There is, unquestionably, a physiognomy of disease.  Let the nurse learn it.

The experienced nurse can always tell that a person has taken a narcotic the night before by the patchiness of the colour about the face, when the re-action of depression has set in; that very colour which the inexperienced will point to as a proof of health.

There is, again, a faintness, which does not betray itself by the colour at all, or in which the patient becomes brown instead of white.  There is a faintness of another kind which, it is true, can always be seen by the paleness.

But the nurse seldom distinguishes.  She will talk to the patient who is too faint to move, without the least scruple, unless he is pale and unless, luckily for him, the muscles of the throat are affected and he loses his voice.

Yet these two faintnesses are perfectly distinguishable, by the mere countenance of the patient.

[Sidenote:  Peculiarities of patients.]

Again, the nurse must distinguish between the idiosyncracies of patients.  One likes to suffer out all his suffering alone, to be as little looked after as possible.  Another likes to be perpetually made much of and pitied, and to have some one always by him.  Both these peculiarities might be observed and indulged much more than they are.  For quite as often does it happen that a busy attendance is forced upon the first patient, who wishes for nothing but to be “let alone,” as that the second is left to think himself neglected.

[Sidenote:  Nurse must observe for herself increase of patient’s weakness, patient will not tell her.]

Again, I think that few things press so heavily on one suffering from long and incurable illness, as the necessity of recording in words from time to time, for the information of the nurse, who will not otherwise see, that he cannot do this or that, which he could do a month or a year ago.  What is a nurse there for if she cannot observe these things for herself?  Yet I have known—­and known too among those—­and chiefly among those—­whom money and position put in possession of everything which money and position could give—­I have known, I say, more accidents (fatal, slowly or rapidly) arising from this want of observation among nurses than from almost anything else.  Because a patient could get out of a warm-bath alone a month ago—­because a patient could walk as far as his bell a week ago, the nurse concludes that he can do so now.  She has never observed the change; and the patient is lost from being left in a helpless state of exhaustion, till some one accidentally comes in.  And this not from any unexpected apoplectic, paralytic, or fainting fit (though even these could be expected far more, at least, than they are now, if we did but observe).  No, from the unexpected, or to be expected, inevitable, visible, calculable, uninterrupted increase of weakness, which none need fail to observe.