Everything you do in a patient’s room, after he is “put up” for the night, increases tenfold the risk of his having a bad night.  But, if you rouse him up after he has fallen asleep, you do not risk, you secure him a bad night.

One hint I would give to all who attend or visit the sick, to all who have to pronounce an opinion upon sickness or its progress.  Come back and look at your patient after he has had an hour’s animated conversation with you.  It is the best test of his real state we know.  But never pronounce upon him from merely seeing what he does, or how he looks, during such a conversation.  Learn also carefully and exactly, if you can, how he passed the night after it.

[Sidenote:  Effects of over-exertion on sick.]

People rarely, if ever, faint while making an exertion.  It is after it is over.  Indeed, almost every effect of over-exertion appears after, not during such exertion.  It is the highest folly to judge of the sick, as is so often done, when you see them merely during a period of excitement.  People have very often died of that which, it has been proclaimed at the time, has “done them no harm."[3]

Remember never to lean against, sit upon, or unnecessarily shake, or even touch the bed in which a patient lies.  This is invariably a painful annoyance.  If you shake the chair on which he sits, he has a point by which to steady himself, in his feet.  But on a bed or sofa, he is entirely at your mercy, and he feels every jar you give him all through him.

[Sidenote:  Difference between real and fancy patients.]

In all that we have said, both here and elsewhere, let it be distinctly understood that we are not speaking of hypochondriacs.  To distinguish between real and fancied disease forms an important branch of the education of a nurse.  To manage fancy patients forms an important branch of her duties.  But the nursing which real and that which fancied patients require is of different, or rather of opposite, character.  And the latter will not be spoken of here.  Indeed, many of the symptoms which are here mentioned are those which distinguish real from fancied disease.

It is true that hypochondriacs very often do that behind a nurse’s back which they would not do before her face.  Many such I have had as patients who scarcely ate anything at their regular meals; but if you concealed food for them in a drawer, they would take it at night or in secret.  But this is from quite a different motive.  They do it from the wish to conceal.  Whereas the real patient will often boast to his nurse or doctor, if these do not shake their heads at him, of how much he has done, or eaten or walked.  To return to real disease.

[Sidenote:  Conciseness necessary with sick.]

Conciseness and decision are, above all things, necessary with the sick.  Let your thought expressed to them be concisely and decidedly expressed.  What doubt and hesitation there may be in your own mind must never be communicated to theirs, not even (I would rather say especially not) in little things.  Let your doubt be to yourself, your decision to them.  People who think outside their heads, the whole process of whose thought appears, like Homer’s, in the act of secretion, who tell everything that led them towards this conclusion and away from that, ought never to be with the sick.