What It Is, and What It Is Not
By Florence Nightingale
New York D. Appleton and Company 1860 [First American Edition]
Below is the Preface and Intro to Florence Nightingale’s book, “Notes on Nursing”. She is one of the greatest pioneers in nursing. To the left you will find the links to each individual chapter, indexed for quick reference. Read this entire book online and later return here to easily find great quotes and passages to incorporate into your assignments.
*”Sidenotes” will appear as this.
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.
Disease a reparative process.
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?
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.
Of the sufferings of disease, disease not always the cause.
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.
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.
What nursing ought to do.
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.
Nursing the sick little understood.
It has been said and written scores of times, that every woman makes a good nurse. I believe, on the contrary, that the very elements of nursing are all but unknown.
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 practiced, seems to be expressly constituted to unmake what God had made disease to be, viz., a reparative process.
Nursing ought to assist the 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.
Another and the commonest exclamation which will be instantly made is– Would you do nothing, then, in cholera, fever, etc.?–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 the disease.
Nursing the well.
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.
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 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 the 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.
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.
 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 whitewashing; 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 an 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 institution 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.