I have often seen really good nurses distressed, because they could not impress the doctor with the real danger of their patient; and quite provoked because the patient “would look” either “so much better” or “so much worse” than he really is “when the doctor was there.”  The distress is very legitimate, but it generally arises from the nurse not having the power of laying clearly and shortly before the doctor the facts from which she derives her opinion, or from the doctor being hasty and inexperienced, and not capable of eliciting them.  A man who really cares for his patients, will soon learn to ask for and appreciate the information of a nurse, who is at once a careful observer and a clear reporter.

CONCLUSION.

[Sidenote:  Sanitary nursing as essential in surgical as in medical cases, but not to supersede surgical nursing.]

The whole of the preceding remarks apply even more to children and to puerperal woman than to patients in general.  They also apply to the nursing of surgical, quite as much as to that of medical cases.  Indeed, if it be possible, cases of external injury require such care even more than sick.  In surgical wards, one duty of every nurse certainly is prevention.  Fever, or hospital gangrene, or pyaemia, or purulent discharge of some kind may else supervene.  Has she a case of compound fracture, of amputation, or of erysipelas, it may depend very much on how she looks upon the things enumerated in these notes, whether one or other of these hospital diseases attacks her patient or not.  If she allows her ward to become filled with the peculiar close foetid smell, so apt to be produced among surgical cases, especially where there is great suppuration and discharge, she may see a vigorous patient in the prime of life gradually sink and die where, according to all human probability, he ought to have recovered.  The surgical nurse must be ever on the watch, ever on her guard, against want of cleanliness, foul air, want of light, and of warmth.

Nevertheless let no one think that because sanitary nursing is the subject of these notes, therefore, what may be called the handicraft of nursing is to be undervalued.  A patient may be left to bleed to death in a sanitary palace.  Another who cannot move himself may die of bed-sores, because the nurse does not know how to change and clean him, while he has every requisite of air, light, and quiet.  But nursing, as a handicraft, has not been treated of here for three reasons:  1.  That these notes do not pretend to be a manual for nursing, any more than for cooking for the sick; 2.  That the writer, who has herself seen more of what may be called surgical nursing, i.e. practical manual nursing, than, perhaps, any one in Europe, honestly believes that it is impossible to learn it from any book, and that it can only be thoroughly learnt in the wards of a hospital; and she also honestly believes that the perfection of surgical nursing may be seen practised by the old-fashioned “Sister” of a London hospital, as it can be seen nowhere else in Europe. 3.  While thousands die of foul air, &c., who have this surgical nursing to perfection, the converse is comparatively rare.