seminal, or groundbreaking in literature reviews
A Primary Source is any material where the author presents his or her own research, theory, ideas, or experience.
Examples:
a research article outlining the methodology and outcomes of the author/authors’ research
NOTES ON NURSING
What it is, and what it is not
BY
FLORENCE NIGHTINGALE
New York
D. Appleton and Company
1860
[First American Edition]
PREFACE.
THE following notes are by no means intended as a rule of thought by which nurses
can teach themselves to nurse, still less as a manual to teach nurses to nurse. They are
meant simply to give hints for thought to women who have personal charge of the
health of others. Every woman, or at least almost every woman, in England has, at one
time or another of her life, charge of the personal health of somebody, whether child
or invalid,–in other words, every woman is a nurse. Every day sanitary knowledge, or
the knowledge of nursing, or in other words, of how to put the constitution in such a
state as that it will have no disease, or that it can recover from disease, takes a higher
place. It is recognized as the knowledge which every one ought to have–distinct from
medical knowledge, which only a profession can have.
If, then, every woman must at some time or other of her life, become a nurse, i.e.,
have charge of somebody’s health, how immense and how valuable would be the
produce of her united experience if every woman would think how to nurse.
I do not pretend to teach her how, I ask her to teach herself, and for this purpose I
venture to give her some hints.
TABLE OF CONTENTS.
PAGE
VENTILATION AND WARMING 12
HEALTH OF HOUSES 24
PETTY MANAGEMENT 35
NOISE 44
VARIETY 58
TAKING FOOD 63
WHAT FOOD? 69
BED AND BEDDING 79
LIGHT 84
CLEANLINESS OF ROOMS AND WALLS 87
PERSONAL CLEANLINESS 93
CHATTERING HOPES AND ADVICES 95
OBSERVATION OF THE SICK 105
CONCLUSION 126
APPENDIX 137
NOTES ON NURSING:
WHAT IT IS AND WHAT IT IS NOT.
SHALL we begin by taking it as a general
principle–that all disease, at some period or other
of its course, is more or less a reparative process,
not necessarily accompanied with suffering: an
effort of nature to remedy a process of poisoning
or of decay, which has taken place weeks,
months, sometimes years beforehand, unnoticed,
the termination of the disease being then, while
the antecedent process was going on, determined?
Disease a reparative process.
If we accept this as a general principle, we shall
be immediately met with anecdotes and instances
to prove the contrary. Just so if we were to take,
as a principle–all the climates of the earth are
meant to be made habitable for man, by the
efforts of man–the objection would be
immediately raised,–Will the top of Mount Blanc
ever be made habitable? Our answer would be, it
will be many thousands of years before we have
reached the bottom of Mount Blanc in making the
earth healthy. Wait till we have reached the
bottom before we discuss the top.
In watching diseases, both in private houses and
in public hospitals, the thing which strikes the
experienced observer most forcibly is this, that
the symptoms or the sufferings generally
considered to be inevitable and incident to the
disease are very often not symptoms of the
disease at all, but of something quite different–of
the want of fresh air, or of light, or of warmth, or
of quiet, or of cleanliness, or of punctuality and
care in the administration of diet, of each or of all
of these. And this quite as much in private as in
hospital nursing.
Of the sufferings of disease,
disease not always the cause.
The reparative process which Nature has
instituted and which we call disease, has been
hindered by some want of knowledge or attention,
in one or in all of these things, and pain,
suffering, or interruption of the whole process sets
in.
If a patient is cold, if a patient is feverish, if a
patient is faint, if he is sick after taking food, if he
has a bed-sore, it is generally the fault not of the
disease, but of the nursing.
I use the word nursing for want of a better. It has
been limited to signify little more than the
administration of medicines and the application of
poultices. It ought to signify the proper use of
fresh air, light, warmth, cleanliness, quiet, and the
proper selection and administration of diet–all at
the least expense of vital power to the patient.
What nursing ought to do.
It has been said and written scores of time, that
every woman makes a good nurse. I believe, on
the contrary, that the very elements of nursing are
all but unknown.
Nursing the sick little
understood.
By this I do not mean that the nurse is always to
blame. Bad sanitary, bad architectural, and bad
administrative arrangements often make it
impossible to nurse. But the art of nursing ought
to include such arrangements as alone make what
I understand by nursing, possible.
The art of nursing, as now practised, seems to be
expressly constituted to unmake what God had
made disease to be, viz.,a reparative process.
To recur to the first objection. If we are asked, Is
such or such a disease a reparative process? Can
such an illness be unaccompanied with suffering?
Will any care prevent such a patient from
suffering this or that?–I humbly say, I do not
know. But when you have done away with all that
pain and suffering, which in patients are the
symptoms not of their disease, but of the absence
of one or all of the above-mentioned essentials to
the success of Nature’s reparative processes, we
shall then know what are the symptoms of and the
sufferings inseparable from the disease.
Nursing ought to assist the
reparative process.
Another and the commonest exclamation which
will be instantly made is–Would you do nothing,
then, in cholera, fever, &c.?–so deep-rooted and
universal is the conviction that to give medicine is
to be doing something,or rather everything; to
give air, warmth, cleanliness, &c., is to do
nothing. The reply is, that in these and many other
similar diseases the exact value of particular
remedies and modes of treatment is by no means
ascertained, while there is universal experience as
to the extreme importance of careful nursing in
determining the issue of disease.
II. The very elements of what constitutes good
nursing are as little understood for the well as for
the sick. The same laws of health or of nursing,
for they are in reality the same, obtain among the
well as among the sick. The breaking of them
produces only a less violent consequence among
the former than among the latter,–and this
sometimes, not always.
Nursing the well.
It is constantly objected,–”But how can I obtain
this medical knowledge? I am not a doctor. I must
leave this to doctors.”
Oh, mothers of families! You who say this, do
you know that one in every seven infants in this
civilized land of England perishes before it is one
year old? That, in London, two in every five die
before they are five years old? And, in the other
great cities of England, nearly one out of
two? * “The life duration of tender babies” (as
some Saturn, turned analytical chemist, says) “is
the most delicate test” of sanitary conditions. Is
Little understood.
all this premature suffering and death necessary?
Or did Nature intend mothers to be always
accompanied by doctors? Or is it better to learn
the piano-forte than to learn the laws which
subserve the preservation of offspring?
Macaulay somewhere says, that it is extraordinary
that, whereas the laws of motions of the heavenly
bodies, far removed as they are from us, are
perfectly well understood, the laws of the human
mind, which are under our observation all day and
every day, are no better understood than they
were two thousand years ago.
But how much more extraordinary is it that,
whereas what we might call the coxcombries of
education–e.g., the elements of astronomy–are
now taught to every school-girl, neither mothers
of families of any class, nor school-mistresses of
any class, nor nurses of children, nor nurses of
hospitals, are taught anything about those laws
which God has assigned to the relations of our
bodies with the world in which He has put them.
In other words, the laws which make these bodies,
into which He has put our minds, healthy or
unhealthy organs of those minds, are all but
unlearnt. Not but that these laws–the laws of life–
are in a certain measure understood, but not even
mothers think it worth their while to study them–
to study how to give their children healthy
existences. They call it medical or physiological
knowledge, fit only for doctors.
Another objection.
We are constantly told,–”But the circumstances
which govern our children’s healths are beyond
our control. What can we do with winds? There is
the east wind. Most people can tell before they get
up in the morning whether the wind is in the
east.”
To this one can answer with more certainty than
to the former objections. Who is it who knows
when the wind is in the east? Not the Highland
drover, certainly, exposed to the east wind, but
the young lady who is worn out with the want of
exposure to fresh air, to sunlight, &c. Put the
latter under as good sanitary circumstances as the
former, and she too will not know when the wind
is in the east.
I. VENTILATION AND WARMING.
The very first canon of nursing, the first and the
last thing upon which a nurse’s attention must be
fixed, the first essential to a patient, without
which all the rest you can do for him is as
nothing, with which I had almost said you may
leave all the rest alone, is this: TO KEEP THE
AIR HE BREATHES AS PURE AS THE
EXTERNAL AIR, WITHOUT CHILLING HIM.
Yet what is so little attended to? Even where it is
thought of at all, the most extraordinary
misconceptions reign about it. Even in admitting
air into the patient’s room or ward, few people
ever think, where that air comes from. It may
come from a corridor into which other wards are
ventilated, from a hall, always unaired, always
full of the fumes of gas, dinner, of various kinds
of mustiness; from an underground kitchen, sink,
washhouse, water-closet, or even, as I myself
have had sorrowful experience, from open sewers,
loaded with filth; and with this the patient’s room
or ward is aired, as it is called–poisoned, it should
rather be said. Always air from the air without,
and that, too, through those windows, through
which the air comes freshest. From a closed court,
especially if the wind do not blow that way, air
may come as stagnant as any from a hall or
corridor.
First rule of nursing, to keep the
air within as pure as the air
without.
Again, a thing I have often seen both in private
houses and institutions. A room remains
uninhabited; the fire-place is carefully fastened up
with a board; the windows are never opened;
probably the shutters are kept always shut;
perhaps some kind of stores are kept in the room;
no breath of fresh air can by possibility enter into
that room, nor any ray of sun. The air is stagnant,
musty, and corrupt as it can by possibility be
made. It is quite ripe to breed small-pox, scarletfever, diptheria, or anything else you please. *
Yet the nursery, ward, or sick room adjoining will
positively be aired (?) by having the door opened
into that room. Or children will be put into that
room, without previous preparation, to sleep.
A short time ago a man walked into a back-
kitchen in Queen square, and cut the throat of a
poor consumptive creature, sitting by the fire. The
murderer did not deny the act, but simply said,
“It’s all right.” Of course he was mad.
But in our case, the extraordinary thing is that the
victim says, “It’s all right,” and that we are not
mad. Yet, although we “nose” the murderers, in
the musty unaired unsunned room, the scarlet
fever which is behind the door, or the fever and
hospital gangrene which are stalking among the
crowded beds of a hospital ward, we say, “It’s all
right.”
With a proper supply of windows, and a proper
supply of fuel in open fire-places, fresh air is
comparatively easy to secure when the patient or
patients are in bed. Never be afraid of open
windows then. People don’t catch cold in bed.
This is a popular fallacy. With proper bed-clothes
and hot bottles, if necessary, you can always keep
a patient warm in bed, and well ventilate him at
the same time.
Without chill.
But a careless nurse, be her rank and education
what it may, will stop up every cranny and keep a
hot-house heat when her patient is in bed,–and, if
he is able to get up, leave him comparatively
unprotected. The time when people take cold (and
there are many ways of taking cold, besides a cold
in the nose,) is when they first get up after the
two-fold exhaustion of dressing and of having had
the skin relaxed by many hours, perhaps days, in
bed, and thereby rendered more incapable of reaction. Then the same temperature which
refreshes the patient in bed may destroy the
patient just risen. And common sense will point
out, that, while purity of air is essential, a
temperature must be secured which shall not chill
the patient. Otherwise the best that can be
expected will be a feverish re-action.
To have the air within as pure as the air without, it
is not necessary, as often appears to be thought, to
make it as cold.
In the afternoon again, without care, the patient
whose vital powers have then risen often finds the
room as close and oppressive as he found it cold
in the morning. Yet the nurse will be terrified, if a
window is opened. *
I know an intelligent humane house surgeon who
makes a practice of keeping the ward windows
open. The physicians and surgeons invariably
close them while going their rounds; and the
house surgeon very properly as invariably opens
them whenever the doctors have turned their
backs.
Open windows.
In a little book on nursing, published a short time
ago, we are told, that, “with proper care it is very
seldom that the windows cannot be opened for a
few minutes twice in the day to admit fresh air
from without.” I should think not; nor twice in the
hour either. It only shows how little the subject
has been considered.
Of all the methods of keeping patients warm the
very worst certainly is to depend for heat on the
breath and bodies of the sick. I have known a
medical officer keep his ward windows
hermetically closed. Thus exposing the sick to all
the dangers of an infected atmosphere, because he
was afraid that, by admitting fresh air, the
temperature of the ward would be too much
lowered. This is a destructive fallacy.
What kind of warmth desirable.
To attempt to keep a ward warm at the expense of
making the sick repeatedly breathe their own hot,
humid, putrescing atmosphere is a certain way to
delay recovery or to destroy life.
Do you ever go into the bed-rooms of any persons
of any class, whether they contain one, two, or
twenty people, whether they hold sick or well, at
night, or before the windows are opened in the
morning, and ever find the air anything but
unwholesomely close and foul? And why should
it be so? And of how much importance it is that it
should not be so? During sleep, the human body,
even when in health, is far more injured by the
influence of foul air than when awake. Why can’t
you keep the air all night, then, as pure as the air
without in the rooms you sleep in? But for this,
you must have sufficient outlet for the impure air
you make yourselves to go out; sufficient inlet for
the pure air from without to come in. You must
have open chimneys, open winows, or ventilators;
no close curtains round your beds; no shutters or
Bedrooms most universally
foul.
curtains to your windows, none of the
contrivances by which you undermine your own
health or destroy the chances of recovery of your
sick. *
A careful nurse will keep a constant watch over
her sick especially weak, protracted, and
collapsed cases, to guard against the effects of the
loss of vital heat by the patient himself. In certain
diseased states much less heat is produced than in
health; and there is a constant tendency to the
decline and ultimate extinction of the vital powers
by the call made upon them to sustain the heat of
the body. Cases where this occurs should be
watched with the greatest care from hour to hour,
I had almost said from minute to minute. The feet
and legs should be examined by the hand from
time to time, and wherever a tendency to chilling
is discovered, hot bottles, hot bricks, or warm
flannels, with some warm drink, should be made
use of until the temperature is restored. The fire
should be, if necessary, replenished. Patients are
frequently lost in the latter stages of disease from
want of attention to such simple precautions. The
nurse may be trusting to the patient’s diet, or his
medicine, or to the occasional dose of stimulant
which she is directed to give him, while the
patient is all the while sinking from want of a
little external warmth. Such cases happen at all
times, even during the height of summer. This
fatal chill is most apt to occur towards early
morning at the period of the lowest temperature of
the twenty four hours, and at the time when the
effect of the preceding day’s diets is exhausted.
When warmth must be most
carefully looked to.
Generally speaking, you may expect that weak
patients will suffer cold much more in the
morning than in the evening. The vital powers are
much lower. If they are feverish at night, with
burning hands and feet, they are almost sure to be
chilly and shivering in the morning. But nurses
are very fond of heating the footwarmer at night,
and of neglecting it in the morning, when they are
busy. I should reverse the matter.
All these things require common sense and care.
Yet perhaps in no one single thing is so little
common sense shown, in all ranks, as in
nursing. *
The extraordinary confusion between cold and
ventilation, even in the minds of well educated
people, illustrates this. To make a room cold is by
no means necessarily to ventilate it. Nor is it at all
necessary, in order to ventilate a room, to chill it.
Yet, if a nurse finds a room close, she will let out
the fire, thereby making it closer, or she will open
the door into a cold room, without a fire, or an
open window in it, by way of improving the
ventilation. The safest atmosphere of all for a
patient is a good fire and an open window,
excepting in extremes of temperature. (Yet no
nurse can ever be made to understand this.) To
ventilate a small room without draughts of course
requires more care than to ventilate a large one.
Cold air not ventilation, nor
fresh air a method of chill.
Another extraordinary fallacy is the dread of night
air. What air can we breathe at night but night air?
The choice is between pure night air from without
and foul night air from within. Most people prefer
the latter. An unaccountable choice. What will
they say if it is proved to be true that fully onehalf of all the disease we suffer from is
occasioned by people sleeping with their windows
shut? An open window most nights in the year
can never hurt any one. This is not to say that
light is not necessary for recovery. In great cities,
night air is often the best and purest air to be had
in the twenty-four hours. I could better understand
in towns shutting the windows during the day
than during the night, for the sake of the sick. The
absence of smoke, the quiet, all tend to making
night the best time for airing the patients. One of
our highest medical authorities on Consumption
and Climate has told me that the air in London is
never so good as after ten o’clock at night.
Night air.
Always air your room, then, from the outside air,
if possible. Windows are made to open; doors are
made to shut–a truth which seems extremely
difficult of apprehension. I have seen a careful
nurse airing her patient’s room through the door,
near to which were two gaslights, (each of which
consumes as much air as eleven men,) a kitchen, a
corridor, the composition of the atmosphere in
which consisted of gas, paint, foul air, never
changed, full of effluvia, including a current of
sewer air from an ill-placed sink, ascending in a
Air from the outside. Open your
windows, shut your doors.
continual stream by a well-staircase, and
discharging themselves constantly into the
patient’s room. The window of the said room, if
opened, was all that was desirable to air it. Every
room must be aired from without–every passage
from without. But the fewer passages there are in
a hospital the better.
If we are to preserve the air within as pure as the
air without, it is needless to say that the chimney
must not smoke. Almost all smoky chimneys can
be cured–from the bottom, not from the top. Often
it is only necessary to have an inlet for air to
supply the fire, which is feeding itself, for want of
this, from its own chimney. On the other hand,
almost all chimneys can be made to smoke by a
careless nurse, who lets the fire get low and then
overwhelms it with coal; not, as we verily believe,
in order to spare herself trouble, (for very rare is
unkindness to the sick), but from not thinking
what she is about.
Smoke.
In laying down the principle that the first object
of the nurse must be to keep the air breathed by
her patient as pure as the air without, it must not
be forgotten that everything in the room which
can give off effluvia, besides the patient,
evaporates itself into his air. And it follows that
there ought to be nothing in the room, excepting
him, which can give off effluvia or moisture. Out
of all damp towels, &c., which become dry in the
room, the damp, of course, goes into the patient’s
air. Yet this “of course” seems as little thought of,
as if it were an obsolete fiction. How very seldom
you see a nurse who acknowledges by her
practice that nothing at all ought to be aired in the
patient’s room, that nothing at all ought to be
cooked at the patient’s fire! Indeed the
arrangements often make this rule impossible to
observe.
Airing damp things in a
patient’s room.
If the nurse be a very careful one, she will, when
the patient leaves his bed, but not his room, open
the sheets wide, and throw the bed-clothes back,
in order to air his bed. And she will spread the
wet towels or flannels carefully out upon a horse,
in order to dry them. Now either these bed-clothes
and towels are not dried and aired, or they dry and
air themselves into the patient’s air. And whether
the damp and effluvia do him most harm in his air
or in his bed, I leave to you to determine, for I
cannot.
Even in health people cannot repeatedly breathe
air in which they live with impunity, on account
of its becoming charged with unwholesome
matter from the lungs and skin. In disease where
everything given off from the body is highly
noxious and dangerous, not only must there be
plenty of ventilation to carry off the effluvia, but
everything which the patient passes must be
instantly removed away, as being more noxious
than even the emanations from the sick.
Effluvia from excreta.
Of the fatal effects of the effluvia from the
excreta it would seem unnecessary to speak, were
they not so constantly neglected. Concealing the
utensils behind the vallance to the bed seems all
the precaution which is thought necessary for
safety in private nursing. Did you but think for
one moment of the atmosphere under that bed, the
saturation of the under side of the mattress with
the warm evaporations, you would be startled and
frightened too!
The use of any chamber utensil without a
lid * should be utterly abolished, whether among
the sick or well. You can easily convince yourself
of the necessity of this absolute rule, by taking
one with a lid, and examining the under side of
that lid. It will be found always covered,
whenever the utensil is not empty, by condensed
offensive moisture. Where does that go, when
there is no lid?
Chamber utensils without lids.
Earthenware, or if there is any wood, highly
polished and varnished wood, are the only
materials fit for patients’ utensils. The very lid of
the old abominable close-stool is enough to breed
a pestilence. It becomes saturated with offensive
matter, which scouring is only wanted to bring
out. I prefer an earthenware lid as being always
cleaner. But there are various good new-fashioned
arrangements.
A slop pail should never be brought into a sick
room. It should be a rule invariable, rather more
important in the private house than elsewhere,
that the utensil should be carried directly to the
Abolish slop-pails.
water-closet, emptied there, rinsed there, and
brought back. There should always be water and a
cock in every water-closet for rinsing. But even if
there is not, you must carry water there to rinse
with. I have actually seen, in the private sick
room, the utensils emptied into the foot-pan, and
put back unrinsed under the bed. I can hardly say
which is most abominable, whether to do this or
to rinse the utensil inthe sick room. In the best
hospitals it is now a rule that no slop pail shall
ever be brought into the wards, but that the
utensils shall be carried direct to be emptied and
rinsed at the proper place. I would it were so in
the private house.
Let no one ever depend upon fumigations,
“disinfectants,” and the like, for purifying the air.
The offensive thing, not its smell, must be
removed. A celebrated medical lecturer began one
day, “Fumigations, gentlemen, are of essential
importance. They make such an abominable smell
that they compel you to open the window.” I wish
all the disinfecting fluids invented made such an
“abominable smell” that they forced you to admit
fresh air. That would be a useful invention.
Fumigations.
II.–HEALTH OF HOUSES. *
There are five essential points in securing the
health of houses:–
1. Pure air.
2. Pure water.
3. Efficient drainage.
4. Cleanliness.
5. Light.
Without these, no house can be healthy. And it
will be unhealthy just in proportion as they are
deficient.
Health of houses. Five points
essential.
1. To have pure air, your house be so constructed
as that the outer atmosphere shall find its way
with ease to every corner of it. House architects
hardly ever consider this. The object in building a
house is to obtain the largest interest for the
money, not to save doctors’ bills for the tenants.
But, if tenants should ever become so wise as to
refuse to occupy unhealthy constructed houses,
Pure air.
and if Insurance Companies should ever come to
understand their interest so thoroughly as to pay a
Sanitary Surveyor to look after the houses where
their clients live, speculative architects would
speedily be brought to their senses. As it is, they
build what pays best. And there are always people
foolish enough to take the houses they build. And
if in the course of time the families die off, as is
so often the case, nobody ever thinks of blaming
any but Providence * for the result. Ill-informed
medical men aid in sustaining the delusion, by
laying the blame on “current contagions.” Badly
constructed houses do for the healthy what badly
constructed hospitals do for the sick. Once insure
that the air in a house is stagnant, and sickness is
certain to follow.
2. Pure water is more generally introduced into
houses than it used to be, thanks to the exertions
of the sanitary reformers. Within the last few
years, a large part of London was in the daily
habit of using water polluted by the drainage of
its sewers and water closets. This has happily
been remedied. But, in many parts of the country,
well water of a very impure kind is used for
domestic purposes. And when epidemic disease
shows itself, persons using such water are almost
sure to suffer.
Pure water.
3. It would be curious to ascertain by inspections,
how many houses in London are really well
drained. Many people would say, surely all or
most of them. But many people have no idea in
what good drainage consists. They think that a
sewer in the street, and a pipe leading to it from
the house is good drainage. All the while the
sewer may be nothing but a laboratory from
which epidemic disease and ill health is being
distilled into the house. No house with any
untrapped drain pipe communicating immediately
with a sewer, whether it be from water closet,
sink, or gully-grate, can ever be healthy. An
untrapped sink may at any time spread fever or
pyæmia among the inmates of a palace.
Drainage.
The ordinary oblong sink is an abomination. That
great surface of stone, which is always left wet, is
always exhaling into the air. I have known whole
houses and hospitals smell of the sink. I have met
Sinks.
just as strong a stream of sewer air coming up the
back staircase of a grand London house from the
sink, as I have ever met at Scutari; and I have
seen the rooms in that house all ventilated by the
open doors, and the passages all unventilated by
the closed windows, in order that as much of the
sewer air as possible might be conducted into and
retained in the bed-rooms. It is wonderful.
Another great evil in house construction is
carrying drains underneath the house. Such drains
are never safe. All house drains should begin and
end outside the walls. Many people will readily
admit, as a theory, the importance of these things.
But how few are there who can intelligently trace
disease in their households to such causes! Is it
not a fact, that when scarlet fever, measles, or
small-pox appear among the children, the very
first thought which occurs is, “where” the children
can have “caught” the disease? And the parents
immediately run over in their minds all the
families with whom they may have been. They
never think of looking at home for the source of
the mischief. If a neighbour’s child is seized with
small-pox, the first question which occurs is
whether it had been vaccinated. No one would
undervalue vaccination; but it becomes of
doubtful benefit to society when it leads people to
look abroad for the source of evils which exist at
home.
4. Without cleanliness, within and without your
house, ventilation is comparatively useless. In
certain foul districts of London, poor people used
to object to open their windows and doors
because of the foul smells that came in. Rich
people like to have their stables and dunghill near
their houses. But does it ever occur to them that
with many arrangements of this kind it would be
safer to keep the windows shut than open? You
cannot have the air of the house pure with dungheaps under the windows. These are common all
over London. And yet people are surprised that
their children, brought up in large “well-aired”
nurseries and bed-rooms suffer from children’s
epidemics. If they studied Nature’s laws in the
matter of children’s health, they would not be so
surprised.
Cleanliness.
There are other ways of having filth inside a
house besides having dirt in heaps. Old papered
walls of years’ standing, dirty carpets, uncleansed
furniture, are just as ready sources of impurity to
the air as if there were a dung-heap in the
basement. People are so unaccustomed from
education and habits to consider how to make a
home healthy, that they either never think of it at
all, and take every disease as a matter of course,
to be “resigned to” when it comes “as from the
hand of Providence;” or if they ever entertain the
idea of preserving the health of their households
as a duty, they are very apt to commit all kinds of
“negligences and ignorances” in performing it.
5. A dark house is always an unhealthy house,
always an ill-aired house, always a dirty house.
Want of light stops growth, and promotes
scrofula, rickets, &c., among the children.
Light.
People lose their health in a dark house, and if
they get ill they cannot get well again in it. More
will be said about this farther on.
Three out of many “negligences and ignorances”
in managing the health of houses generally, I will
here mention as specimens–1. That the female
head in charge of any building does not think it
necessary to visit every hole and corner of it
every day. How can she expect those who are
under her to be more careful to maintain her
house in a healthy condition than she who is in
charge of it?–2. That it is not considered essential
to air, to sun, and to clean rooms while
uninhabited; which is simply ignoring the first
elementary notion of sanitary things, and laying
the ground ready for all kinds of diseases.–3. That
the window, and one window, is considered
enough to air a room. Have you never observed
that any room without a fire-place is always
close? And, if you have a fire-place, would you
cram it up not only with a chimney-board, but
perhaps with a great wisp of brown paper, in the
throat of the chimney–to prevent the soot from
coming down, you say? If your chimney is foul,
sweep it; but don’t expect that you can ever air a
room with only one aperture; don’t suppose that to
shut up a room is the way to keep it clean. It is the
best way to foul the room and all that is in it.
Three common errors in
managing the health of houses.
Don’t imagine that if you, who are in charge, don’t
look to all these things yourself, those under you
will be more careful than you are. It appears as if
the part of a mistress now is to complain of her
servants, and to accept their excuses–not to show
them how there need be neither complaints made
nor excuses.
But again, to look to all these things yourself does
not mean to do them yourself. “I always open the
windows,” the head in charge often says. If you
do it, it is by so much the better, certainly, than if
it were not done at all. But can you not insure that
it is done when not done by yourself? Can you
insure that it is not undone when your back is
turned? This is what being “in charge” means.
And a very important meaning it is, too. The
former only implies that just what you can do
with your own hands is done. The latter that what
ought to be done is always done.
Head in charge must see to
House Hygiene, not do it
herself.
And now, you think these things trifles, or at least
exaggerated. But what you “think” or what I
“think” matters little. Let us see what God thinks
of them. God always justifies His ways. While we
are thinking, He has been teaching. I have known
cases of hospital pyæmia quite as severe in
handsome private houses as in any of the worst
hospitals, and from the same cause, viz., foul air.
Yet nobody learnt the lesson. Nobody
learnt anything at all from it. They went
on thinking–thinking that the sufferer had
scratched his thumb, or that it was singular that
“all the servants” had “whitlows,” or that
something was “much about this year; there is
always sickness in our house.” This is a favourite
mode of thought–leading not to inquire what is
the uniform cause of these general “whitlows,”
but to stifle all inquiry. In what sense is
“sickness” being “always there,” a justification of
its being “there” at all?
Does God think of these things
so seriously?
I will tell you what was the cause of this hospital
pyæmia being in that large private house. It was
that the sewer air from an ill-placed sink was
carefully conducted into all the rooms by
sedulously opening all the doors, and closing all
the passage windows. It was that the slops were
emptied into the foot pans!–it was that the
How does He carry out His
laws?
How does He teach His laws?
utensils were never properly rinsed;–it was that
the chamber crockery was rinsed with dirty
water:–it was that the beds were never properly
shaken, aired, picked to pieces, or changed. It was
that the carpets and curtains were always musty;–
it was that the furniture was always dusty;–it was
that the papered walls were saturated with dirt;–it
was that the floors were never cleaned;–it was
that the uninhabited rooms were never sunned, or
cleaned, or aired;–it was that the cupboards were
always reservoirs of foul air;–it was that the
windows were always tight shut up at night;–it
was that no window was ever systematically
opened even in the day, or that the right window
was not opened. A person gasping for air might
open a window for himself. But the servants were
not taught to open the windows, to shut the doors;
or they opened the windows upon a dank well
between high walls, not upon the airier court; or
they opened the room doors into the unaired halls
and passages, by the way of airing the rooms.
Now all this is not fancy, but fact. In that
handsome house I have known in one summer
three cases of hospital pyæmia, one of phlebitis,
two of consumptive cough; all
the immediateproducts of foul air. When, in
temperate climates, a house is more unhealthy in
summer than in winter, it is a certain sign of
something wrong. Yet nobody learns the lesson.
Yes, God always justifies His ways. He is
teaching while you are not learning. This poor
body loses his finger, that one loses his life. And
all from the most easily preventible causes. *
The houses of the grandmothers and great
grandmothers of this generation, at least the
country houses, with front door and back door
always standing open, winter and summer, and a
thorough draught always blowing through–with
all the scrubbing, and cleaning, and polishing, and
scouring which used to go on, the grandmothers,
and still more the great grandmothers, always out
of doors and never with a bonnet on except to go
to church, these things entirely account for the
fact so often seen of a great grandmother, who
was a tower of physical vigour descending into a
grandmother perhaps a little less vigorous but still
sound as a bell and healthy to the core, into a
mother languid and confined to her carriage and
house, and lastly into a daughter sickly and
confined to her bed. For, remember, even with a
general decrease of mortality you may often find
a race thus degenerating and still oftener a family.
You may see poor little feeble washed-out rags,
children of a noble stock, suffering morally and
physically, throughout their useless, degenerate
lives, and yet people who are going to marry and
to bring more such into the world, will consult
nothing but their own convenience as to where
they are to live, or how they are to live.
With regard to the health of houses where there is
a sick person, it often happens that the sick room
is made a ventilating shaft for the rest of the
house. For while the house is kept as close,
unaired, and dirty as usual, the window of the sick
room is kept a little open always, and the door
occasionally. Now, there are certain sacrifices
which a house with one sick person in it does
make to that sick person: it ties up its knocker; it
lays straw before it in the street. Why can’t it keep
itself thoroughly clean and unusually well aired,
in deference to the sick person?
Don’t make your sick-room into
a ventilating shaft for the whole
house.
We must not forget what, in ordinary language, is
called “Infection;”*–a thing of which people are
generally so afraid that they frequently follow the
very practice in regard to it which they ought to
avoid. Nothing used to be considered so
infectious or contagious as small-pox; and people
not very long ago used to cover up patients with
heavy bed clothes, while they kept up large fires
and shut the windows. Small-pox, of course,
under this regime, is very “infectious.” People are
somewhat wiser now in their management of this
disease. They have ventured to cover the patients
lightly and to keep the windows open; and we
hear much less of the “infection” of small-pox
than we used to do. But do people in our days act
with more wisdom on the subject of “infection” in
fevers–scarlet fever, measles, &c.–than their
forefathers did with small-pox? Does not the
popular idea of “infection” involve that people
should take greater care of themselves than of the
patient? that, for instance, it is safer not to be too
Infection.
much with the patient, not to attend too much to
his wants? Perhaps the best illustration of the
utter absurdity of this view of duty in attending on
“infectious” diseases is afforded by what was very
recently the practice, if it is not so even now, in
some of the European lazarets–in which the
plague-patient used to be condemned to the
horrors of filth, overcrowding, and want of
ventilation, while the medical attendant was
ordered to examine the patient’s tongue through
an opera-glass and to toss him a lancet to open his
abscesses with?
True nursing ignores infection, except to prevent
it. Cleanliness and fresh air from open windows,
with unremitting attention to the patient, are the
only defence a true nurse either asks or needs.
Wise and humane management of the patient is
the best safeguard against infection.
There are not a few popular opinions, in regard to
which it is useful at times to ask a question or
two. For example, it is commonly thought that
children must have what are commonly called
“children’s epidemics,” “current contagions,” &c.,
in other words, that they are born to have measles,
hooping-cough, perhaps even scarlet fever, just as
they are born to cut their teeth, if they live.
Why must children have
measles, &c.
Now, do tell us, why must a child have measles?
Oh because, you say, we cannot keep it from
infection–other children have measles–and it must
take them–and it is safer that it should.
But why must other children have measles? And
if they have, why must yours have them too?
If you believed in and observed the laws for
preserving the health of houses which inculcate
cleanliness, ventilation, white-washing, and other
means, and which, by the way, are laws, as
implicitly as you believe in the popular opinion,
for it is nothing more than an opinion, that your
child must have children’s epidemics, don’t you
think that upon the whole your child would be
more likely to escape altogether?
III. PETTY MANAGEMENT.
All the results of good nursing, as detailed in
these notes, may be spoiled or utterly negatived
Petty management.
by one defect, viz.: in petty management, or in
other words, by not knowing how to manage that
what you do when you are there, shall be done
when you are not there. The most devoted friend
or nurse cannot be always there. Nor is it
desirable that she should. And she may give up
her health, all her other duties, and yet, for want
of a little management, be not one-half so
efficient as another who is not one-half so
devoted, but who has this art of multiplying
herself–that is to say, the patient of the first will
not really be so well cared for, as the patient of
the second.
It is as impossible in a book to teach a person in
charge of sick how to manage, as it is to teach her
how to nurse. Circumstances must vary with each
different case. But it is possible to press upon her
to think for herself: Now what does happen
during my absence? I am obliged to be away on
Tuesday. But fresh air, or punctuality is not less
important to my patient on Tuesday than it was on
Monday. Or: At 10 P.M. I am never with my
patient; but quiet is of no less consequence to him
at 10 than it was at 5 minutes to 10.
Curious as it may seem, this very obvious
consideration occurs comparatively to few, or, if
it does occur, it is only to cause the devoted friend
or nurse to be absent fewer hours or fewer
minutes from her patient–not to arrange so as that
no minute and no hour shall be for her patient
without the essentials of her nursing.
A very few instances will be sufficient, not as
precepts, but as illustrations.
Illustrations of the want of it.
A strange washerwoman, coming late at night for
the “things,” will burst in by mistake to the
patient’s sickroom, after he has fallen into his first
doze, giving him a shock, the effects of which are
irremediable, though he himself laughs at the
cause, and probably never even mentions it. The
nurse who is, and is quite right to be, at her
supper, has not provided that the washerwoman
shall not lose her way and go into the wrong
room.
Strangers coming into the sick
room.
The patient’s room may always have the window
open. But the passage outside the patient’s room,
Sick room airing the whole
house.
though provided with several large windows, may
never have one open. Because it is not understood
that the charge of the sick-room extends to the
charge of the passage. And thus, as often happens,
the nurse makes it her business to turn the
patient’s room into a ventilating shaft for the foul
air of the whole house.
An uninhabited room, a newly-painted room, * an
uncleaned closet or cupboard, may often become
the reservoir of foul air for the whole house,
because the person in charge never thinks of
arranging that these places shall be always aired,
always cleaned; she merely opens the window
herself “when she goes in.”
Uninhabited room fouling the
whole house.
An agitating letter or message may be delivered,
or an important letter or message not delivered; a
visitor whom it was of consequence to see, may
be refused, or one whom it was of still more
consequence to not see may be admitted–because
the person in charge has never asked herself this
question, What is done when I am not there? *
Delivery and non-delivery of
letters and messages.
At all events, one may safely say, a nurse cannot
be with the patient, open the door, eat her meals,
take a message, all at one and the same time.
Nevertheless the person in charge never seems to
look the impossibility in the face.
Add to this that the attempting this impossibility
does more to increase the poor patient’s hurry and
nervousness than anything else.
It is never thought that the patient remembers
these things if you do not. He has not only to
think whether the visit or letter may arrive, but
whether you will be in the way at the particular
day and hour when it may arrive. So that
your partial measures for “being in the way”
yourself, only increase the necessity for his
thought. Whereas, if you could but arrange that
the thing should always be done whether you are
there or not, he need never think at all about it.
For the above reasons, whatever a patient can do
for himself, it is better, i. e. less anxiety, for him
to do for himself, unless the person in charge has
the spirit of management.
Partial measures such as “being
always in the way” yourself,
increase instead, of saving, the
patient’s anxiety. Because they
must be only partial.
It is evidently much less exertion for a patient to
answer a letter for himself by return of post, than
to have four conversations, wait five days, have
six anxieties before it is off his mind, before the
person who has to answer it has done so.
Apprehension, uncertainty, waiting, expectation,
fear of surprise, do a patient more harm than any
exertion. Remember, he is face to face with his
enemy all the time, internally wrestling with him,
having long imaginary conversations with him.
You are thinking of something else. “Rid him of
his adversary quickly,” is a first rule with the
sick. *
For the same reasons, always tell a patient and tell
him beforehand when you are going out and when
you will be back, whether it is for a day, an hour,
or ten minutes. You fancy perhaps that it is better
for him if he does not find out your going at all,
better for him if you do not make yourself “of to

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