I should add here a few words of caution as to the time of year best fitted for treatment.  In the summer seclusion is often undesirable when the patient is well enough to gain help by change of air; moreover, at this season massage is less agreeable than in winter, and, as a rule, I find it harder to feed and to fatten persons at rest during our summer heats.  That this rule is not without exception has been shown by Drs. Goodell and Sinkler, both of whom have attained some remarkable successes in midsummer.

One of the questions of most importance in the carrying out of this treatment is the choice of a nurse.  Just as it is desirable to change the home of the patient, her diet, her atmosphere, so also is it well, for the mere alterative value of such change, to surround her with strangers and to put aside any nurse with whom she may have grown familiar.  As I have sometimes succeeded in treating invalids in their own homes, so have I occasionally been able to carry through cases nursed by a mother, or sister, or friend of exceptional firmness; but to attempt this is to be heavily handicapped, and the position should never be accepted if it be possible to make other arrangements.  Any firm, intelligent woman of tact, a stranger to the patient, is better than the old style of nurse, now, happily, disappearing.  The nurse for these cases ought to be a young, active, quick-witted woman, capable of firmly but gently controlling her patient.  She ought to be intelligent, able to interest her patient, to read aloud, and to write letters.  The more of these cases she has seen and nursed, the easier becomes the task of the doctor.  Young, I have said she ought to be, but youthful would be a better word.  If, as she grows older, the nurse loses the strenuous enthusiasm with which she made her first entrance into her work, scarcely any amount of conscientious devotion or experience will ever replace it; but there are fortunate people who seem never to grow old in this sense.  It is always to be borne in mind that most of these patients are over-sensitive, refined, and educated women, for whom the clumsiness, or want of neatness, or bad manners, or immodesty of a nurse may be a sore and steadily-increasing trial.  To be more or less isolated for two months in a room, with one constant attendant, however good, is hard enough for any one to endure; and certain quite small faults or defects in a nurse may make her a serious impediment to the treatment, because no mere technical training will dispense in the nurse any more than in the physician with those finer natural qualifications which make their training available.  Over-harshness is in some ways worse than over-easiness, because it makes less pleasant the relation between nurse and patient, and the latter should regard the former as her “next friend.”  Let the nurse, therefore, place upon the doctor the burden of decision in disputed matters; his position will not be injured with the patient by strict enforcement of the letter of the law, while the nurse’s may be.  But one nurse will suit one patient and not another:  so that I never hesitate to change my nurse if she does not fit the case, and to change if necessary more than once.